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Percutaneous Treatment of Synovial cysts of the Lumbar Facet Joint: Technique, Success and Failure Rate 2004

Solsberg, Murray, M.D.

Purpose:
The purpose of this study was to evaluate the long-term outcome of patients treated percutaneously for synovial cysts of the lumbar facets.

Methods and Materials:
38 patients with synovial cysts of the lumbar facet joints treated at our facility between 1999 and 2003 were contacted by telephone in November and December 2003. The patient's current pain level, limitations of daily activities and additional surgical and conservative treatments were recorded. These patients were treated with a standardized technique under fluoroscopic guidance. The standard technique was to first enter the facet joint with a 22-gauge spinal needle and aspirate any fluid. After arthrography confirmed that a cyst was present the joint was anesthetized with 2 % Xylocaine. The joint capsule then was distended until there was loss of resistance indicating cyst or capsule rupture. Then, Depo-Medrol 40 mg was instilled into the joint. Pre and post procedure visual pain analog diagrams and scores were completed and the values recorded. We also contacted each patient at 48 hours post procedure and noted the pain level. The demographics and pain responses were then analyzed. The chart, MRI and fluoroscopic images were also reviewed and the size and location of the facet cyst was noted.

Results:
26 women and 12 men were treated. The average age at time of treatment was 59 years. The average pain level prior to the procedure was 6/10 and immediate post-procedure was 1/10. The average time of follow-up was 20 months (range 3- 42 months). Twenty (53%) patients had no back pain or radiculopathy. In four (11 %) patients the radiculopathy was resolved but they stil l had mild (pain level < 4/10) low back pain. Six (16%) patients reported no improvement in their pain post-procedure but were still managed conservatively (without surgery) with pain levels all less than 4/10. Eight (21 %) patients had little or only short term improvement after the procedure and needed surgery. One patient had persistent pain and radiculopathy even after surgery.

Conclusions:
Radiculopathy was successfully treated in 64 % of our patients. No patients reported significant worsening of symptoms after treatment. The majority of patients at our facility with synovial cysts of the lumbar spine were successfully managed with conservative therapy.