Facet Joint Synovial Cysts Research Articles

Percutaneous CT-guided treatment of lumbar facet joint synovial cysts.

Symptomatic intraspinal lumbar facet joint synovial cysts can be managed both conservatively and surgically. Diagnosis of the lumbar facet joint cyst is made through cross-sectional imaging of the spine, either by computerized tomography (CT) scan, myelography, or most commonly magnetic resonance imaging. Conservative treatment by facet joint injection can be performed under fluoroscopic or CT guidance, although only CT guidance provides direct visualization of the cyst confirming accurate needle placement. This case report illustrates the use of percutaneous CT-guided facet joint cyst treatment as a temporizing measure or alternative to surgical treatment in the proper clinical scenario.

Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients

Background context Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine. Previous reports have supported operative and nonoperative management. Facet joint steroid injection with cyst rupture is occasionally performed, but there has been no systematic evaluation of this treatment option. Purpose To profile the role of facet joint steroid injections with cyst rupture in the treatment of lumbar facet joint synovial cysts. Study design/setting Retrospective chart review and long-term follow-up of patients treated for lumbar facet joint synovial cysts. Patient sample One hundred one patients treated for lumbar facet joint synovial cysts with fluoroscopically guided corticosteroid facet joint injection and attempted cyst rupture. Outcome measures Oswestry Disability Index and numeric rating scale score for back and leg pain. Methods A retrospective review and a subsequent interview were conducted to collect pretreatment and posttreatment pain and disability scores along with details of subsequent treatment interventions. Group differences in pain and disability scores were assessed using paired t test. Multiple clinical factors were analyzed in terms of risk for surgical intervention using logistic regression modeling and Cox proportional hazards modeling. Results Successful cyst rupture was confirmed fluoroscopically in 81% of cases. Fifty-five patients (54%) required subsequent surgery over a period averaging 8.4 months because of inadequate symptom relief. All patients reported significant improvement in back pain, leg pain, and disability at 3.2 years postinjection, regardless of their subsequent treatment course (p<.0001 in all groups). There was no significant difference in current pain between patients who received injections only and those who underwent subsequent surgery. Conclusions This study presents the largest clinical series of nonsurgical treatment for lumbar facet joint synovial cysts. Lumbar facet joint steroid injection with attempted cyst rupture is correlated with avoiding subsequent surgery in half of treated patients. Successful cyst rupture does not appear to have added benefit, and it was associated with worse disability 3 years postinjection. Long-term outcomes are similar, regardless of subsequent surgery.

Image-guided lumbar facet joint infiltration in nonradicular low back pain

Objective:To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP).Materials and Methods:Forty-four patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. The majority (n = 24) had facetal pain with no evidence of significant facetal arthropathy on imaging. Fifteen patients had radiological evidence of facetal arthropathy, one had a facet joint synovial cyst, three were post–lumbar surgery patients, and two patients had spondylolysis. Facet joint injections were carried out under fluoroscopic guidance in 39 patients and under CT guidance in 5 cases. Pain relief was assessed using the visual analog scale at 1 h post-procedure and, thereafter, at 1, 4, 12, and 24 weeks.Results:A total of 141 facet joints were infiltrated in 44 patients over a 2-year period. There was significant pain relief in 81.8% patients 1 h after the procedure, in 86.3% after 1 week, in 93.3% after 4 weeks, in 85.7% after 12 weeks, and in 62.5% after 24 weeks. No major complications were encountered.Conclusions:Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With meticulous patient selection, we achieved long-term success rates of over 60%. We conclude that this method represents an important alternative treatment for nonradicular back pain.

Ganglion cyst of a lumbar facet joint in an adolescent—a case report

‘Lumbar facet joint synovial cyst’ is the recent terminology used to describe cysts within and outside the lumbar spinal canal. These include ganglion cysts, synovial cysts and cysts arising from the ligamentum flavum. Ganglion or synovial cysts typically arise from the joints and tendon sheaths of the appendicular skeleton but are uncommon in the spinal facet joints and rare in an adolescent. This case report illustrates a 14-year-old female patient of the senior author (JHP) with lumbar facet joint cyst who presented with lower back pain. Excisional biopsy was performed and the histology confirmed the diagnosis of a ganglion cyst.

