Percutaneous puncture of zygapophysial joint synovial cyst with fluoroscopic guidance

Objective. To introduce a minimally invasive, percutaneous fluoroscopic technique for treating symptomatic zygapophysial joint (z-joint) synovial cysts. Methods. Chart review to describe the clinical presentation, representative imaging, technical procedural details, and follow-up of a 72-year-old female with a symptomatic lumbar z-joint synovial cyst. Results. Before the cyst puncture, the patient failed conservative care including transforaminal epidural and intra-articular z-joint injections. Immediately after the puncture, and at 4-month follow-up, the patient was free of left lower extremity radicular pain. Computed tomography at 4 months post puncture showed resolution of the cyst. There was no recurrence of left leg pain at 30-month follow-up. Conclusion. This technical case report illustrates that puncture of an intraspinal z-joint synovial cyst using an interlaminar approach with fluoroscopic guidance may be safely performed with effective relief of radicular symptoms.