Targeted Radiofrequency Ablation as an Adjunct in Treatment of Lumbar Facet Cysts

Abstract

Lumbar facet cysts are frequently found in patients with facet degeneration and segmental instability. When the facet cyst is localized in the neural foramina and lateral recess or becomes large, it can cause radiculopathy or neurogenic claudication. These symptomatic cysts are typically treated interventionally with drainage and a corticosteroid injection or attempts via overinflation to rupture the cyst; however, these procedures have a significant recurrence rate (up to 50%) and often need to be repeated or lead to lumbar surgery if unsuccessful. This is the first report of using targeted radiofrequency (RF) current as an adjunct to cyst drainage. Although RF has been used for years to treat facet pain indirectly by targeting the medial facet nerve branches, with this technique, under image guidance, the actual cyst is percutaneously drained and then cauterized along with the associated facet capsule, where the original cyst developed. This has improved overall results with less cyst recurrence than previous percutaneous methods and was documented with both intermediate and long-term followup clinically and with magnetic resonance imaging (MRI) scans. This report reviews the underlying anatomy and pathology of the facet joint relating to the development of facet cysts and how current percutaneous treatments for lumbar facet cysts can be supplemented and improved by adding targeted RF ablation to the percutaneous options available to treat a lumbar facet cyst.

Lumbar Facet Cyst as a Rare Cause of L5 Radiculopathy: A Case Report

“…In this technique the cyst is percutaneously drained under image guidance and then cauterized along with the associated facet capsule and facet joint, where the original cyst developed. The outcomes from this study and long-term follow-up demonstrated that this technique reduces the frequency of cyst recurrence compared to simple aspiration and steroid injection or cyst rupture [26].…”

“…A recent study described the use of targeted radiofrequency ablation to manage facet cyst [26]. In this technique the cyst is percutaneously drained under image guidance and then cauterized along with the associated facet capsule and facet joint, where the original cyst developed.…”

Effect of radiofrequency denervation on pain severity among patients with cervical, thoracic or lumbar spinal pain: A clinical retrospective study

“…The success of RFA has been demonstrated in patients with severe spinal stenosis or pathological FJ cysts and patients who do not require surgery after examination and imaging modalities [ 35 , 36 ]. If sufficient soft tissue is coagulated, patients can experience lasting clinical relief of their symptoms and improvement in spinal motion.…”

Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management

“…This joint fluid in one or both facets is often seen on axial MRI scans or in cases with development of facet cysts. Radiofrequency thermocoagulation can be used after cyst drainage to reduce the incidence of cyst recurrence [ 19 ]. Pulsed radiofrequency has been used directly to the synovium and within large and small joints elsewhere in the body for pain control [ 20 ].…”