Facet Joint Synovial Cysts Research Articles

Long-term effectiveness and feasibility of CT-guided cryoablation as a novel treatment option for symptomatic lumbar synovial cysts.

To present a case series with a long-term follow-up of CT-guided cryoablation procedure for the minimally invasive treatment of symptomatic lumbar facet synovial cyst with a mean follow-up of 38months (range, 15-55). We present a retrospective, uncontrolled clinical case series in a single institution on patients treated with CT-guided cryoablation for symptomatic lumbar facet joint synovial cyst refractory to or not suitable for imaging-guided rupture procedure. In two cases, patients underwent cryoablation and cyst rupture within a 2-week period. Outcome measures were post-procedural radiologic studies and clinical examinations up to the end of the follow-up. Selected patients underwent post-procedural clinical and CT and MRI imaging which were reviewed up to the conclusion of the follow-up. All patients were clinically assessed and evaluated by spine surgery team. Technical success was complete resolution of patient's symptoms. We treated 3 females and 3 males (mean age 64years). Four patients had cysts located at L4-L5, and the remaining two at L5-S1. We used two cryoprobes in five patients, and three in one. Clinical and/or technical success was documented in all cases (mean follow-up, 38months [range, 15-55]). We found no major complications related to the cryoablation itself. Our initial experience with CT-guided cryoablation for symptomatic lumbar facet synovial cysts describes a less invasive alternative treatment option to surgery for the management of such lesions. Our long-term outcome experience showed low recurrence and complication rates. CT-guided cryoablation may be a reasonable alternative approach to treat lumbar synovial cysts that are refractory or contraindicated to the rupture procedure and where surgical management is unfeasible.

Minimally Invasive Relief: Percutaneous Aspiration And Intra-Articular Steroid Injection for Lumbar Facet-Joint Synovial Cysts-A Case Report

Lumbar facet joint synovial cysts are fluid-filled sacs that develop near the facet joints in the lumbar spine. These cysts typically result from degenerative changes or wear and tear in the spine, leading to the enlargement of the facet joint capsule and the formation of a cyst which may cause symptomatic nerve root compression and may lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. percutaneous aspiration of facet-joint synovial cysts are known to provide immediate improvement in symptoms and the absence of relapse during the follow-up period. These can be particularly beneficial for elderly and high-risk patients who are not suitable candidates for surgery or not willing to undergo surgery. These case report is submitted to highlights the effectiveness of this treatment option and suggests that it should be considered in the management of facet-joint synovial cysts.

CT-guided ozone mixture injection in treatment of symptomatic lumbar facet synovial cysts.

To evaluate the clinical and radiological outcomes, in terms of safety and efficacy, of a new treatment method for symptomatic lumbar facet synovial cysts (LFSC), based on ozone injection inside the cyst. We retrospectively reviewed clinical records and imaging studies of 77 patients who underwent CT-guided ozone treatment of symptomatic facet joint synovial cysts in our department over a 5-year span. Clinical outcome was assessed with Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) evaluations, obtained prior to the intervention and at 1-, 3-, 6- and 12-months follow-up. Follow-up MRI imaging at 6 and 12 months were obtained and confronted with the pre-procedural MRI to analyse cyst modification after the intervention. Ozone administration was technically successful in 100% of procedures; no immediate complications occurred. At 1 month evaluation, 92% of the patients referred partial or complete symptomatic response; 86% of patients at 3 months and 84% at 6 months confirmed symptoms improvement; final assessment, at 12 months after intervention, outlined overall significant clinical improvement in 81% of patients. During the 12 months of follow-up only 3 patients had a relapse of the cyst (at 6 months) that were retreated with a 100% success. CT-guided ozone therapy for symptomatic LFSC is a safe and innovative treatment option, with good clinical results at 12 months follow-up in a significative percentage of patients, thus reducing the need for invasive surgical interventions.

