Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Skeletal Radiol. 2024 Jun;53(6):1135-1144. doi: 10.1007/s00256-023-04544-9. Epub 2023 Dec 14.
To evaluate success rates of computed tomography (CT)-guided lumbar facet synovial cyst (LFC) rupture.
We retrospectively reviewed all LFC ruptures performed by a single musculoskeletal radiologist with > 10 years of experience, using posterior facet approach and/or direct puncture by ipsilateral/contralateral interlaminar, or transforaminal approach. All patients also received a corticosteroid injection. Rupture rates were calculated, and clinical success rate was determined through medical record review. Pre-procedure magnetic resonance imaging (MRI) images and CT procedure images were also reviewed for LFC and facet joint imaging features that may predict rupture.
There were 37 patients, 17 (46%) female and 20 (54%) male, ages 62 ± 12 (range 39-87) years. Thirty-four (92%) of LFC were successfully ruptured, 17 (50%) by facet approach and 17 (50%) by direct cyst puncture. At least one direct puncture approach was possible in 35 (95%) patients. No MRI or CT LFC or facet joint features predicted cyst rupture. Thirty-one (91%) of patients reported immediate pain relief, and 19 (53%) did not have further intervention for LFC-related pain. Sixteen (84%) of these patients remained pain-free for an average follow-up time period of 28 months. Fourteen (39%) of patients required surgical intervention. There were no complications.
Our systematic approach to CT-guided LFC rupture is safe and has high technical and clinical success rates similar to prior studies. Since there are no definitive imaging features that determine rupture success, this procedure can almost always be attempted as a first-line treatment for LFC.
评估计算机断层扫描（CT）引导下腰椎小关节滑膜囊肿（LFC）破裂的成功率。
我们回顾性分析了一位拥有超过 10 年经验的肌肉骨骼放射科医生进行的所有 LFC 破裂病例，使用后关节突入路和/或同侧/对侧关节突间或经椎间孔直接穿刺。所有患者均接受皮质类固醇注射。通过病历回顾计算破裂率，并确定临床成功率。还回顾了术前磁共振成像（MRI）图像和 CT 程序图像，以寻找可能预测破裂的 LFC 和小关节成像特征。
共有 37 例患者，17 例（46%）为女性，20 例（54%）为男性，年龄 62±12 岁（范围 39-87 岁）。34 例（92%）LFC 破裂成功，17 例（50%）通过关节突入路，17 例（50%）通过直接囊肿穿刺。35 例（95%）患者至少有一种直接穿刺方法可行。MRI 或 CT 上 LFC 或小关节的特征均不能预测囊肿破裂。31 例（91%）患者立即感到疼痛缓解，19 例（53%）患者无需进一步干预 LFC 相关疼痛。16 例（84%）患者在平均 28 个月的随访时间内保持无痛。14 例（39%）患者需要手术干预。无并发症发生。
我们采用 CT 引导下 LFC 破裂的系统方法安全有效，技术和临床成功率均较高，与既往研究相似。由于没有确定的影像学特征来确定破裂的成功率，因此该方法几乎可以作为 LFC 的一线治疗方法。
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