Educational Exhibit Abstract No. 420 - Lumbar facet joint cyst intervention: A minimally invasive treatment option we can offer our spine patients for a common cause of radiculopathy

Abstract

Learning Objectives The purpose is to illustrate the potential clinical usefulness of CT guided lumbar facet synovial cyst rupture/decompression as a minimally invasive treatment of associated radicular back pain. Background Since starting a CT guided spine practice within the last two years, we treated 5 patients with symptomatic lumbar facet cysts. They consisted of 2 men and 3 women, mean age 62 with ongoing radicular pain referred by either Orthopedic Surgery or Neurosurgery. All patients had MR lumbar spine imaging showing unilateral lumbar facet synovial cysts causing mass effect upon the adjacent thecal sac and nerve root. All patients had congruent radicular pain at the level of the cyst on physical exam by their referring physician and prior to treatment. All 5 patient underwent CT guided facet joint injection with dilute contrast followed by a steroid/anesthetic combination until the cyst ruptured and/or a second needle was placed directly into the cyst via an interlaminar approach to aspirate and fenestrate the cyst. Cyst rupture was verified with contrast seen free flowing in the epidural space. Clinical Findings/Procedure Details Successful rupture/decompression of the cysts was achieved in all cases. Contiguity of contrast from the facet joint into the cyst was 100%. All patients reported significant improvement in pain score as measured by VAS. The mean pre and post procedure VAS were 6.4 and 1, respectively. Conclusion and/or Teaching Points Lumbar facet joint cysts are a more and more recognized cause of low back pain. Procedural treatments have ranged from epidural steroid injections, facet joint injections to surgical resection. Unfortunately, the literature is not robust in the description of CT guided facet joint cyst rupture/decompression for the treatment of associated radicular pain. The largest series may include just a half dozen or so patients. For many radiologist, whether Interventional, Neuro, or Musculoskeletal who have embarked to treat spine patients, CT guided lumbar facet joint cyst rupture/decompression appears to be a viable treatment option for their patients. Certainly larger cohorts and longer follow up is needed to assess the long term efficacy and durability of the procedure.