A novel technique for surgical excision of a symptomatic lumbar spine facet joint synovial cyst using a cyst dyeing method: a report of two cases and a literature review

The aim of this study was to investigate the efficacy of a cyst dyeing technique that was used during the surgical excision of facet joint cysts in 2 cases. We evaluated the patients’ clinical outcomes and perioperative complications after decompression of lumbar spinal stenosis caused by the cysts. Two patients, who underwent surgical decompression for symptomatic lumbar spinal stenosis caused by facet cysts in August and October 2020, were reviewed. Their main complaints were severe low back pain and sciatica 1 or 2 months ago, for which they visited Wooridul Spine Hospital, Daegu, Korea. Under general anesthesia, the cysts were removed with the cyst dyeing method, using indigo carmine. Clinical outcomes were assessed by preoperative and postoperative visual analog scale (VAS) scores. Perioperative complications were observed.Favorable clinical outcomes and no perioperative complications were reported. Low back pain and sciatica improved, as shown by changes of the VAS score from 9 or 8 to 1, and no dural defects were observed. The cyst dyeing method is an effective technique for the surgical removal of symptomatic lumbar spine facet joint cysts.

Fluoroscopy-guided percutaneous rupture of lumbar facet joint synovial cyst: An alternative to surgery

Lumbosacral radiculopathy is very common presentation in old age people. Of the more common causes, the rarest is the presence of Lumbar intrasynovial cysts (LISCs). This case report of a 64 year old patient presenting with low back pain radiating to left leg and presence of a LISC (MRI finding) at L4-L5 has set a very good example for considering FGPCR for treatment. The patient reported 90% relief in pain after the procedure. So FGPCR can be considered before proceeding for surgery.

A rare cause of radiculopathy: facet joint synovial cyst protruding into the spinal canal.

A rare cause of radiculopathy: facet joint synovial cyst protruding into the spinal canal.

Efficacy of Fluoroscopy-Guided Lumbar Facet Joint Synovial Cyst Rupture with Intra-Articular Steroid Injection after Laminectomy.

PurposeWe retrospectively evaluated the technical success rate and long-term efficacy of fluoroscopy-guided synovial cyst rupture followed by an intra-articular steroid injection at the post-laminectomy lumbar facet.Materials and MethodsWe selected subjects who had undergone a fluoroscopy-guided synovial cyst rupture with simultaneous intra-articular steroid injection within 6 months of MRI and demonstrated a symptomatic facet joint synovial cyst at the level of a previous lumbar laminectomy. Fourteen patients were enrolled, and we determined whether cyst rupture and symptom improvement were achieved after each procedure. The degrees of symptom improvement were categorized into 4: 1) symptoms improved (30% or more reduction, based on pre-procedural and post-procedural Numerical Pain Rating Scale scores), 2) symptoms not improved, 3) patient underwent surgery after injection, and 4) loss of follow-up.ResultsThe success rate of percutaneous synovial cyst rupture decreased with repeated procedures (62.5% for the first procedure and 0% to 33.3% for additional procedures). However, 80% of the patients had symptom improvement with the procedures, overall. The surgery rate was 14.3% in 14 patients.ConclusionFor patients with post-laminectomy symptomatic lumbar facet joint synovial cysts, fluoroscopy-guided synovial cyst rupture with intra-articular steroid injection may be an effective and less invasive treatment before considering a surgical approach.

Percutaneous Endoscopic Lumbar Approach to a Facet Joint Synovial Cyst: Case Report and Review of the Literature

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

New classification of facet joint synovial cysts.

Facet cysts develop due to degeneration of the zygapophyseal joints and can lead to radiculopathy and neurogenic claudication. Various surgical options are available for facet cyst excision. The aim was to facilitate surgical treatment of lumbar facet cysts based on a new classification. We retrospectively analyzed all patients of the last 10years in whom a facet cyst was surgically removed (ipsilateral laminotomy, contralateral laminotomy, and segmental fusion). Several radiological parameters were analyzed and correlated with the patients' outcome (residual symptoms, perioperative complications, need for re-operation, need for secondary fusion, facet cyst recurrence). One hundred eleven patients (55 women; median age 64years) could be identified. Thirty-three (48%) of 69 cases, for which MRI data were available, were classified as medial facet cyst (compressing the spinal canal), 6 facet cysts were localized intraforaminal (9%) and 30 cases (43%) mediolateral (combination of both). The contralateral approach had the lowest rate for revision surgery (7.5%, p = .038) and the lowest prevalence of residual complaints (7.5%, p = .109). A spondylolisthesis and a higher/steeper angle of the facet joints were associated with poorer patient outcome. Lateral facet joint cysts are best resected by a contralateral approach offering the best outcome while medial cysts are suitable for removal by an ipsilateral laminotomy. The approach of mediolateral cysts can be determined by the width of the lamina and the angle of the joint. Segmental fusion should be considered in cases with detected spondylolisthesis and/or steep facet joints.

