Original article| Volume 86, ISSUE 9, P1767-1771, September 2005

Procedure-Based Nonsurgical Management of Lumbar Zygapophyseal Joint Cyst–Induced Radicular Pain


      Sabers SR, Ross SR, Grogg BE, Lauder TD. Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst–induced radicular pain.


      To evaluate the success of fluoroscopically guided, contrast-enhanced lumbar zygapophyseal joint (Z-joint) aspiration and steroid injection combined with transforaminal epidural steroid injections (TFESIs) for the treatment of lumbar Z-joint cyst–induced radicular pain.


      Retrospective case series with independent follow-up.


      Institutional, referral center.


      Twenty-three patients referred to a single provider for procedure-based management of radicular pain believed secondary to lumbar Z-joint cyst. Inclusion criteria consisted of lumbar radicular pain that was consistent with the level and side of the Z-joint cyst as a causative lesion.


      Eighteen patients were treated with a fluoroscopically guided, contrast-enhanced Z-joint aspiration and steroid injection at the level of the causative cyst coupled with a fluoroscopically guided, contrast-enhanced TFESI over the level of the presumably irritated spinal nerve.

      Main Outcome Measures

      Patient satisfaction, and whether or not surgery was performed.


      Fifty percent of patients treated with the procedure had significant long-term benefit and avoided surgical intervention at an average follow-up of 9.9 months.


      Fluoroscopically guided, contrast-enhanced spinal procedures as part of an aggressive nonsurgical treatment program are a safe and effective alternative to surgical intervention for lumbar Z-joint cyst–induced radicular pain.

      Key Words

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        • Abdullah A.
        • Chambers R.
        • Daut D.
        Lumbar nerve root compression by synovial cysts of the ligamentum flavum. Report of four cases.
        J Neurosurg. 1984; 60: 617-620
        • Baum J.
        • Hanley E.
        Intraspinal synovial cyst simulating spinal stenosis. A case report.
        Spine. 1986; 11: 487-489
        • Kao C.
        • Uihlein A.
        • Bickel W.
        • Soule E.
        Lumbar intraspinal extradural ganglion cyst.
        J Neurosurg. 1968; 29: 168-172
        • Knox A.
        • Fon G.
        The appearances of lumbar intraspinal synovial cysts.
        Clin Radiol. 1991; 44: 397-401
        • Schreiber F.
        • Nielsen A.
        Lumbar spinal extradural cysts.
        Am J Surg. 1950; 80: 124-126
        • Yuh W.
        • Drew J.
        • Weinstein J.
        • et al.
        Intraspinal synovial cysts. Magnetic resonance evaluation.
        Spine. 1990; 16: 740-745
        • Jackson Jr, D.E.
        • Atlas S.W.
        • Mani J.R.
        • Norman D.
        Intraspinal synovial cysts.
        Radiology. 1989; 170: 527-530
        • Hemminghytt S.
        • Daniels D.
        • Williams A.
        • Haughton V.
        Intraspinal synovial cysts.
        Radiology. 1982; 145: 375-376
        • Liu S.S.
        • Williams K.D.
        • Drayer B.P.
        • Spetzler R.F.
        • Sonntag V.K.
        Synovial cysts of the lumbosacral spine.
        Am J Roentgenol. 1990; 154: 163-166
        • Casselman E.S.
        Radiologic recognition of symptomatic spinal synovial cysts.
        Am J Neuroradiol. 1985; 6: 971-973
        • Bjorkengren A.G.
        • Kurz L.T.
        • Resnick D.
        • Sartoris D.J.
        • Garfin S.R.
        Symptomatic intraspinal synovial cysts.
        Am J Roentgenol. 1987; 149: 105-107
        • Budris D.
        Intraspinal lumbar synovial cyst.
        Orthopedics. 1991; 14: 618-620
        • Bhushan C.
        • Hodges F.
        • Wityk J.
        Synovial cyst (ganglion) of the lumbar spine simulating extradural mass.
        Neuroradiology. 1979; 18: 263-268
        • Eyster E.F.
        • Scott W.
        Lumbar synovial cysts.
        Neurosurgery. 1989; 24: 112-115
        • Hong Y.
        • O’Grady T.
        • Carlsson C.
        • Casey J.
        • Clements D.
        Percutaneous aspiration of lumbar facet synovial cyst.
        Anesthesiology. 1995; 82: 1061-1062
        • Hsu K.
        • Zucherman J.
        • Shea W.
        • Jeffrey R.
        Lumbar intraspinal synovial and ganglion cysts (facet cysts).
        Spine. 1995; 20: 80-89
        • Lin R.M.
        • Wey K.L.
        Gas-containing “ganglion” cyst of lumbar posterior longitudinal ligament at L3. Case report.
        Spine. 1993; 18: 2528-2532
        • Lyons M.K.
        • Atkinson J.L.
        • Wharen R.E.
        • Deen H.G.
        • Zimmerman R.S.
        • Lemens S.M.
        Surgical evaluation and management of lumbar synovial cysts.
        J Neurosurg Spine. 2000; 93: 53-57
        • Parlier-Cuau C.
        • Wybier M.
        • Nizard R.
        • Champsaur P.
        • Le Hir P.
        • Laredo J.D.
        Symptomatic lumbar facet joint synovial cysts.
        Radiology. 1999; 210: 509-513
        • Slipman C.
        • Lipetz J.
        • Wakeshima Y.
        • Jackson H.
        Nonsurgical treatment of zygapophyseal joint cyst–induced radicular pain.
        Arch Phys Med Rehabil. 2000; 81: 973-977
        • Slosar P.J.
        • Reynolds J.B.
        • Schofferman J.
        • Goldthwaite N.
        • White A.H.
        • Keaney D.
        Patient satisfaction after circumferential lumbar fusion.
        Spine. 2000; 25: 722-760
        • Daltroy L.H.
        • Cats-Baril W.L.
        • Katz J.N.
        • Fossel A.H.
        • Liang M.H.
        The North American spine society lumbar spine outcome assessment instrument.
        Spine. 1996; 21: 741-749