Outcome of Percutaneous Lumbar Synovial Cyst Rupture in Patients with Lumbar Radiculopathy

Background: Lumbar synovial cysts can result from spondylosis of facet joints. These cysts canencroach on adjacent nerve roots, causing symptoms of radiculopathy. Currently the only definitivetreatment for these symptoms is surgery, which may involve laminectomy or laminotomy, with orwithout spinal fusion. Surgery has been reported to successfully relieve radicular pain in 83.5%of patients by Zhenbo et al. Little information is available concerning the efficacy and outcome ofpercutaneous fluoroscopic synovial cyst rupture for treatment of facet joint synovial cysts.Objective: The goal of this investigation was to assess the efficacy of fluoroscopically guidedlumbar synovial cyst rupture, in particular for its relief of radicular symptoms and its potential toreduce the need for surgical intervention.Study Design: Retrospective evaluation of a case series.Setting: University hospital and urban public health care system.Methods: With approval from the Institutional Review Board of Case Western Reserve University/MetroHealth Medical Center, we reviewed the medical charts of patients with lumbar radiculopathywho underwent percutaneous lumbar synovial cyst rupture. The 30 patients in the cohort weretreated by one pain specialist between 2006 and 2013. These patients were diagnosed withmoderate to severe lower back pain, radiculopathy, and ranged in age from 42 to 80 years. Patientswere followed up for a minimum of 6 months and up to 24 months. Pre- and post-procedure painassessments were reviewed by clinical chart review. In addition post-procedure pain assessmentsand duration of pain relief were obtained with telephone interviews. Pain had been reported by thepatients using a numeric rating scale of 0 – 10 (0 = no pain; 10 = worst possible pain). Charts werereviewed to determine if surgery was eventually performed to correct radicular symptoms.Results: More than 6 months of pain relief was achieved in 14/30 patients (46%) and betweenone and 6 months of pain relief was achieved in 7/30 patients (23.3%). Nine patients (30.0%) hadrecurrence of the synovial cyst requiring repeat rupture and 6 patients (20.0%) required surgicalintervention for cyst removal. A Wilcoxon signed-rank test demonstrated that the difference innumeric pain rating scale scores before and after the procedure was statistically significant (P <0.0001). The average pain reduction was 71.2%. No complications were reported.Limitations: The results are limited by the retrospective nature of the data collection and the lackof detailed information regarding patients’ functional improvement.Conclusions: Rupture of percutaneous lumbar synovial cysts in patients with lumbar radiculopathywas associated with immediate relief of radicular symptoms. In 80% of the patients, synovial cyst ruptureeliminated the need for surgical interventions over the measured term. This minimally invasive procedurehelps relieve pain in a subset of a patient population associated with these characteristics and is useful formanagement of this condition. Cyst expansion and failure to rupture with possible neuronal compressionare the potential complications of this procedure. This complication did not occur in the study population.Key words: Fluoroscopically guided lumbar synovial cyst rupture, lumbar synovial cyst, lumbarzygapophyseal joint cyst, nonsurgical intervention, radiculopathy, spondylosis