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21KF-021
Non-Surgical Management : Percutaneous Aspiration of Lumbar Facet Joint Cyst With Radiculopathy of Lower Extremity
Jiyong Lee1, Youngkwon Ko1, 2, Chan Noh1, 2, SunYeul Lee1, 2, Young Sup Shin1, 2, Won Hyung Lee1, 2
Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital1
Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University2
INTRODUCTION
Facet joint cyst of the lumbar spine are uncommon intraspinal abnormalities thought to be secondary to degenerative changes of the joints. They can cause chronic back pain, radiculopathy, and symptoms of spinal stenosis. We report a case of aspiration of a lumbar facet joint cyst resulting in marked improvement in symptoms.
CASE
A 59-year-old female patient visited our clinic complaining of right pelvic pain and radiation pain in the right lower extremity that had occurred 3 weeks before admission. Lumbar sympathetic ganglion block (LSGB) and L3/4 selective transforaminal epidural block (STE) were perfomed at a local hospital before admission to our clinic, but there was no improvement in symptoms. L5 STE was performed, pregabalin 25mg and aceclofenac 100mg twice a day prescribed, and lumbar spine magnetic resonance imaging (MRI) were planned, and an outpatient appointment was made 3 weeks later. After 3 weeks, the patient showed no improvement in symptoms, and MRI showed a suspicious prominent osteophyte of right facet joint at L3/4 with moderate central canal stenosis and right L4 nerve root compression. The angle of the facet joint and midline was confirmed through MRI. After setting the angle of the C-arm to 36 degrees, the chiba needle was used to enter the facet joint space. Aspiration was attempted with a syringe through the facet joint, and about 0.3cc of cystic fluid was aspirated. Afterwards, local anesthetics and steroids were injected into the joint space and the procedure was completed. Two weeks later after the procedure, the patient confirmed that the pain was significantly relieved than before. There were no MRI images taken after procedure because the symptoms were relieved.
CONCLUSION
In patients with the above symptoms, we have to differentiate for various diseases. Herniated nucleus pulposus(HNP), neurofibroma, hematoma and meningioma may also show similar symptoms and can be confirmed by MRI or CT. The facet joint cyst shows an extradural defect the posterior side of the nerve root, and HNP shows a defect the anterior side of the nerve root. For our patient, percutaneous aspiration performed by using the technique describe earlier was successful in reducing her symptoms. We think that percutaneous aspiration of symptomatic lumbar facet joint cysts should be considered as a treatment option before surgical intervention.