Synovial Cyst Direct Puncture, Overpressurization, and Rupture Under Fluoroscopy

Synovial cysts are common causes of lumbar neural encroachment that can be treated with image-guided needle aspiration/rupture or surgical resection [1, 2]. Percutaneous aspiration/rupture can provide immediate and short-term relief, though surgery is more definitive and enduring [1, 2]. These image...

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Bibliographic Details
Published in:Pain medicine (Malden, Mass.) Mass.), 2019-03, Vol.20 (3), p.575-577
Main Authors: Kim, Dong Kun, McKenzie, Gavin A
Format: Article
Language:English
Subjects:
Care and treatment
Case reports
Causes of
Cysts
Fluoroscopy
Ganglion
Hypodermic needles
Medical imaging
Pain management
Radiculopathy
Spinal diseases
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Summary:Synovial cysts are common causes of lumbar neural encroachment that can be treated with image-guided needle aspiration/rupture or surgical resection [1, 2]. Percutaneous aspiration/rupture can provide immediate and short-term relief, though surgery is more definitive and enduring [1, 2]. These images are from a 78-year-old male who presented with acute, chronic right L5 distribution numbness and pain. Lumbar spine magnetic resonance imaging demonstrated a right L5-S1 intraspinal synovial cyst displacing the foraminal right L5 nerve root (Figure 1). Using fluoroscopy, the proceduralist transforaminally blocked the L5 nerve to minimize intraprocedural discomfort, then overpressurized and ruptured the cyst (Figure 2). The patient reported immediate relief of pain with ongoing relief seven months later.
ISSN:1526-2375
1526-4637
DOI:10.1093/pm/pny264