A combination of pathologies - facet joint synovial cyst, epidural lipomatosis and conjoined nerve root anomaly in the lumbar spine of a 45-year-old patient. A case report

Facet joint synovial cysts are abnormal fluid-filled cystic formations that develop from a degenerative process of the facet joints. Spinal epidural lipomatosis is a process of excessive accumulation of fat in the epidural space. Conjoined nerve root (CNR) anomaly refers to an anatomical variation in which two adjacent nerve roots share a common dural sleeve. The aforementioned three rare pathologies cause the same pathological process of stenosis, therefore compressing the nervous structures. A 45-year-old female patient was admitted to the Department of Neurosurgery with severe low back and radicular pain, and numbness along her left leg. Antalgic posture, painful paravertebral muscle tenderness, L4 radiculopathy, and L5 and S1 dermatome hypoesthesia on the left as well as positive straight leg raising sign (Laseque) were present upon examination. CT and MRI scanning showed stenosis on L4-L5 level caused by bilateral synovial cyst formation. Microsurgical decompression by foraminotomy at L4-L5 level on the left with dissection of the synovial cyst and epidural lipomatosis was performed. In the course of the operation CNR anomaly was discovered. The complete decompression alleviated the symptoms and after 3 uneventful postoperative days the patient was discharged. Spinal stenosis causing compression upon nervous structures is a process that could be caused by a number of conditions. The incidence of rare pathologies and anomalies or even the more rarely occurring combination of them must be considered on daily basis in the clinical practice in order to make the correct diagnosis and plan the best possible treatment for the patient.

Principles and applications of the balanced steady-state free precession sequence in small animal low-field MRI.

Magnetic resonance imaging (MRI) in small animal practice is largely based on classic two-dimensional spin-echo, inversion recovery and gradient-echo sequences which are largely limited by low spatial resolution, especially in low-field (LF)-MRI scanners. Nowadays, however, the availability of volumetric sequences can open new perspectives and enhance the diagnostic potential of this imaging modality. Balanced steady-state free precession (bSSFP) is a three-dimensional gradient-echo sequence in which image contrast is given by the ratio of T2 and T1, resulting in low soft-tissue signal, poor cerebral grey/white matter distinction and a bright signal from free fluid and fat. Such properties, along with a high signal-to-noise ratio and a very high spatial resolution deriving from acquisition of contiguous blocks of data, make this sequence perfectly suited for morphologic imaging, particularly for fluid-containing structures. Although bSSFP is widely adopted in human medical imaging, the use of this sequence in veterinary radiology is limited to anatomic studies of the inner ear and quadrigeminal cistern. This review aims to discuss the technical background of the bSSFP sequence and its possible advantageous applications in small animal LF-MRI for different specific disorders of the spine (arachnoid diverticula, small disc herniation, facet joint synovial cysts), brain (supracollicular fluid accumulation, traumatic injuries) and ligaments (complete and partial tears).

Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.

Percutaneous CT-guided facet joint synovial cyst rupture: Success with refractory cases and technical considerations

Percutaneous image-guided rupture of lumbar facet synovial cysts can improve clinical outcomes and obviate the need for open surgery. This series describes eleven patients who had successful CT-guided lumbar facet synovial cyst ruptures, 82% of which experienced excellent pain relief at a minimum of one-year follow-up. Of the five patients who failed prior fluoroscopic-guided synovial cyst rupture, 80% had a successful CT-guided rupture and one-year sustained pain relief. These findings reinforce minimally invasive CT-guided treatment as an excellent option to improve patient symptoms and potentially avoid open surgery.

Progressive Neurological Deficit Secondary to Lumbar Facet Synovial Cysts: Two Case Studies and a Literature Review

This article describes two case studies involving lumbar facet joint synovial cyst causing acute sciatica and progressive neurological deficit. The cases involve women, 57 and 69 years old, respectively. The first patient was presented with left buttock and lower leg pain, numbness and paresthesia, while the second one had progressive right lower leg pain for 3 months. Magnetic resonance imaging revealed a high intensity cystic lesion arising from the facet joint, subsequently causing spinal stenosis and exiting nerve root compression. Surgery was performed, including laminectomy and cyst excision. Microscopic observation confirmed synovial cysts. Following operation, clinical symptoms of the patients improved significantly with no neurological sequelae. Based on our experience with these two patients treated by open surgery in our hospital, this study attempted to more thoroughly elucidate the significance and treatment outcome of a surgically treated lumbar synovial cyst. Moreover, relevant literature was reviewed, with a focus on their clinical presentations, imaging findings, and postoperative surgical outcomes.

