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Research ArticleSpine Imaging and Spine Image-Guided Interventions

Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts

V.N. Shah, N.D. von Fischer, C.T. Chin, E.L. Yuh, M.R. Amans, W.P. Dillon and C.P. Hess
American Journal of Neuroradiology November 2017, DOI: https://doi.org/10.3174/ajnr.A5428
V.N. Shah
aFrom the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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N.D. von Fischer
aFrom the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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  • ORCID record for N.D. von Fischer
C.T. Chin
aFrom the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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E.L. Yuh
aFrom the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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M.R. Amans
aFrom the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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W.P. Dillon
aFrom the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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C.P. Hess
aFrom the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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  • Fig 1.
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    Fig 1.

    Successful CT-guided cyst puncture, aspiration, and fenestration. A, Axial T2-weighted MR image demonstrates bilateral L4–5 facet synovitis and a thin-rimmed T2-hyperintense cyst arising from the left L4–5 facet joint. B, Intraprocedural CT image shows contrast opacification of the cyst via injection into a 22-ga spinal needle placed within the left L4–5 facet joint (step 1). A second 22-ga spinal needle has been advanced coaxially into the cyst via a translaminar approach (step 2). C, CT image obtained after cyst aspiration and repeat fenestration demonstrates successful cyst perforation with leakage of contrast into the epidural space (arrow, step 3). D, Follow-up MR imaging shows resolution of the treated cyst.

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    Fig 2.

    Calcified synovial cysts. A, Axial T2-weighted MR image shows severe bilateral L5–S1 facet arthrosis with thick-rimmed facet cysts (arrows), which result in severe lateral recess narrowing on the right and indentation of the thecal sac on the left. B, Axial CT image shows peripheral calcification of both cysts (arrows). Direct cyst puncture and fenestration were not performed in this patient, who instead underwent CT-guided facet injections and nerve blocks and ultimately required an operation.

Tables

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    Table 1:

    Demographic data

    RespondersNonrespondersP Value
    Age (mean) (yr)61.5 (11.4)59.3 (8.4).65a
    Sex (No.) (%).34b
        Male21 (36)1 (17)
        Female37 (64)5 (83)
    Presenting symptoms (No.) (%).58b
        Radiculopathy27 (47)2 (33)
        Axial back pain4 (6)0 (0)
        Both27 (47)4 (67)
    • ↵a P value based on the 2-sample t test of the difference between means.

    • ↵b P value based on a χ2 test of the difference in proportions.

    • View popup
    Table 2:

    Differences in imaging characteristics of cysts between responders and nonresponders

    RespondersNonrespondersP Value
    LFSC size (mean) (SD) (mm)10.1 (3.7)9.3 (2.5).62a
    Cyst level (No.) (%).66b
        L1–L21 (2)0 (0)
        L2–L33 (5)1 (17)
        L3–L46 (10)1 (17)
        L4–L535 (60)2 (33)
        L5–S113 (22)2 (33)
    MRI central canal stenosis (No.) (%).70b
        None19 (33)2 (33)
        Mild9 (15)0 (0)
        Moderate11 (19)1 (17)
        Severe19 (33)3 (50)
    MRI signal intensity (No.) (%).011b
        High T2 with a thin rim39 (72)1 (17)
        High T2 with a thick rim13 (24)5 (83)
        Low T22 (4)0 (0)
    CT characteristics (No.) (%).027b
        Calcified14 (24)4 (67)
        Not calcified44 (76)2 (33)
    • ↵a P value based on the 2-sample t test of the difference between means.

    • ↵b P value based on a χ2 test of the difference in proportions.

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    Table 3:

    Differences in imaging characteristics of cysts between patients who required surgery and those who did not at long-term follow-up

    SurgeryNo SurgeryP Value
    LFSC size (mean) (SD) (mm)10.5 (3.9)9.5 (3.3).32a
    MRI signal intensity (No.) (%).07b
        High T2 with a thin rim11 (48)24 (78)
        High T2 with a thick rim11 (48)6 (19)
        Low T21 (4)1 (3)
    CT characteristics (No.) (%).003b
        Calcified12 (48)4 (12)
        Not calcified13 (52)28 (88)
    • ↵a P value based on the 2-sample t test of the difference between means.

    • ↵b P value based on a χ2 test of the difference in proportions.

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V.N. Shah, N.D. von Fischer, C.T. Chin, E.L. Yuh, M.R. Amans, W.P. Dillon, C.P. Hess
Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts
American Journal of Neuroradiology Nov 2017, DOI: 10.3174/ajnr.A5428

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Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts
V.N. Shah, N.D. von Fischer, C.T. Chin, E.L. Yuh, M.R. Amans, W.P. Dillon, C.P. Hess
American Journal of Neuroradiology Nov 2017, DOI: 10.3174/ajnr.A5428
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