Usefulness of percutaneous rupture for lumbar facet cysts: A retrospective study

Abstract

Background: Percutaneous rupture of lumbar facet cysts (LFC) is the only non-surgical treatment able to directly reduce cysts. However, this is not yet a common procedure, and its effectiveness, including the evaluation of complications, remains unclear. This study aimed to evaluate the clinical outcomes of percutaneous rupture for LFC and elucidate whether this minimally invasive procedure could become an alternative to surgeries for cases resistant to conservative treatments. Methods: This study investigated 51 symptomatic patients with LFC for whom conservative treatments were ineffective and who underwent percutaneous rupture of the LFC. All patients were followed-up for >2 years after the treatment. Clinical evaluations (Visual Analogue Scale [VAS], recovery rate calculated with Japanese Orthopedic Association scores) and radiographic evaluations (size of LFC based on magnetic resonance imaging [MRI]) were performed from pretreatment to final follow-up. Results: Successful LFS rupture, without hospitalization and general anesthesia, was achieved in 43 patients. No serious complications occurred during treatment through the last observation. Satisfactory clinical results were obtained (VAS: 11.1 mm, recovery rate: 83.1 %), and significant reduction of LFC was recognized in all cases based on post-treatment MRI. No successful rupture cases required subsequent surgical treatments, although there were 3 cases of LFC recurrence that required an additional percutaneous rupture treatment. Conclusions: Percutaneous rupture for LFC is not only a safe and minimally invasive procedure without any serious complications or requirements for hospitalization and general anesthesia, but also a very useful procedure that can prevent surgery for cases resistant to conservative treatments.

Efficacy of Percutaneous Image-Guided Rupture of Lumbar Facet Cysts: A Retrospective Study

“…In the remaining patient, although the pain was not relieved, the patient did not agree to undergo surgery and preferred to undergo conservative treatments (Table 2). 5 [16]). Successful rupture of the cyst was achieved in an 81-year-old male patient.…”

“…Te JOA score improved from 14 points at pretreatment to 29 points at the last observation, with a 100% recovery rate. 6 [16]). In the case of a 65-year-old female patient, successful cyst rupture was not achieved, and leakage of the contrast agent outside the joint and unimproved symptoms were observed.…”

“…After sufficient skin disinfection, 5 mL of 1% mepivacaine (Nissin Pharmaceutical Co., Ltd., Yamagata, Japan) was administered to achieve local anesthesia. Fluoroscopic images illustrating the LFC rupture procedure from this point onward are presented in Figure 2 [ 16 ]. A 22G needle (Hakko Co., Ltd, Tokyo, Japan) was inserted into the facet joint space under fluoroscopy, and the contrast agent (Omnipaque 240, GE Healthcare Japan Corporation, Tokyo, Japan) was injected into the joint space with monitoring.…”