Outcome of Percutaneous Lumbar Synovial Cyst Rupture in Patients with Lumbar Radiculopathy

Background: Lumbar synovial cysts can result from spondylosis of facet joints. These cysts can encroach on adjacent nerve roots, causing symptoms of radiculopathy. Currently the only definitive treatment for these symptoms is surgery, which may involve laminectomy or laminotomy, with or without spinal fusion. Surgery has been reported to successfully relieve radicular pain in 83.5% of patients by Zhenbo et al. Little information is available concerning the efficacy and outcome of percutaneous fluoroscopic synovial cyst rupture for treatment of facet joint synovial cysts. Objective: The goal of this investigation was to assess the efficacy of fluoroscopically guided lumbar synovial cyst rupture, in particular for its relief of radicular symptoms and its potential to reduce the need for surgical intervention. Study Design: Retrospective evaluation of a case series. Setting: University hospital and urban public health care system. Methods: With approval from the Institutional Review Board of Case Western Reserve University/ MetroHealth Medical Center, we reviewed the medical charts of patients with lumbar radiculopathy who underwent percutaneous lumbar synovial cyst rupture. The 30 patients in the cohort were treated by one pain specialist between 2006 and 2013. These patients were diagnosed with moderate to severe lower back pain, radiculopathy, and ranged in age from 42 to 80 years. Patients were followed up for a minimum of 6 months and up to 24 months. Pre- and post-procedure pain assessments were reviewed by clinical chart review. In addition post-procedure pain assessments and duration of pain relief were obtained with telephone interviews. Pain had been reported by the patients using a numeric rating scale of 0 – 10 (0 = no pain; 10 = worst possible pain). Charts were reviewed to determine if surgery was eventually performed to correct radicular symptoms. Results: More than 6 months of pain relief was achieved in 14/30 patients (46%) and between one and 6 months of pain relief was achieved in 7/30 patients (23.3%). Nine patients (30.0%) had recurrence of the synovial cyst requiring repeat rupture and 6 patients (20.0%) required surgical intervention for cyst removal. A Wilcoxon signed-rank test demonstrated that the difference in numeric pain rating scale scores before and after the procedure was statistically significant (P < 0.0001). The average pain reduction was 71.2%. No complications were reported. Limitations: The results are limited by the retrospective nature of the data collection and the lack of detailed information regarding patients’ functional improvement. Conclusions: Rupture of percutaneous lumbar synovial cysts in patients with lumbar radiculopathy was associated with immediate relief of radicular symptoms. In 80% of the patients, synovial cyst rupture eliminated the need for surgical interventions over the measured term. This minimally invasive procedure helps relieve pain in a subset of a patient population associated with these characteristics and is useful for management of this condition. Cyst expansion and failure to rupture with possible neuronal compression are the potential complications of this procedure. This complication did not occur in the study population. Key words: Fluoroscopically guided lumbar synovial cyst rupture, lumbar synovial cyst, lumbar zygapophyseal joint cyst, nonsurgical intervention, radiculopathy, spondylosis

Metallosis-induced Facet Joint Synovial Cyst after Spinal Instrumentation Surgery

Metallosis is an uncommon complication of metal implantation. It most commonly occurs after knee and hip joint replacement, but it has also been reported in other joints such as the shoulder, wrist, and elbow. A 43-year-old man with L4-5 spondylolisthesis underwent L4-5 laminectomy and posterolateral fusion with pedicle screw instrumentation 7 years previously. Low back pain radiating to the bilateral lower limbs developed 2 months prior to presentation. The L3-4 facet joint synovial cyst compressing dura was diagnosed via magnetic resonance imaging. We removed the pedicle screws and performed a total excision of the cystic mass. At the 1-year follow-up, the patient was pain-free. Metallosis should be considered as a late complication of spinal implantation surgery. It can induce synovial cysts that cause radicular symptoms. Surgical intervention produced good results in this case.

Kissing Spine and the Retrodural Space of Okada: More Than Just a Kiss?

