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Poster displayed – Chronic pain management
P217 New approach for percutaneous resolution of an intracal facet synovial cyst
  1. Juan Bernardo Schuitemaker Requena1,2,
  2. Gonzalo Mansilla Gervilla1,3,
  3. Albert Fortuny Conrado1,4,
  4. Eloymar Rivero Novoa5,
  5. Roger Daniel Moreno6,
  6. Veronica Margarita Vargas Raidi7,
  7. Vicente Sorribes Alcaraz8 and
  8. Arturo Cohen Sanchez9,10
  1. 1Pain Medicine, Grup Creu Groga, Calella de Mar, Spain
  2. 2Pain Medicine, IMECBA, Instituto de Medicina y Cirugía Barcelona, Barcelona, Spain
  3. 3Anesthesia and Pain Medicine, Centre Hospitalari de Manresa - Fundació Althaia, Barcelona, Spain
  4. 4Anesthesia and Pain Medicine, Fundació Sanitaria Mollet, Mollet del Vallès, Spain
  5. 5Anesthesia and Pain Medicine, Servicio de Anestesiología Centro Médico Teknon, ANESTALIA, Barcelona, Spain
  6. 6Anesthesia and Pain Medicine, Hospital Universitari Valle de Hebrón, Barcelona, Spain
  7. 7Anesthesia and Pain Medicine, Consorci Sanitari del Maresme. Hospital de Mataró, Mataró, Spain
  8. 8Anesthesia and Pain Medicine, Consorci Sanitari de Terrassa, Terrassa, Spain
  9. 9Aesthetic Medicine, IMECBA, Instituto de Medicina y Cirugía Barcelona, Barcelona, Spain
  10. 10Aesthetic Medicine, Clínica Brasó, Sant Cugat del Vallès, Spain

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims 67-year-old man with acute clinically severe right L5 breakthrough radiculalgia, which improves with axial loads and worsens in decubitus.In MRI a L5-S1 space synovial cyst 8 mm, originating in the right facet joint that contacts and displaces the roots of the cauda equina (Fig. 1).We perform an interventional approach to the cyst with a percutaneous right L5 - S1 zygapophyseal transarticular approach with Quincke 22Gx90 mm needle.Needle advancement is performed with tunnel vision in a 30° oblique projection until its impossible to progress the needle any deeper.As it is not possible to enter the light of the cyst, filed hydrodissection was attempted, thus it is decided to approach the cyst with a needle guide of the same diameter but 150mm in length.

Methods The guide was progressed in lateral projection until the light of the cyst, the guide was removed and contrast placed through the needle. Once passage was seen through the contrast to the right L5 foramen, without evidence of cystic image, the needle was removed. patient sent to recovery room . After the procedure the symptoms disapeared from the radicular point of view, and in 14 months of follow-up, he remained asymptomatic.

Conclusions Facet cyst can develop from arthritic facet joint, the one located intracanal and make contact with a nerve root, may produce radicular clinic 1,2.We present this case with a technique, which to the best of our knowledge, has not been described before,an interventional approach, minimally invasive saving the patient from undergoing spinal surgery. 1ShahRV,et al.SpineJ2003;3:479-88;2Wilby MJ,etal.Spine(PhilaPa1976)2009;34:2518-24;3ChazenJL,et al.ClinImaging2018;49:7-11.

Abstract P217 Figure 1
Abstract P217 Figure 1

Left, axial T2 view showing a right L5 synovial cyst displacing the ipsilateral root and contacting the descending roots of the cauda equina. Right: sagittal STIR image showing a cyst in the canal

  • Chronic pain
  • neuropathic pain
  • nerve injury
  • facet synovial cyst
  • radicular pain

https://doi.org/10.1136/rapm-2024-ESRA.314

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