Fluoroscopically guided aspiration of a symptomatic lumbar zygapophyseal joint cyst: A case report

Gregory E. Lutz and Timothy C. Shen

The Archives of Physical Medicine and Rehabilitation

Volume 83, Issue 12, Pages 1789-1791

New York surgeons Gregory Lutz and Timothy Shen have highlighted the interesting case of a patient with severe low back pain caused by a Facet (Zygoapophyseal) joint cyst. The patient was a female in her forties - the most common group affected by this condition. She had a four month history of low back pain, which referred down her right leg and was made worse by standing.

An MRI scan showed a Pars fracture (Spondylolysthesis) of the L4-L5 region, as well as a Synovial cyst at the L4-L5 Facet joint - these cysts are commonly associated with Facet joint degeneration. The authors' treatment consisted of local anaesthetic injection followed by aspiration of the Facet joint cyst using a fine gauge needle. This intricate procedure was done under 'flouroscopy' (moving x-ray) guidance to ensure the needle got to the precise location of the cyst. The patient was followed up one month later and reported being completely pain free.

Lutz and Shen stated that corticosteroid injections into the Facet joint may also be effective in resolving this pain, and should be attempted before more invasive procedures such as laminectomy (surgical removal of the Lamina of the vertebra) are undertaken.

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