Spontaneous Resolution Of Lumbar Facet Joint Cyst
Downs, E., & Marshman, L. A. G. (2018). Spontaneous Resolution of Lumbar Facet Joint Cyst. World neurosurgery, 115, 414–416. https://doi.org/10.1016/j.wneu.2018.04.197
View Original Source →Abstract
BACKGROUND: Juxtafacet cysts (JFCs) are uncommon spinal lesions that can cause neural compression and are typically managed surgically. Rarely, JFCs can spontaneously resolve. CASE DESCRIPTION: We present the case of a spontaneously resolving right L4/5 JFC in an otherwise fit and well 60-year-old female. She presented with progressive chronic lower back pain and intermittent sciatica. She had no neurologic deficit. The patient was keen to avoid surgical intervention. After 19 months her symptoms had significantly improved, and repeat magnetic resonance image demonstrated complete resolution of the lesion. CONCLUSIONS: While surgery to remove a JFC ± spinal stabilization remains the mainstay and definitive treatment for symptomatic JFCs, patients without neurologic deficit may be safely managed conservatively pending possible spontaneous resolution. Spontaneous resolution may reflect the natural history of the condition.
Case Details
Disease Location
Intervertebral disk
Personal Characteristics
60-year-old female
Clinical Characteristics
Presented with progressive chronic low back pain (clbp) and intermittent right sciatica. On examination, she had a reduced range of movement in her lumbar spine and no neurological deficit. Magnetic resonance imaging (MRI) demonstrated disk degeneration and facet hypertrophy with a right l4/5 juxtafacet cyst (jfc). She received a sacral epidural and right l4/5 transforaminal steroid injection, which effected some improvement in her right sciatica. She then underwent bilateral l4/5 facet joint radiofrequency neurotomies (rfns) and participated in the pregabalin versus gabapentin in the treatment of sciatica study
Remission Characteristics
Approximately 19 months after her initial presentation, her sciatica had completely resolved and her clbp had significantly improved. Repeat MRI demonstrated complete jfc resolution
Treatment & Mechanisms
Proposed Remission Mechanisms
Possible causes for jfc resolution include cyst rupture, as seen in other regions in the body, or a reduction in the local intraarticular forces that contributed to synovial herniation through the facet joint capsule
Clinical Treatment
Sacral epidural and right l4/5 transforaminal steroid injection bilateral l4/5 facet joint radiofrequency neurotomies