Lumbar synovial cyst treatment (a) patient positioning, (b) puncture, (c) sterile air injection after rinsing, (d) ruptured cyst.
Indication: Painful nerve compression due to a synovial cyst

Target:

  • - Degenerative facet joint causing the synovial
  • - Sometimes, direct synovial cyst puncture

Procedure:

  • - Patient is placed prone on the CT table
  • - Axial scan (generally at the lower two lumbar levels) to locate the synovial cyst and the correspondent facet joint
  • - Posterolateral approach
  • - CT fluoroscopy-guided direct puncture from skin to the facet joint with a 20 or 22 G needle
  • - Contrast media injection resulting in opacification of facet joint and synovial cyst
  • - Pressure increase with saline to rupture the cyst
  • - In the case of unbearable pain, the procedure should be stopped and direct cystic puncture should be performed (same technique as lumbar epidural infiltration). Direct puncture is easy to perform because the synovial cyst is already filled with contrast media. Cystic rinsing with saline to dilute cyst content followed by pressure increase to rupture cyst wall
  • - Steroid injection to complete the procedure

Danger: Easy procedure, without any particular risk
Synovial cyst treatment: cyst decompression with facet joint puncture only.
Synovial cyst treatment: combined approach. Direct cystic puncture after failure of cyst decompression with facet joint approach.