Departments of Orthopaedic Surgery.
Radiology, University of Virginia, Charlottesville, VA.
Clin Spine Surg. 2021 Aug 1;34(7):E410-E414. doi: 10.1097/BSD.0000000000001146.
Retrospective case series at a single academic medical center.
The aim was to determine if specific clinical, radiologic, and procedural factors are associated with conversion to surgery after fluoroscopically guided cyst rupture.
Percutaneous fluoroscopic rupture of facet cysts can often be the definitive treatment; however, it is unknown before the procedure who will ultimately proceed to formal surgical decompression. Differences in clinical, radiographic, and procedural factors of facet cysts may relate to the difference in efficacy of fluoroscopically guided cyst rupture.
A continuous cohort of 45 patients who underwent fluoroscopically guided cyst rupture was evaluated. The primary outcome measured rate of conversion to surgery and of those that underwent surgery, the rate of decompression and fusion compared with fusion alone was noted. Secondary outcomes included analysis of clinical, radiologic, and procedural variables to determine if there were risk factors associated with conversion to surgery.
Twenty-nine percent of patients eventually underwent a surgical procedure with an average interval to surgery of 95 days after attempted rupture. Thirty-eight percent of patients that underwent surgery had a decompression and fusion. Failure of percutaneous cyst rupture trended toward significance for a future surgical decompression (P=0.08).
Percutaneous facet cyst rupture is potentially a definitive treatment for this condition; however, it is unknown ahead of time who will proceed to definitive surgical decompression. On the basis of the data in this study, less than one-third of patients who had a fluoroscopically guided facet cyst rupture went on to surgery. There were no clinical, radiographic, or procedural details which could be used to robustly predict failure of percutaneous treatment. At this time, it is recommended to continue to attempt this nonoperative treatment intervention when there is a clinical indication after discussion of the risks and benefits with the patient.
单家学术医疗中心的回顾性病例系列。
目的是确定在荧光引导下囊肿破裂后转为手术的特定临床、影像学和程序因素是否相关。
经皮荧光引导下关节突囊肿破裂通常可以作为明确的治疗方法；然而，在手术前并不知道哪些患者最终需要进行正式的减压手术。关节突囊肿的临床、影像学和程序因素的差异可能与荧光引导下囊肿破裂的疗效差异有关。
评估了 45 例接受荧光引导下囊肿破裂的连续队列患者。主要结局指标是手术转化率，以及那些接受手术的患者中，减压融合与单纯融合的比率。次要结局包括对临床、影像学和程序变量的分析，以确定是否存在与手术转化率相关的危险因素。
29%的患者最终接受了手术治疗，平均在尝试破裂后 95 天进行手术。38%接受手术的患者进行了减压融合。经皮囊肿破裂失败与未来手术减压有趋势相关（P=0.08）。
经皮关节突囊肿破裂可能是这种疾病的一种明确治疗方法；然而，在手术前并不知道哪些患者会进行明确的减压手术。基于本研究的数据，不到三分之一的接受荧光引导下关节突囊肿破裂的患者进行了手术。没有临床、影像学或程序细节可以用来可靠地预测经皮治疗的失败。目前，在与患者讨论了风险和收益后，如果有临床指征，建议继续尝试这种非手术治疗干预。
