대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제82권1호
  • /
  • Pages.162-172
  • /
  • 2021
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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척추 후궁절제술 이후 발생한 요추 후관절 활액낭에서 투시유도 하 낭종파열술 및 관절 내 스테로이드 주입술의 임상적 경험

Efficacy of Fluoroscopy-Guided Lumbar Facet Joint Synovial Cyst Rupture with Intra-Articular Steroid Injection after Laminectomy

  • 김효진 (분당서울대학교병원 영상의학과) ;
  • 이영준 (분당서울대학교병원 영상의학과) ;
  • 이준우 (분당서울대학교병원 영상의학과) ;
  • 강유선 (분당서울대학교병원 영상의학과) ;
  • 안중모 (분당서울대학교병원 영상의학과)
  • Hyo Jin Kim (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Eugene Lee (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Joon Woo Lee (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Yusuhn Kang (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Joong Mo Ahn (Department of Radiology, Seoul National University Bundang Hospital)
  • 투고 : 2019.11.14
  • 심사 : 2020.07.15
  • 발행 : 2021.01.01
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초록

목적 요추 후궁절제술 시행 부위 후관절 활액낭에 대해 투시유도 하 경피적 낭종파열술 및 스테로이드 주입술을 시행 받은 환자에 관하여 후향적으로 시술의 성공률 및 임상적 효과를 분석하였다. 대상과 방법 투시유도 하 경피적 후관절 낭종파열술과 관절 내 스테로이드 주입술을 시행 받은 환자이면서, 시술 전 6개월 이내 촬영한 요추 자기공명영상 상 이전 후궁절제술 부위와 후 관절 활액낭종의 위치가 일치하는 것이 증명된 환자, 그리고 그 낭종의 위치가 신경학적 증상을 설명하는 것으로 판단되는 환자를 대상(14명)으로 하였으며 시술 후 낭종파열의 성공유무와 증상의 호전 정도를 조사하였다. 결과 시술이 반복될수록 낭종파열의 성공률은 감소하였지만(첫 시술에서는 62.5%, 그 이후의 시술에서는 0~33%), 80%의 환자가 시술 후 증상 호전을 보였다. 추적관찰 기간 내 낭종에 대한 수술률은 14.3%였다. 결론 요추 후궁절제술 시행 부위 후관절 활액낭에 대한 투시유도 하 경피적 낭종파열술 및 스테로이드 주입술은 효과적인 치료 방법으로서, 수술적 치료를 고려하기 전에 먼저 시도해 볼 수 있다.

Purpose We retrospectively evaluated the technical success rate and long-term efficacy of fluoroscopy-guided synovial cyst rupture followed by an intra-articular steroid injection at the post-laminectomy lumbar facet. Materials and Methods We selected subjects who had undergone a fluoroscopy-guided synovial cyst rupture with simultaneous intra-articular steroid injection within 6 months of MRI and demonstrated a symptomatic facet joint synovial cyst at the level of a previous lumbar laminectomy. Fourteen patients were enrolled, and we determined whether cyst rupture and symptom improvement were achieved after each procedure. The degrees of symptom improvement were categorized into 4: 1) symptoms improved (30% or more reduction, based on pre-procedural and post-procedural Numerical Pain Rating Scale scores), 2) symptoms not improved, 3) patient underwent surgery after injection, and 4) loss of follow-up. Results The success rate of percutaneous synovial cyst rupture decreased with repeated procedures (62.5% for the first procedure and 0% to 33.3% for additional procedures). However, 80% of the patients had symptom improvement with the procedures, overall. The surgery rate was 14.3% in 14 patients. Conclusion For patients with post-laminectomy symptomatic lumbar facet joint synovial cysts, fluoroscopy-guided synovial cyst rupture with intra-articular steroid injection may be an effective and less invasive treatment before considering a surgical approach.

키워드

참고문헌

  1. Bydon M, Papadimitriou K, Witham T, Wolinsky JP, Sciubba D, Gokaslan Z, et al. Treatment of spinal synovial cysts. World Neurosurg 2013;79:375-380
  2. Themistoklis KM, Papasilekas TI, Boviatsis KA, Giakoumettis DA, Vlachakis EN, Themistocleous MS, et al. Spinal synovial cysts. A case series and current treatment options. J Clin Neurosci 2018;57:173-177
  3. Chazen JL, Leeman K, Singh JR, Schweitzer A. Percutaneous CT-guided facet joint synovial cyst rupture: success with refractory cases and technical considerations. Clin Imaging 2018;49:7-11
  4. Lutz GE, Nicoletti MR, Cyril GE, Harrison JR, Lutz C, Solomon JL, et al. Percutaneous rupture of zygapophyseal joint synovial cysts: a prospective assessment of nonsurgical management. PM R 2018;10:245-253
  5. Shuang F, Hou SX, Zhu JL, Ren DF, Cao Z, Tang JG. Percutaneous resolution of lumbar facet joint cysts as an alternative treatment to surgery: a meta-analysis. PLoS One 2014;9:e111695
  6. Eshraghi Y, Desai V, Cajigal Cajigal C, Tabbaa K. Outcome of percutaneous lumbar synovial cyst rupture in patients with lumbar radiculopathy. Pain Physician 2016;19:E1019-E1025
  7. Huang AJ, Bos SA, Torriani M, Simeone FJ, Chang CY, Pomerantz SR, et al. Long-term outcomes of percutaneous lumbar facet synovial cyst rupture. Skeletal Radiol 2017;46:75-80
  8. Haider SJ, Na NR, Eskey CJ, Fried JG, Ring NY, Bao MH, et al. Symptomatic lumbar facet synovial cysts: clinical outcomes following percutaneous CT-guided cyst rupture with intra-articular steroid injection. J Vasc Interv Radiol 2017;28:1083-1089
  9. Amoretti N, Huwart L, Foti P, Boileau P, Amoretti ME, Pellegrin A, et al. Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections. Eur Radiol 2012;22:2836-2840
  10. Martha JF, Swaim B, Wang DA, Kim DH, Hill J, Bode R, et al. Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients. Spine J 2009;9:899-904
  11. Ortiz AO, Tekchandani L. Improved outcomes with direct percutaneous CT guided lumbar synovial cyst treatment: advanced approaches and techniques. J Neurointerv Surg 2014;6:790-794
  12. Allen TL, Tatli Y, Lutz GE. Fluoroscopic percutaneous lumbar zygapophyseal joint cyst rupture: a clinical outcome study. Spine J 2009;9:387-395
  13. Parlier-Cuau C, Wybier M, Nizard R, Champsaur P, Le Hir P, Laredo JD. Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long-term followup in 30 patients. Radiology 1999;210:509-513
  14. Walcott BP, Coumans JV. Postlaminectomy synovial cyst formation: a possible consequence of ligamentum flavum excision. J Clin Neurosci 2012;19:252-254
  15. Kato M, Konishi S, Matsumura A, Hayashi K, Tamai K, Shintani K, et al. Clinical characteristics of intraspinal facet cysts following microsurgical bilateral decompression via a unilateral approach for treatment of degenerative lumbar disease. Eur Spine J 2013;22:1750-1757
  16. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149-158
  17. Cambron SC, McIntyre JJ, Guerin SJ, Li Z, Pastel DA. Lumbar facet joint synovial cysts: does T2 signal intensity predict outcomes after percutaneous rupture? AJNR Am J Neuroradiol 2013;34:1661-1664
  18. Kwan BYM, Salehi F, Jia S, McGregor S, Duggal N, Pelz D, et al. Retrospective review of percutaneous synovial cyst ruptures: increased thickness of the T2 hypointense rim on post-rupture MRI may be associated with need for subsequent surgery. J Neurointerv Surg 2017;9:797-800
  19. Rauchwerger JJ, Candido KD, Zoarski GH. Technical and imaging report: fluoroscopic guidance for diagnosis and treatment of lumbar synovial cyst. Pain Pract 2011;11:180-184
  20. Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging 2018;9:773-789
  21. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology 2007;106:591-614
  22. Karamouzian S, Ebrahimi-Nejad A, Shahsavarani S, Keikhosravi E, Shahba M, Ebrahimi F. Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation. Asian Spine J 2014;8:646-652
  23. Lee JH, An JH, Lee SH. Comparison of the effectiveness of interlaminar and bilateral transforaminal epidural steroid injections in treatment of patients with lumbosacral disc herniation and spinal stenosis. Clin J Pain 2009;25:206-210