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Direct Puncture of Symptomatic Synovial Cysts: Clinical Experience in 90 Patients 2014

Category Interventional Keith E. Kortman Purpose Pararticular facet cysts are a relatively common cause of radiculophy. Traditional treatment has involved cyst resection, usually in association with facetectomy and instrumentation. Noninvasive percutaneous treatment has typically included epidural and/or intra-articular corticosteroid injections. Cyst rupture can be achieved by higher volume intra-articular fact joint injections. The purpose of this study was to determine the technical feasibility and outcomes associated with direct cyst puncture and rupture using CT guidance. Materials & Methods Ninety patients with symptomatic synovial cysts were treated with direct CT puncture and rupture in conjunction with epidural corticosteroid injection. The procedures were performed on an outpatient basis without conscious sedation. Clinical features, imaging findings, and outcomes are presented. Results Needle access for successful cyst puncture was achieved in 88 patients. All patients with successfully punctured cysts experinced immediate symptomatic relief. Pain relief was sustained in the large majoriity of patients. Cyst resolution or subsatntial size reduction was documented in nearly all patients who underwent subsequent cross-sectional imaging studies. Conclusion Symptomatic parartiular synovial cysts can be safely and effectively treated with direct needle pucture and rupture using CT guidance in an outpatient setting. Sustained favorable clinical outcomes are achieved in the large majority of patients, obviating the need for surgical treatment. References Onofrio BM, Mih AD. Synovial Cysts of the Spine Neurosurgery 22 (1988): 642-7 Hsu, KY, et al. Lumbar intraspinal synovial and ganglion cysts (facet cysts): ten-year experience in evaluation and treatment. Spine 20.1 (1995): 80-89. Lyons MK, Atkinson JLD, et al. Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. Journal of Neurosurgery Spine 93(1) July 2000 : 53-57 Epstein NE, Baisden J. The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surg Neurol Int 2012;3, Suppl S3:157-66 Bureau NJ, Kaplan PA, Dussault RG Lumbar Facet Joint Synovial Cyst: Percutaneous Treatment with Steroid Injections and Distension- Clinical and Imaging Follow-up in Twelve Patients. Vascular and Interventional Radiology 221(1) October 2001: Ortiz AO, Tekchandani L. Improved outcomes with direct percutaneous CT guided lumbar synovial cyst treatment: advanced approaches and techniques. J Neurointerventional Surgery November, 2013 (Epub ahead of print)