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Percutaneous CT-Guided Treatment of Intraspinal Synovial Cyst 2005

Interventional Spine

Sonia V Bermudez, MD
Anibal J Morillo , MD, Non ASSR Member
Monica D Ocampo , MD, Non ASSR Member
Andres Rodriguez , MD, Non ASSR Member

Purpose

To describe the spectrum of appearances and main diagnostic clues that can be encountered in Magnetic Resonance Imaging (MRI) of lumbar facet synovial cysts (LFSC). To show our experience and results with CT-guided percutaneous treatment of synovial cysts.

Methods & Materials

MRI examinations of all patients with LFSCs in a two-year period were reviewed, with special
attention to their signal characteristics. Eight patients with LFSCs were treated percutaneously with CT-guided arthrography and cyst opacification, distention, and rupture. Two patients required a second percutaneous intervention. One patient's LFSC could not be distended by facet joint injection, and was approached by direct cyst puncture. Pain was evaluated before and after the procedure, using a visual analogue pain scale of 0-10.

Results

In our series, LFSCs ocassionally possessed a calcified rim. They appeared isointense to slightly hyperintense relative to cerebrospinal fluid on both T1- and T2- weighted MR images.
Some of them could be located in the ligamentum flavum, while others lied in the posterior midline, adjacent to the spinous processes. LFSCs were most frequent at the L4-L5 level.
Pain relief was referred by all the patients in our series. Six patients had excellent results, with complete symptom resolution. Two patients had marked improvement with occasional pain. To date, none of them have required additional surgical treatment.

Conclusion

The diagnosis of LFSCs is more easily established with MRI. CT-guided percutaneous treatments is a safe and effective choice for symptomatic LFSC patients. It should be indicated as an alternative to surgery, mainly in patients with high surgical risk.

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