Minimally invasive CT guided treatment of intraspinal synovial cyst

Abstract

BACKGROUND:

Intraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically.

CASE REPORT:

A 77-year old polymorbid patient presented with bilateral low back painwhich worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection with installation of local anesthetic together with corticosteroid and rupture of the cyst was successfully used. A month after the procedure his pain improved, the usage of analgesics diminished and his over-all quality of life improved.

CONCLUSIONS:

Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

KEYWORDS:

intraspinal synovial cyst, pain, percutaneous CT guided treatment, polymorbid patient, radiculopathy

The differentiation between nociception and pain is often ignored

The differentiation between nociception and pain is often ignored. Pain emerges from the brain according to apparent danger to body tissues. Nociception is the neural processes of processing noxious stimuli (mechanical, thermal or chemical changes above a certain threshold) that have the potential to damage tissue. 
Increased central sensitization is an (mal)adaptation that occurs when the body experience persisted pain. This optimizes the likelihood of tissue healing and minimize the risk of secondary injury in the beginning. Over time, sensitization may lose its value and become a problem of its own (chronic pain). Changes on cortical level occur. Certain strategies can treat people with central sensitization due to the plasticity of the brain. The main strategy within CLBP-patients is the cognitive and behavioral strategies: 
- Reduce feelings of helplessness and uncontrollability (establish a sense of control over pain)
- Change pain coping strategies
- Attention to activity planning and pacing
- Give education about pain and the factors that modulate it 

> from Moseley et al.; Neurorehabilitation and Neural Repair 26 (2012) 646-652. All rights reserved to the American Society of Neurorehabilitation.