Use this link to view the PDF file: CT-GUIDED LUMBAR FACET SYNOVIAL CYST INTERVENTION: WHAT THE RADIOLOGIST NEEDS TO KNOW
Introduction: Lumbar facet synovial cysts (LFSC) that project into the spinal canal can cause low back pain, radiculopathy, neurogenic claudication, motor weakness, and sensory loss. Treatment options include percutaneous rupture, cyst steroid injection, and surgical resection. Image-guided cyst rupture is commonly performed through the facet joint by either radiography or CT fluoroscopy with the goals of pain relief, cyst rupture, and/or complete or partial regression of the cyst.
Objectives: 1. Review the clinical presentation and imaging appearance of LFSCs on MRI and CT. 2. Discuss the usefulness of CT-guided LFSC rupture/decompression as a minimally invasive treatment of associated radicular back pain. 3. Discuss the techniques in performing CT-guided LFSC rupture/decompression. 4. Identify and understand the indications, contraindications, and potential complications associated with performing CT-guided LFSC intervention.
Outline: 1. Imaging appearance of LFSC on CT and MRI A. Discuss reported relationship between LFSC signal intensity on MR imaging and outcomes as it relates to percutaneous rupture success and need for subsequent surgery. 2. Clinical presentation of LFSC 3. Overview of CT guided LFSC intervention A. Indications and Contraindications B. Techniques of the Procedure a. Pre-procedure planning b. Medications (anesthetics, corticosteroids, contrast agents) c. Cyst rupture versus cyst steroid injection d. Post-procedure imaging C. Potential Complications D. Advantages and disadvantages of CT versus fluoroscopy for performing the procedure
Conclusions: Percutaneous CT-guided lumbar facet synovial cyst intervention is a safe, reliable, and reproducible method of treating symptomatic facet cysts nonsurgically.