Department of Orthopedics, New England Baptist Hospital, Boston, MA 02120, USA.
Spine J. 2009 Nov;9(11):899-904. doi: 10.1016/j.spinee.2009.06.010. Epub 2009 Aug 6.
Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine. Previous reports have supported operative and nonoperative management. Facet joint steroid injection with cyst rupture is occasionally performed, but there has been no systematic evaluation of this treatment option.
To profile the role of facet joint steroid injections with cyst rupture in the treatment of lumbar facet joint synovial cysts.
STUDY DESIGN/SETTING: Retrospective chart review and long-term follow-up of patients treated for lumbar facet joint synovial cysts.
One hundred one patients treated for lumbar facet joint synovial cysts with fluoroscopically guided corticosteroid facet joint injection and attempted cyst rupture.
Oswestry Disability Index and numeric rating scale score for back and leg pain.
A retrospective review and a subsequent interview were conducted to collect pretreatment and posttreatment pain and disability scores along with details of subsequent treatment interventions. Group differences in pain and disability scores were assessed using paired t test. Multiple clinical factors were analyzed in terms of risk for surgical intervention using logistic regression modeling and Cox proportional hazards modeling.
Successful cyst rupture was confirmed fluoroscopically in 81% of cases. Fifty-five patients (54%) required subsequent surgery over a period averaging 8.4 months because of inadequate symptom relief. All patients reported significant improvement in back pain, leg pain, and disability at 3.2 years postinjection, regardless of their subsequent treatment course (p<.0001 in all groups). There was no significant difference in current pain between patients who received injections only and those who underwent subsequent surgery.
This study presents the largest clinical series of nonsurgical treatment for lumbar facet joint synovial cysts. Lumbar facet joint steroid injection with attempted cyst rupture is correlated with avoiding subsequent surgery in half of treated patients. Successful cyst rupture does not appear to have added benefit, and it was associated with worse disability 3 years postinjection. Long-term outcomes are similar, regardless of subsequent surgery.
腰椎小关节滑膜囊肿是腰椎的良性退行性病变。之前的报告支持手术和非手术治疗。偶尔会进行小关节类固醇注射伴囊肿破裂，但这种治疗选择尚未进行系统评估。
分析经皮腰椎小关节类固醇注射伴囊肿破裂治疗腰椎小关节滑膜囊肿的作用。
研究设计/设置：对接受经皮腰椎小关节滑膜囊肿治疗的患者进行回顾性图表审查和长期随访。
101 例经皮腰椎小关节滑膜囊肿患者，行荧光透视引导下皮质类固醇小关节注射并尝试囊肿破裂。
腰痛和腿痛的 Oswestry 残疾指数和数字评分量表评分。
回顾性分析和随后的访谈，收集治疗前后的疼痛和残疾评分以及后续治疗干预的详细信息。使用配对 t 检验评估疼痛和残疾评分的组间差异。使用逻辑回归模型和 Cox 比例风险模型分析多种临床因素与手术干预的风险。
81%的病例在荧光透视下确认囊肿破裂成功。55 例（54%）患者因症状缓解不足，平均 8.4 个月后需要进行后续手术。所有患者在注射后 3.2 年报告腰痛、腿痛和残疾显著改善（所有组均<.0001）。接受注射治疗和接受后续手术的患者的当前疼痛无显著差异。
本研究报告了非手术治疗腰椎小关节滑膜囊肿的最大临床系列。腰椎小关节类固醇注射伴囊肿破裂尝试与避免半数接受治疗的患者接受后续手术相关。成功的囊肿破裂似乎没有额外的益处，并且与注射后 3 年的残疾更严重相关。无论是否进行后续手术，长期结果都相似。