Percutaneous Treatment with Steroid Injections and Distension of Facet Synovial Cyst -A case report-

Facet joint synovial cysts are uncommon intraspinal abnormalities, which appear to be secondary to degenerative changes of the joints. They can cause chronic back pain and radiculopathy, as shown in spinal stenosis. When symptomatic cysts fail to respond to conservative measurements, surgical decompression is known as the standard treatment. Percutaneous steroid injections, and distension of the cysts under fluoroscopic guidance, may be a minimally invasive treatment option. Here, the case of a patient with a symptomatic L5-S1 facet joint synovial cyst and left S1 radiculopathy, who responded satisfactorily to percutaneous treatment, is presented.

Synovial cysts and the lithotomy position causing cauda equina syndrome

We describe a case of cauda equina syndrome caused by synovial cysts and the lithotomy position. A transurethral resection of the prostate was performed under spinal anesthesia in the lithotomy position. We believe that this is the first case report of facet joint synovial cysts and the lithotomy position causing ischemic neurologic injury to the cauda equina. Other etiologies such as needle trauma, neurotoxicity, hematoma, and abscess were not evident. We believe that positioning the patient in the lithotomy position narrowed the cross-sectional area of the spinal canal in a patient with a coexisting critically stenosed lumbar spinal canal. The resultant mechanical pressure caused an ischemic compression injury to the cauda equina.

Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging.

A retrospective review of 303 MRI scans of the lumbar spine was conducted. To determine the prevalence of lumbar facet joint synovial cysts arising from the joints anteriorly and posteriorly. To examine the association of these cysts with facet joint osteoarthritis and degenerative disc disease. Sporadic reports of such cysts exist as do limited studies describing the prevalence of symptomatic anterior facet joint synovial cysts. However, the overall prevalence of lumbar facet joint synovial cysts has not been formally studied, and the mechanism of formation of these cysts is not fully understood. One observer undertook a review of MRI of the lumbar spine from one facility in a series of 303 patients referred mostly for back pain or radiculopathy. The presence of lumbar facet joint synovial cysts, their relationship to the facet joint, the degree of associated facet joint osteoarthritis, the presence of spondylolisthesis, and the degree of associated disc degeneration were recorded. Seven anterior cysts (prevalence = 2.3%) were identified, only two of which did not clearly cause nerve root compression. Twenty-three posterior cysts in 22 patients (prevalence = 7.3%) were identified. Statistically significant associations with increased frequency and severity of facet joint osteoarthritis and with spondylolisthesis were demonstrated compared to patients without cysts. Both anterior and posterior lumbar facet joint synovial cysts are rare. Posterior cysts are more common than anterior cysts. Both types of cysts are related to facet joint osteoarthritis but not to disc disease.

Lumbar facet joint synovial cyst: percutaneous treatment with steroid injections and distention--clinical and imaging follow-up in 12 patients.

To determine the imaging characteristics of lumbar facet joint synovial cysts after percutaneous treatment with steroid injections and distention of the cyst and to correlate these findings with the clinical outcome. Clinical outcome and imaging findings were retrospectively studied in 12 patients (four men, eight women) aged 45-79 years (mean, 60 years) with a symptomatic lumbar facet joint synovial cyst treated with percutaneous steroid injections. At varying times after the procedure, patients were contacted for clinical follow-up, and repeat imaging was performed to verify the status of the cyst. Excellent pain relief was achieved in nine (75%) of 12 patients. At follow-up imaging, the cyst completely regressed in six (67%) of these nine patients, partially regressed in two (22%) patients, and was unchanged in one (11%) patient. One (8%) of the 12 patients had transient pain relief, with recurrence of symptoms at short intervals after each of three injections. No pain relief was achieved in two (17%) of 12 patients. Image-guided percutaneous steroid injections are often effective in the treatment of lumbar facet joint synovial cysts and may result in complete regression of the cyst.

Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases

OBJECTIVESynovial cysts of the vertebral facet joints are a source of nerve root compression. Different surgical procedures are in use, but no consensus has been formed so far as to...

MR imaging of lumbar facet joint synovial cysts.

The increasing application of magnetic resonance (MR) imaging of the spine has raised the awareness of lumbar facet synovial cysts (LFSC). This well recognised, yet uncommon condition, presents with low back pain and radiculopathy due to the presence of an extradural mass. The commonest affected level is L4/5 with a mild degenerative spondylolisthesis a frequent associated finding. MR imaging is the technique of choice to detect and diagnose a LFSC. This pictorial essay, drawing on experience of 43 cases seen in 40 patients, illustrates the spectrum of appearances that can be encountered and suggest differing causes for the variable signal characteristics exhibited. Computed tomography (CT) can be of value in some cases to aid interpretation of the MR images. In addition, CT facet arthrography by injection of air or iodinated non-ionic contrast medium may be used to confirm the diagnosis in doubtful cases as well as noting whether the patients presenting symptoms can be provoked. A comprehensive review of the existing literature is presented.

Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long-term follow-up in 30 patients.

To study the results of facet joint intraarticular steroid injections in patients with symptomatic lumbar facet joint synovial cysts. Data from 30 patients (age range, 44-82 years; mean age, 67 years) with nerve root pain due to a lumbar facet joint synovial cyst and treated with facet joint steroid injection were retrospectively studied. On the basis of MacNab criteria, the clinical course of nerve root pain was evaluated after 1 (n = 30) and 6 (n = 28) months. Data from long-term follow-up (mean, 26 months) were also available in 14 nonsurgically treated patients. After 1 month, the nerve root pain outcome was excellent or good in 20 patients (67%) and fair or poor in 10 (33%). After 6 months, 10 (50%) of these 20 patients still had excellent or good results, and 18 (60%) of the 30 patients had a fair or poor clinical status, 14 of whom underwent surgery; two patients (7%) were lost to follow-up. Excellent and good results were maintained at further follow-up (range, 9-50 months). One-third of patients with symptomatic lumbar facet joint synovial cysts had long-lasting acceptable benefit from facet joint steroid injections in this study. Steroid injection should be indicated before surgery.

Juxtafacet Cysts as a Cause of Low Back Pain

A case of persistent low back pain occurring in association with facet joint synovial cysts is presented. A history of low back pain and negative plain radiographs illustrate the nonspecific nature of the problem these cysts cause. Magnetic resonance imaging (MRI) clearly demonstrates the presence of lumbar facet joint cysts. Our patient underwent a L5-S1 laminectomy prior to presenting with a new episode of low back pain. Workup, including computed tomography (CT) scan and MRI, confirmed the presence of bilateral synovial cysts at the L4-5 level. Our patient exhibited a partial clinical improvement after surgical excision of bilateral facet joint cysts.Intraspinal synovial or ganglion cysts of the facet joints are rarely diagnosed. They originate from the synovium of the facet articulation. They can be a source of low back pain1 and present an important diagnostic and therapeutic challenge. Their presence can be easily overlooked using standard radiological techniques2 which may only demonstrate nonspecific degenerative changes such as disc space narrowing and osteophytes. If the patient undergoes surgery and the cyst is not identified preoperatively, the patient may be left with persistent back pain. Computed tomography scan and myelogram have been shown to demonstrate cystic lesions with calcified walls typical of facet joint cysts.3,4 In our case MRI definitively identified what was suspected on the CT scan. It is proposed that MRI is also a valuable, if not better imaging technique of the identification of these cysts.

Compression of thoracic nerve root by a facet joint synovial cyst: Case report

Synovial cysts are not an uncommon feature in the mobile spinal segments. The lack of reports at the thoracic level has stimulated us to present this patient with compression of the 10th dorsal root.

Lumbar facet joint injection: indication, technique, clinical correlation, and preliminary results.

Lumbar facet joint injection: indication, technique, clinical correlation, and preliminary results.