Yang Allison Y, Hutchins Troy A, Shah Lubdha M, Woods Lacey, Safazadeh Ghazaleh, Winegar Blair A, Hudson Anna, Peckham Miriam E
Department of Radiology and Imaging Sciences, Indiana University, United States.
Departments of Radiology and Imaging Sciences University of Utah Health Sciences Center, United States.
Interv Pain Med. 2024 Nov 15;3(4):100447. doi: 10.1016/j.inpm.2024.100447. eCollection 2024 Dec.
Facet synovial cysts (FSCs) are benign, extradural outpouchings arising from the facet joint that can cause radiculopathy. Effectiveness of CT-guided indirect percutaneous cyst rupture (IPCR) alone and direct fenestration (DF) treatment alone have previously been reported in large cohorts. We performed a retrospective review of all FSCs treated under CT-guidance at a single institution where patients underwent IPCR, and IPCR followed by DF if necessary. We hypothesized that CT-guided FSC rupture would demonstrate similar effectiveness to previously reported fluoroscopic-guided methods, with potential improvement due to the opportunity to employ the DF technique in cases of IPCR failure.
A search was conducted of all CT-guided FSC rupture procedures over 10 years. Data included demographics, needle gauge used for IPCR and DF, rupture success, cyst size and T2 intensity, presence of spinal hardware, and cyst location. Subsequent surgery at the level of the cyst was documented.
90 FSC rupture attempts were performed on 75 patients (28 M/47 F). FSC rupture using IPCR had a 70.0% success rate. In 22 FSC rupture attempts, IPCR failed and was followed by DF, with a success rate of combined IPCR + DF of 90.6 %. Subsequent surgery was required for 36.0% of patients involving the same level as the cyst or cysts.
Rates of successful FSC rupture under CT-guidance increased when the indirect rupture technique could be followed by direct fenestration in cases of failure. Our findings emphasize the benefits of flexibility afforded to the operator with CT-guidance.
小关节滑膜囊肿（FSCs）是起源于小关节的良性硬膜外袋状膨出，可导致神经根病。此前已有大型队列研究报道了单纯CT引导下间接经皮囊肿破裂（IPCR）和单纯直接开窗术（DF）治疗的有效性。我们对在单一机构接受CT引导治疗的所有FSCs患者进行了回顾性研究，这些患者接受了IPCR治疗，必要时接受IPCR后再行DF治疗。我们假设CT引导下的FSC破裂与先前报道的透视引导方法具有相似的有效性，并且由于在IPCR失败的情况下有机会采用DF技术，可能会有更好的效果。
对10年来所有CT引导下的FSC破裂手术进行了检索。数据包括人口统计学资料、IPCR和DF所用的针号、破裂成功率、囊肿大小和T2信号强度、脊柱内固定物的存在情况以及囊肿位置。记录了囊肿水平的后续手术情况。
对75例患者（28例男性/47例女性）进行了90次FSC破裂尝试。IPCR治疗FSC破裂的成功率为70.0%。在22次FSC破裂尝试中，IPCR失败，随后进行了DF，IPCR + DF联合成功率为90.6%。36.0%的患者需要在与囊肿相同水平进行后续手术。
在CT引导下，当间接破裂技术失败后可进行直接开窗术时，FSC破裂成功率会提高。我们的研究结果强调了CT引导为操作者提供的灵活性的益处。
