Devoted to diagnostic and interventional spine imaging and therapeutics


Percutaneous Rupture of Lumbar Facet Synovial Cysts: What Factors Predict Success? 2014

Category Interventional David Pastel
Sword Cambron
John McIntyre
Purpose Lumbar facet synovial cysts (LFSCs) most commonly arise in the setting of degenerative spondylosis and are a cause of back pain and radiculopathy (1-4). Treatment options include percutaneous rupture and surgical removal. We previously reported that T2 hyperintense and intermediate signal intensity LFSCs are easier to rupture and less likely to need surgery (5). Cyst size and location did not affect percutaneous rupture or surgical rates. The purpose of this follow-up analysis is to identify additional surgeries performed within our study group and identify other features that may predict outcome in patients undergoing percutaneous LFSC rupture. Materials & Methods We retrospectively reviewed the clinical outcome and imaging of 110 patients with 113 LFSCs who underwent attempted CT-guided synovial cyst rupture as primary treatment for symptomatic LFSCs. The rates of successful cyst rupture and need for subsequent surgery were recorded. Follow-up ranged from 7-93 months after the last attempted percutaneous rupture. This study will update the follow-up period by 18 months and report any additional surgeries performed within our study group. The following data will also be collected as they relate to percutaneous rupture success and need for subsequent surgery: BMI, narcotic use, previous back surgery, cyst wall calcification, facet effusion size, and spondylolisthesis. Results As previously reported, LFSC rupture was technically successful in 87% of all cases, with the highest success rates found in cyst of high and intermediate signal intensity. We reported lowest post-procedure surgical rates (29%) in patients with high signal intensity cysts. As discussed above, we will record additional surgeries performed since we first reported our data and analyze additional factors they may predict success. Conclusion Most patients with symptomatic LFSCs can avoid surgery with percutaneous rupture (5). Patients with T2-hyperintense synovial cysts are most likely to benefit from nonsurgical intervention (5). This study will identify additional features as described above that may predict outcome in patients undergoing percutaneous LFSC rupture. Information such as this can be valuable when selecting and counseling patients on their treatment options for symptomatic LFSCs References 1 . Eyster, E. F., & Scott, W. R. Lumbar synovial cysts: report of eleven cases.1989 Neurosurgery, 24(1), 112-115 2 . Lyons, M.K. et al. Spinal lumbar synovial cysts. Diagnosis and management challenge 2000. Journal of Neurosurgery, 93(1 Suppl), 3-57. 3. Abdullah AF, Chambers RW, Daut DP. Lumbar nerve root compression by synovial cysts of the ligamentum flavum. 1984;60:617–20. 4. Alicioglu B, Sut N. Synovial cysts of the lumbar facet joints: a retrospective magnetic resonance imaging study investigating their relation with degenerative. 5. Cambron SC, McIntyre JJ, Guerin SJ, Li Z, Pastel DA. Lumbar Facet Joint Synovial Cysts: Does T2 Signal Intensity Predict Outcomes Following Percutaneous Rupture? Accepted for publication AJNR.