Lumbar Facet Joint Synovial Cysts: Does T2 Signal Intensity Predict Outcomes after Percutaneous Rupture?

Abstract

BACKGROUND AND PURPOSE Lumbar facet synovial cysts are a cause of back pain and radiculopathy with facet joint degeneration, the most common cause for cyst formation. Typically, LFSCs are T2 hyperintense on MR imaging, but the signal intensity is variable. Treatment options include percutaneous rupture and surgical resection. This study evaluates the relationship between LFSC signal intensity on MR imaging and outcomes as it relates to percutaneous rupture success and need for subsequent surgery. MATERIALS AND METHODS A retrospective review of 110 patients who underwent CT fluoroscopic-guided rupture of symptomatic LFSCs was performed. The LFSCs were characterized by their T2 signal intensity on MR imaging and divided into 3 groups: high, intermediate, and low T2 signal intensity. The rates of successful cyst rupture and need for subsequent surgery were recorded. RESULTS Percutaneous LFSC rupture was technically successful in 87% of all cases. Cyst rupture was successful in 89% and 90% of high and intermediate signal intensity cysts, respectively, and in 65% of low signal intensity cysts (P = .017, .030). High signal intensity cysts had lower postprocedural surgical rates (29%) when compared with intermediate and low signal cyst as a group (P = .045). CONCLUSIONS T2 hyperintense and intermediate signal intensity LFSCs are easier to rupture, perhaps because the cysts contain a higher proportion of fluid and are less gelatinous or calcified than T2 hypointense cysts. Patients with T2 hyperintense LFSCs are less likely to need surgery.

Lumbar Facet Synovial Cysts: Imaging Characteristics and Percutaneous Treatment

“…We have found a higher rate of successful percutaneous rupture in intermediate and high-signal-intensity LFSCs (89% and 90%) compared with low-signal intensity LFSCs (65%). 8 Highsignal-intensity LFSCs also have a lower postprocedural surgical rate (29%) compared with intermediate-and low-signal-intensity LFSCs (48%). 8…”

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

“…Lumbar facet synovial cysts (LFSCs), which arise secondarily to degenerative changes of the facet joints, are relatively common, with an incidence of 1% 1 2. Synovial cysts occur most commonly at the L4–L5 level and are associated with radiculopathy and, in severe cases, neurogenic claudication 1 3.…”

“…Synovial cysts occur most commonly at the L4–L5 level and are associated with radiculopathy and, in severe cases, neurogenic claudication 1 3. Management of LFSCs includes surgical excision and non-surgical percutaneous image-guided rupture 1 4 5.…”

“…Synovial cysts occur most commonly at the L4–L5 level and are associated with radiculopathy and, in severe cases, neurogenic claudication 1 3. Management of LFSCs includes surgical excision and non-surgical percutaneous image-guided rupture 1 4 5. Although the success of percutaneous synovial cyst ruptures is high, a relatively high percentage of patients have recurrence and then go on to surgical management (45–54%) 1 5…”

“…MRI characteristics of synovial cysts typically consist of a well-circumscribed extradural lesion adjacent to the facet joint with a low signal on T1-weighted and high signal on T2-weighted sequences with a T2 hypointense rim 1 3 6. A recent study showed that there is a variable distribution of the synovial cyst signal on T2-weighted images, which may be related to differences in protein content, blood products, and/or calcification 1.…”