Percutaneous Treatment with Steroid Injections and Distension of Facet Synovial Cyst -A case report-

요추 추간관절 활액낭의 경피적 치료 증례 -증례 보고-

  • Lee, Seuk Jin (Department of Anesthesiology and Pain Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital) ;
  • Kim, Young Ki (Department of Anesthesiology and Pain Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital) ;
  • Jung, Hwa Sung (Department of Anesthesiology and Pain Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital) ;
  • Lim, Jong Bum (Department of Anesthesiology and Pain Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital) ;
  • Lee, Chung (Department of Anesthesiology and Pain Medicine, Seoul Asan Medical Center)
  • 이석진 (울산대학교 의과대학 강릉아산병원 마취통증학과교실) ;
  • 김영기 (울산대학교 의과대학 강릉아산병원 마취통증학과교실) ;
  • 정화성 (울산대학교 의과대학 강릉아산병원 마취통증학과교실) ;
  • 임종범 (울산대학교 의과대학 강릉아산병원 마취통증학과교실) ;
  • 이청 (서울아산병원 마취통증의학교실)
  • Received : 2005.09.05
  • Accepted : 2005.12.01
  • Published : 2005.12.10

Abstract

Facet joint synovial cysts are uncommon intraspinal abnormalities, which appear to be secondary to degenerative changes of the joints. They can cause chronic back pain and radiculopathy, as shown in spinal stenosis. When symptomatic cysts fail to respond to conservative measurements, surgical decompression is known as the standard treatment. Percutaneous steroid injections, and distension of the cysts under fluoroscopic guidance, may be a minimally invasive treatment option. Here, the case of a patient with a symptomatic L5-S1 facet joint synovial cyst and left S1 radiculopathy, who responded satisfactorily to percutaneous treatment, is presented.

Keywords

References

  1. Bureau NJ, Kaplan PA, Dussault RG: Lumbar facet joint synovial cyst: percutaneous treatment with steroid injections and distentionclinical and imaging follow-up in 12 patients. Radiology 2001; 221: 179-85.
  2. Onofrio BM, Mih AD: Synovial cysts of the spine. Neurosurgery 1988; 22: 642-7.
  3. Trummer M, Flaschka G, Tillich M, Homann CN, Unger F, Eustacchio S: Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases. J Neurol Neurosurg Pscychiarry 2001; 70: 74-7.
  4. Maezawa Y, Baba H, Uchida K, Furusawa N, Kubota C, Yoshizawa K: Spontaneous remission of a solitary intraspinal synovial cyst of the lumbar spine. Eur Spine J 2000; 9: 85-7.
  5. Friedberg SR, Fellows T, Thomas CB, Mancall AC: Experience with sympromatic spinal epidural cysts. Neurosurgery 1994; 34: 989-93.
  6. Hsu KY, Zucherman JF, Shea WJ, Jeffrey RA: Lumbar intraspinal synovial and ganglion facet cysts: ten years' experience in evaluation and treatment. Spine 1995; 20: 80-9.
  7. Lyons MK, Atkinson JL, Atkinson JLD, Wharen RE, Deen HG, Zimmerman RS, et al: Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg 2000; 93: 53-7.
  8. Yarde WL, Arnold PM, Kepes ]], O'Boynick PL, Wilkinson SB, Barnitzky S: Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis. Report of eight cases. Surg Neurol 1995; 43: 459-64.
  9. Salmon B, Martin D, Lenelle J, Stevenaert A: Juxtrafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases. Acta Neurochir (Wien) 2001; 143: 129-34.
  10. Howingron JU, Connolly ES, Voorhies RM: Intraspinal synovial cysts: lO-year experience at the Ochsner Clinic. J Neurosurg 1999; 91: 193-9.
  11. Schmid G, Willburger R,Jergas M, Pennekamp W, Bickert U, Koster 0: Lumbar intraspinal juxtafecet cysts: MR imaging and CT-arthro-graphy. Rafo 2002; 174:1247-52.
  12. Tillich M, Trummer M, Lindbichler F, Flaschka G: Symptomatic intraspinal synovial cysts of the lumbar spine: correlation of MR and surgical findings. Neuroradiology 2001; 43: 1070-75.
  13. Sieber FE, Pauldine R: Anesthesia for the elderly. In: Miller's Anesthesia. 6th ed. Edited by Miller RD, Fleisher LA, Johns RA, Savarese ]], Wiener-Kronish TP, Young WL: Philadelphia, The Elsevier Inc. 2005, p 2440.
  14. Lutz GE, Shen TC: Fluoroscopically guided aspiration of a symptomatic lumbar zygapophyeal joint cyst: a case report. Arch Phys Med Rehabil 2002; 83: 1789-91.
  15. Parlier-Cuau C, Wybier M, Nizard R, Champsaur P, Le Hir P, Laredo ]D: 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.