Targeted Radiofrequency Ablation as an Adjunct in Treatment of Lumbar Facet Cysts.

Jesse Hatgis,Aldo Berti,Robert E Jacobson,Michelle Granville

doi:10.7759/cureus.1318

Abstract

Lumbar facet cysts are frequently found in patients with facet degeneration and segmental instability. When the facet cyst is localized in the neural foramina and lateral recess or becomes large, it can cause radiculopathy or neurogenic claudication. These symptomatic cysts are typically treated interventionally with drainage and a corticosteroid injection or attempts via overinflation to rupture the cyst; however, these procedures have a significant recurrence rate (up to 50%) and often need to be repeated or lead to lumbar surgery if unsuccessful. This is the first report of using targeted radiofrequency (RF) current as an adjunct to cyst drainage. Although RF has been used for years to treat facet pain indirectly by targeting the medial facet nerve branches, with this technique, under image guidance, the actual cyst is percutaneously drained and then cauterized along with the associated facet capsule, where the original cyst developed. This has improved overall results with less cyst recurrence than previous percutaneous methods and was documented with both intermediate and long-term followup clinically and with magnetic resonance imaging (MRI) scans. This report reviews the underlying anatomy and pathology of the facet joint relating to the development of facet cysts and how current percutaneous treatments for lumbar facet cysts can be supplemented and improved by adding targeted RF ablation to the percutaneous options available to treat a lumbar facet cyst.

Highlights

The lumbar facet joints are true synovial joints with hyaline cartilage and a highly innervated fibrous capsule
A lumbar synovial facet cyst can be found as an isolated radiologic finding on magnetic resonance imaging (MRI) scans, but more frequently there is often concurrent facet degeneration, spondylolisthesis, or spinal stenosis
Use of targeted RF current directly into the cyst as well as the connected facet capsule and joint space is safe with proper intraprocedural testing

Summary

Introduction

The lumbar facet joints are true synovial joints with hyaline cartilage and a highly innervated fibrous capsule. The joints have the capacity to hold 1.0-1.5 mL of fluid [1]. Repetitive stress/trauma results in osteoarthritis that causes inflammation and excess joint fluid, which could stretch the capsule [2]. Chronic degenerative inflammation and stress can lead to the development of cystic deformations from the synovial lining of the joint, and the formation of a symptomatic lumbar facet cyst especially, if it develops from the more ventral surface of the facet joint adjacent to the spinal canal and/or neural foramen. A lumbar synovial facet cyst can be found as an isolated radiologic finding on magnetic resonance imaging (MRI) scans, but more frequently there is often concurrent facet degeneration, spondylolisthesis, or spinal stenosis. When the cyst becomes large or is localized in or around the neural foramen, the cyst

Methods

Results

Discussion

Conclusion