Percutaneous puncture of zygapophysial joint synovial cyst with fluoroscopic guidance.
OBJECTIVE
To introduce a minimally invasive, percutaneous fluoroscopic technique for treating symptomatic zygapophysial joint (z-joint) synovial cysts.


METHODS
Chart review to describe the clinical presentation, representative imaging, technical procedural details, and follow-up of a 72-year-old female with a symptomatic lumbar z-joint synovial cyst.


RESULTS
Before the cyst puncture, the patient failed conservative care including transforaminal epidural and intra-articular z-joint injections. Immediately after the puncture, and at 4-month follow-up, the patient was free of left lower extremity radicular pain. Computed tomography at 4 months post puncture showed resolution of the cyst. There was no recurrence of left leg pain at 30-month follow-up.


CONCLUSIONS
This technical case report illustrates that puncture of an intraspinal z-joint synovial cyst using an interlaminar approach with fluoroscopic guidance may be safely performed with effective relief of radicular symptoms.
Melfi
Renée S
RS
Magnolia Diagnostics, New Orleans, Louisiana 70115, USA.
Aprill
Charles N
CN
D000368:Aged; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D013129:Spinal Puncture / Q000379:methods; D013396:Suction / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013581:Synovial Cyst / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery*