Introduction
Evidence & Methods
Few studies currently report the outcome of non-surgical treatment of lumbar synovial cysts. This article discusses one non-surgical technique.
In this retrospective case-series review, the authors found that following steroid injection and attempted percutaneous cyst rupture, 55% of patients proceeded to surgical intervention.
As the largest report of non-operative treatment for cysts, this paper is an important step in investigating this technique. The optimum approach to this group of patients will require a comparative study of alternative strategies.
—The Editors
Although synovial cysts arising from lumbar spinal facet joints are among the most common symptom-producing conditions affecting the lumbar spine, there have been very few comprehensive studies published on the natural history, appropriate evaluation, and management of this condition. Synovial cysts have been reported in association with both facet joints and the ligamentum flavum, but most of the facet joint cysts appear to arise from the joint capsule in association with degenerative spondylosis involving the facet joints [1], [2], [3], [4]. Although these cysts are considered benign, when associated with spinal stenosis or direct nerve root compression, persistent neurogenic claudication or sciatica symptoms can result.
There are currently no established guidelines with respect to treatment of symptomatic lumbar synovial cysts. Treatment options have been reported in several clinical series and include steroid injection and cyst aspiration, as well as surgical excision [4], [5]. Nearly all studies of nonsurgical management of lumbar synovial cysts have involved small numbers of patients [6], [7], [8]. Bureau et al. studied 12 percutaneous steroid injections and reported pain relief in 75% of patients, whereas Slipman et al. and Parlier-Cuau et al. studied 14 and 30 steroid injections, respectively, and reported symptomatic relief in up to one-third of the patients. Studies involving larger patient populations have addressed surgical treatment and have recommended decompressive laminectomy and cyst excision with or without concomitant fusion as an effective treatment option [9], [10], [11], [12], [13], [14], [15]. There have been no clinical series that specifically evaluate the technique of facet joint steroid injection with cyst rupture and how this technique relates to the need for subsequent treatment. This treatment technique is thought to provide symptom relief through a reduction in cyst protrusion onto surrounding anatomy and also through the analgesic effects of locally administered steroid, which is released into the epidural space on successful cyst rupture.
In this study, the role of fluoroscopically guided facet joint steroid injection with cyst rupture is examined in 101 symptomatic cases, with particular attention paid to the need for subsequent surgical intervention.