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Kwon, Kwon, Lee, and Kim: Short-Term Outcome of Fluoroscopic-Guided Steroid Injection Therapy of Lumbar Facet Cyst-Induced Radicular Pain
Musculoskeletal Radiology

Journal of the Korean Society of Radiology 2015; 72(4): 263-270.

Published online: 2 April 2015

DOI: https://doi.org/10.3348/jksr.2015.72.4.263

Short-Term Outcome of Fluoroscopic-Guided Steroid Injection Therapy of Lumbar Facet Cyst-Induced Radicular Pain

Mi-ri Kwon, MD1, Jong Won Kwon, MD1, Jong Seo Lee, MD2, Eun-Sang Kim, MD3

1Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

3Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author: Jong Won Kwon, MD. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel. 82-2-3410-2568, Fax. 82-2-3410-0049, jwjwkwon@gmail.com

Received 16 September 2014       Accepted 29 January 2015

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the short-term effect of fluoroscopic-guided steroid injection therapy of lumbar facet cyst-induced radicular pain.

Materials and Methods

Seventeen patients with radiculopathy due to lumbar synovial cysts, who were treated with fluoroscopically guided injection, were retrospectively evaluated. All plain radiographic images and MR images before the therapy were reviewed. Five patients underwent only the facet joint injection, whereas twelve patients underwent the facet joint injection with perineural injection therapy. The clinical course of pain was evaluated on the first follow-up after therapy.

Results

Effective pain relief was achieved in 11 (64.7%) of the 17 patients. Among 12 patients who underwent facet joint injection with perineural injection, 9 patients (75%) had an effective pain relief. Of 5 patients, 2 (40%) patients only took the facet joint injection and had an effective pain relief.

Conclusion

Fluoroscopic-guided steroid injection therapy shows a good short-term effect in patients with symptomatic lumbar facet joint synovial cysts.

Keywords: Facet Joint, Steroid Injection, Fluoroscopy, Synovial Cyst

Figures and Tables

Fig. 1

A 63-year-old female with synovial cyst presenting radiating pain of right lower extremity.

A. T2-weighted axial MR image shows a 6.3 mm-sized synovial cyst anterior to the right L4-5 facet joint. The synovial cyst shows high signal intensity surrounded by hypointense wall. The synovial cyst and bulging disc lead to central canal stenosis.
B. Contrast agent has been injected into the interfacetal portion of the right L4-5 facet joint shown in left anterior oblique fluoroscopic image.
C. Anteroposterior facet joint arthrogram shows that the injection penetrated a facet joint synovial cyst (arrow), filling it completely.
D. The synovial cyst was ruptured after normal saline injection. Lateral fluoroscopic image shows extravasation of contrast media in the anterior epidural space (arrowheads).
E. Perineural injection was done through right-sided L5 transforaminal approach. Anteroposterior fluoroscopic image of right-sided L5 perineural steroid injection shows medial spread of contrast agent into the epidural space. Two weeks later, the patient had much reduced pain without any discomfort on the lower extremities.
jksr-72-263-g001
Fig. 2

A 47-year-old female with synovial cyst presenting right leg pain and low back pain.

A. T2-weighted axial MR image obtained at the L4-5 level shows a 5 mm-sized hyperintense synovial cyst surrounded by well-demarcated hypointense wall.
B. Axial MR image obtained below the A shows hyperintense effusion in both L4-5 facet joints.
C. After injecting contrast media through right L4-5 facet joint, anteroposterior fluoroscopic image shows the synovial cyst filled with contrast media.
D. The lateral facet joint arthrogram shows the synovial cyst ventrally protruding (arrow). Additional normal saline was injected into the cyst about 3 mL, but the cyst was not ruptured. While epidural leakage of the contrast agent is seen (arrowheads), the cyst has not collapsed. Four weeks after injection, her symptom was much improved, with mild residual discomfort on right lower extremity.
jksr-72-263-g002
Table 1

Descriptive Characteristics of Patients with Lumbar Facet Joint Synovial Cyst

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Parameters No.
Number of patients 17
Facet cyst location (%)
 Right 6 (35.3)
 Left 11 (64.7)
Spinal level of cyst (%)
 L3-4 3 (17.6)
 L4-5 13 (76.5)
 L5-S1 1 (5.9)
MRI signal of cyst (%)
 High 15 (88.2)
 Low 2 (11.8)
Direction of cyst (%)
 Anterior 6 (35.3)
 Anteromedial 7 (41.2)
 Medial 4 (23.5)
Combined osteophytes (%) 15 (88.2)
Combined joint effusion (%) 8 (47.1)
Injection type
 Facet injection only 5
 Facet + perineal injection 12
Cyst rupture (%)
 Success 10 (58.8)
 Failure 7 (41.2)
Short-term results (%)
 No pain 5 (29.4)
 Moderate improvement 6 (35.3)
 Mild improvement 2 (11.8)
 No improvement 3 (17.6)
 Aggravation 1 (5.9)
Table 2

Treatment Outcome of Percutaneous Injection Treatment

jksr-72-263-i002
No Effect (%) Effect (%) p*
Procedures Facet injection only 3 (60) 2 (40) 0.280
Facet and perineural injection 3 (25) 9 (75)
Cyst Not ruptured 3 (42.9) 4 (57.1) 0.644
Ruptured 3 (30) 7 (70)

Note.-*Analyzed by Fisher's exact test

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