Baastrup (“kissing spine”) disease is characterized by contact by adjacent lumbar spinous processes and the presence of lumbar interspinous bursitis. The formation of an adventitious bursa within the interspinous region has been described previously in a retrospective review of routine lumbar magnetic resonance imaging in which the authors demonstrated the prevalence of interspinous bursitis in 8.2% of the study population [1]. These authors found an association between the formation of an interspinous bursa and the presence of associated degenerative changes such as central canal stenosis, disk bulging, and anterolisthesis. However, whether this bursa formation is the result of mechanical impingement from adjacent spinous processes or the result of degenerative conditions has not been fully characterized. Dr. Kikuzo Okada first described a communication pathway between single-level bilateral cervical facet joints in 1981 [2]. He described an extradural space dorsal to the ligamentum flavum that could connect the interlaminar region, interspinous region, and bilateral facet joints. This communication has been described in the lumbar spine, whereby interventional procedures in a single-sided facet joint have demonstrated flow of contrast material to the contralateral facet joint [3]. Usually “kissing spine” is thought to be caused by touching of approximating lumbar spinous processes during lumbar extension. This touching may create an adventitial bursa irritation within the interspinous ligament at the same level. However, we postulate that kissing spine disease may actually be an early sign of segmental instability. The anteroposterior shearing forces in persons with spondylolisthesis or early mid-range segmental instability may cause a friction moment, resulting in the interspinous formation of a bursa. Alternatively, excessive fluid within the facet joint caused by effusion may leak through the retrodural space of Okada to this region between the spinous processes and accumulate in the interspinous bursa. This bursa formation is different from a posterior facet joint synovial cyst in that the cyst has a contiguous relationship to the adjacent facet joint and is located in close proximity to the joint, whereas the adventitial bursa formation is more posterior within

Lumbar Facet Joint Synovial Cysts: Does T2 Signal Intensity Predict Outcomes after Percutaneous Rupture?

Lumbar facet synovial cysts are a cause of back pain and radiculopathy with facet joint degeneration, the most common cause for cyst formation. Typically, LFSCs are T2 hyperintense on MR imaging, but the signal intensity is variable. Treatment options include percutaneous rupture and surgical resection. This study evaluates the relationship between LFSC signal intensity on MR imaging and outcomes as it relates to percutaneous rupture success and need for subsequent surgery. A retrospective review of 110 patients who underwent CT fluoroscopic-guided rupture of symptomatic LFSCs was performed. The LFSCs were characterized by their T2 signal intensity on MR imaging and divided into 3 groups: high, intermediate, and low T2 signal intensity. The rates of successful cyst rupture and need for subsequent surgery were recorded. Percutaneous LFSC rupture was technically successful in 87% of all cases. Cyst rupture was successful in 89% and 90% of high and intermediate signal intensity cysts, respectively, and in 65% of low signal intensity cysts (P = .017, .030). High signal intensity cysts had lower postprocedural surgical rates (29%) when compared with intermediate and low signal cyst as a group (P = .045). T2 hyperintense and intermediate signal intensity LFSCs are easier to rupture, perhaps because the cysts contain a higher proportion of fluid and are less gelatinous or calcified than T2 hypointense cysts. Patients with T2 hyperintense LFSCs are less likely to need surgery.

Magnetic resonance imaging of the lumbar spine with axial loading: A review of 120 cases

To evaluate the imaging findings of patients with clinical symptoms of lower back pain who underwent magnetic resonance imaging (MRI) of the lumbar spine with axial loading. We examined 120 patients by MRI, before and after axial loading, using a compression device that applied 50% of their body weight for a load time of 5min. The dural sac cross area (DSCA) was examined by two experienced radiologists before and after axial load, and their findings were compared. Degenerative abnormalities within and adjacent to the spinal canal were also analyzed. A reduction in DSCA greater than 15mm(2) after axial load was defined as significant, and was found in 81 patients (67.5%) and 138 disc spaces (38.3%). Reduction was most frequent at L4-L5 (n=55). For other disorders, a 9% increase in cases of bulging disc was seen during axial loading, and seven disc spaces showed protrusion/extrusion only after load. Facet joint synovial cysts, foraminal stenosis, and hypertrophy of the flavum ligaments showed almost no differences, pre- and post-load. For adequate evaluation of lumbar symptoms, examination should be performed with axial loading, especially in cases of suspected spinal stenosis.

The significance of percutaneous aspiration of the zygapophysial facet joint synovial cyst: a case series

The significance of percutaneous aspiration of the zygapophysial facet joint synovial cyst: a case series