RT Journal Article
SR Electronic
T1 P217 New approach for percutaneous resolution of an intracal facet synovial cyst
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP A217
OP A218
DO 10.1136/rapm-2024-ESRA.314
VO 49
IS Suppl 1
A1 Schuitemaker Requena, Juan Bernardo
A1 Mansilla Gervilla, Gonzalo
A1 Fortuny Conrado, Albert
A1 Rivero Novoa, Eloymar
A1 Daniel Moreno, Roger
A1 Vargas Raidi, Veronica Margarita
A1 Sorribes Alcaraz, Vicente
A1 Cohen Sanchez, Arturo
YR 2024
UL http://rapm.bmj.com/content/49/Suppl_1/A217.2.abstract
AB 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 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