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Long Term Follow-up of Patients with Symptomatic Synovial Cysts. 75% Treated with Percutaneous Rupture do not Require Surgical Treatment 2014

Category Interventional Todd Miller, MD
Jeremy Steinberger
Lucien Alexandre
Judah Burns, MD
Allan Brook
Purpose To report on the long-term symptom relief and need for subsequent surgery on a cohort of patients treated with percutaneous CT guided synovial cyst rupture. Materials & Methods This IRB approved and HIPAA compliant retrospective review was conducted on patients seen between 2007 and 2010. Office charts, PACS, and the Electronic medical record were reviewed. Patient demographics, symptoms, cyst size, location, degree of calcification, degree of canal stenosis were recorded. Follow-up office visits were evaluated for surgical treatment, symptom relief, and functional status. Results Twenty-three patients were included in the study. Mean follow-up was 5 years. All cysts were successfully ruptured using CT guidance with a single procedure. There were no complications of the procedures. Patients were 60 years old (46-81), Six females, 8 L5/S1, 14 L4/5, 1 L3/4, 1 L 2/3. Average cyst size was 10 mm (5-14). Six patients eventually required surgery for symptom relief. Average cyst size for those requiring surgery was 10 mm. These were evenly divided between levels L5/S1 and patients with and without spinal stenosis. One of the cysts had significant calcification seen on the treatment images. This patient eventually required surgery. Half of the patients required an additional epidural steroid injection during the follow-up period. Conclusion Percutaneous CT Guided rupture of synovial cysts is safe and effective and eliminates the need for surgery in 75% of patients observed over 5 years. References Abdullah AF, Chambers RW, Daut DP. Lumbar nerve root compression by synovial cysts of the ligamentum flavum. Report of four cases. J Neurosurg 1984;60:617–20. Kurz LT, Garfin SR, Unger AS, et al. Intraspinal synovial cyst causing sciatica. J Bone Joint Surg Am 1985;67:865–71. Onofrio BM, Mih AD. Synovial cysts of the spine. Neurosurgery 1988;22:642–7. Bureau NJ, Kaplan PA, Dussault RG. Lumbar facet joint synovial cyst: percutaneous treatment with steroid injections and distention—clinical and imaging follow-up in 12 patients. Radiology 2001;221:179–85. Slipman CW, Lipetz JS, Wakeshima Y, Jackson HB. Nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain. Arch Phys Med Rehabil 2000;81:973–7. Parlier-Cuau C, Wybier M, Nizard R, et al. 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. Radiology 1999;210:509–13. Epstein NE. Lumbar laminectomy for the resection of synovial cysts and coexisting lumbar spinal stenosis or degenerative spondylolisthe- sis: an outcome study. Spine 2004;29:1049–55. Khan AM, Synnot K, Cammisa FP, Girardi FP. Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech 2005;18:127–31. Howington JU, Connolly ES, Voorhies RM. Intraspinal synovial cysts: 10-year experience at the Ochsner clinic. J Neurosurg 1999;91(2 Suppl):193–9. Salmon B, Martin D, Lenelle J, Stevenaert A. Juxtafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases. Acta Neurochir (Wien) 2001;143:129–34. Julia F. Martha, Bryan Swaim, David A. Wang, David H. Kim, James Hill, Rita Bode, Carolyn E. Schwartz, Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients, The Spine Journal, Volume 9, Issue 11, November 2009, Pages 899-904 A Orlando Ortiz, Leena Tekchandani. Improved outcomes with direct percutaneous CT guided lumbar synovial cyst treatment: advanced approaches and techniques J NeuroIntervent Surg neurintsurg-2013-010891Published Online First: 26 November 2013