Long-term effectiveness and feasibility of CT-guided cryoablation as a novel treatment option for symptomatic lumbar synovial cysts

To present a case series with a long-term follow-up of CT-guided cryoablation procedure for the minimally invasive treatment of symptomatic lumbar facet synovial cyst with a mean follow-up of 38 months (range, 15–55).

We present a retrospective, uncontrolled clinical case series in a single institution on patients treated with CT-guided cryoablation for symptomatic lumbar facet joint synovial cyst refractory to or not suitable for imaging-guided rupture procedure. In two cases, patients underwent cryoablation and cyst rupture within a 2-week period. Outcome measures were post-procedural radiologic studies and clinical examinations up to the end of the follow-up. Selected patients underwent post-procedural clinical and CT and MRI imaging which were reviewed up to the conclusion of the follow-up. All patients were clinically assessed and evaluated by spine surgery team. Technical success was complete resolution of patient’s symptoms.

We treated 3 females and 3 males (mean age 64 years). Four patients had cysts located at L4–L5, and the remaining two at L5–S1. We used two cryoprobes in five patients, and three in one. Clinical and/or technical success was documented in all cases (mean follow-up, 38 months [range, 15–55]). We found no major complications related to the cryoablation itself.

Our initial experience with CT-guided cryoablation for symptomatic lumbar facet synovial cysts describes a less invasive alternative treatment option to surgery for the management of such lesions. Our long-term outcome experience showed low recurrence and complication rates. CT-guided cryoablation may be a reasonable alternative approach to treat lumbar synovial cysts that are refractory or contraindicated to the rupture procedure and where surgical management is unfeasible.