학술논문
Effectiveness and Safety of CT-Guided Facet Joint Cyst Rupture for Radicular Pain as First Choice Therapy: A Retrospective Analysis
Original Research Article
Original Research Article
Document Type
Report
Author
Source
Pain Medicine. February 2023, Vol. 24 Issue 2, p158, 7 p.
Subject
Language
English
ISSN
1526-2375
Abstract
Introduction A facet joint cyst of the spine is associated with benign degenerative processes of the zygapophyseal joint and has been recognized as a cause of neurological symptoms [1]. Radicular [...]
Objective. 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. Design. Retrospective data set analysis. Setting. University hospital. Subjects. One hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included. Methods. 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. Results. 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. Conclusions. 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. Key Words: Back Pain; Cyst of the Facet Joint; CT-Guided Rupture; Effectiveness; Safety
Objective. 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. Design. Retrospective data set analysis. Setting. University hospital. Subjects. One hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included. Methods. 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. Results. 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. Conclusions. 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. Key Words: Back Pain; Cyst of the Facet Joint; CT-Guided Rupture; Effectiveness; Safety