Lumbar Facet Joint Synovial Cysts Research Articles

Percutaneous fluoroscopic lumbar facet joint synovial cyst aspiration for manifesting with radiculopathy and low back pain

Percutaneous fluoroscopic lumbar facet joint synovial cyst aspiration for manifesting with radiculopathy and low back pain

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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