Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.
Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany.
Pain Med. 2023 Feb 1;24(2):158-164. doi: 10.1093/pm/pnac116.
To evaluate effectiveness and safety of computed tomography (CT)-guided cyst rupture with intraarticular contrast-enhanced injection of steroid and local anesthetic as first choice therapy in patients with facet joint cyst-induced radicular pain.
Retrospective data set analysis.
University hospital.
One hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included.
The rate of patients without following surgery was assessed and defined as surrogate to measure effectiveness. Patients' characteristics, procedure-associated complications, technical aspects, and imaging findings on magnetic resonance imaging (MRI) were analyzed. A subgroup of 65 patients (54%) underwent telephone interview to assess pain relief and clinical outcome measured by Numeric Rating Scale and Oswestry Disability Index. Analyses between the groups with and without surgery were performed by Fisher exact test and two-sample unpaired t-test, respectively.
The effectiveness of CT-guided cyst rupture was found to be 66.1%. Procedure-induced pain yielded in premature abort in two cases (1.7%). The detection of epidural contrast agent was statistically significantly associated with no need for surgery (P = .010). The cyst level was associated with the status of following surgery (P = .026), that is, cysts at lower lumbar spine were easier to rupture than cysts at other locations (cervical, thoracic, or upper lumbar spine). No further significant association was found.
CT-guided cyst rupture as the first-choice therapy in patients with cyst-induced radicular pain was safe and effective. Successful cyst rupture was associated with no need for surgery. Cysts at lower lumbar spine revealed the highest success rate.
评估 CT 引导下关节内对比增强注射类固醇和局部麻醉剂以破裂关节囊囊肿作为治疗神经根性疼痛的首选方法的有效性和安全性。
回顾性数据集分析。
大学医院。
共纳入 121 例神经根性疼痛归因于关节囊囊肿的患者。
评估无需手术的患者比例，并将其定义为衡量有效性的替代指标。分析患者特征、与操作相关的并发症、技术方面以及磁共振成像（MRI）的影像学发现。对 65 例（54%）患者进行电话随访，以评估疼痛缓解情况和通过数字评分量表和 Oswestry 残疾指数测量的临床结果。采用 Fisher 确切检验和两样本配对 t 检验分别对手术组和非手术组进行分析。
CT 引导下关节囊囊肿破裂的有效率为 66.1%。在 2 例（1.7%）患者中，因操作引起的疼痛导致手术提前终止。硬膜外造影剂的检出与无需手术显著相关（P=0.010）。囊肿水平与是否需要手术相关（P=0.026），即下腰椎的囊肿比其他部位（颈椎、胸椎或胸腰段）的囊肿更容易破裂。未发现其他显著相关性。
作为神经根性疼痛患者的首选治疗方法，CT 引导下关节囊囊肿破裂是安全有效的。成功破裂囊肿与无需手术相关。下腰椎的囊肿显示出最高的成功率。
