CT-guided ozone mixture injection in treatment of symptomatic lumbar facet synovial cysts

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Salvatore Masala https://orcid.org/0000-0003-0032-7970
Adriano Lacchè https://orcid.org/0000-0003-1782-8624
Fabio Salimei
Antonio Ursone
Vincenzo Pipitone
Federica Masino
Giuseppe Maria Andrea D'Arma
Giuseppe Guglielmi https://orcid.org/0000-0002-4325-8330


Ozone injection; lumbar facet synovial cysts; radiculopathy; low-back pain.


Background and aim: To evaluate the clinical and radiological outcomes, in terms of safety and efficacy, of a new treatment method for symptomatic lumbar facet synovial cysts (LFSC), based on ozone injection inside the cyst.

Methods: We retrospectively reviewed clinical records and imaging studies of 77 patients who underwent CT-guided ozone treatment of symptomatic facet joint synovial cysts in our department over a 5-year span.

Clinical outcome was assessed with Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) evaluations, obtained prior to the intervention and at 1-, 3-, 6- and 12-months follow-up.

Follow-up MRI imaging at 6 and 12 months were obtained and confronted with the pre-procedural MRI to analyse cyst modification after the intervention.

Results: Ozone administration was technically successful in 100% of procedures; no immediate complications occurred. At 1 month evaluation, 92% of the patients referred partial or complete symptomatic response; 86% of patients at 3 months and 84% at 6 months confirmed symptoms improvement; final assessment, at 12 months after intervention, outlined overall significant clinical improvement in 81% of patients. During the 12 months of follow-up only 3 patients had a relapse of the cyst (at 6 months) that were retreated with a 100% success.

Conclusions: CT-guided ozone therapy for symptomatic LFSC is a safe and innovative treatment option, with good clinical results at 12 months follow-up in a significative percentage of patients, thus reducing the need for invasive surgical interventions.


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[1] Chebib I, Chang CY, Schwab JH, Kerr DA, Deshpande V, Nielsen GP. Histopathology of synovial cysts of the spine. Histopathology. 2018 May;72(6):923-929. doi: 10.1111/his.13465. Epub 2018 Mar 5. PMID: 29314220.
[2] Janssen SJ, Ogink PT, Schwab JH. The Prevalence of Incidental and Symptomatic Lumbar Synovial Facet Cysts. Clin Spine Surg. 2018 Jun;31(5):E296-E301. doi: 10.1097/BSD.0000000000000648. PMID: 29727308.
[3] Khan AM, Girardi F. Spinal lumbar synovial cysts. Diagnosis and management challenge. Eur Spine J. 2006 Aug;15(8):1176-82. doi: 10.1007/s00586-005-0009-4. Epub 2006 Jan 27. PMID: 16440202; PMCID: PMC3233964.
[4] Hohenberger C, Brawanski A, Ullrich OW, Höhne J, Zeman F, Schebesch KM. Degenerative symptomatic spinal synovial cysts: Clinical presentation and functional outcome. J Clin Neurosci. 2019 Apr; 62:112-116. doi: 10.1016/j.jocn.2018.12.006. Epub 2018 Dec 20. PMID: 30580916.
[5] Splavski B, Rotim A, Brumini I, Koprek I, Gajski D, Božić B, Rotim K. LUMBAR SPINE SYNOVIAL CYST: A CASE SERIES REPORT AND REVIEW OF SURGICAL STRATEGIES. Acta Clin Croat. 2019 Sep;58(3):491-496. doi: 10.20471/acc.2019.58.03.13. PMID: 31969762; PMCID: PMC6971798.
[6] Magalhaes FN, Dotta L, Sasse A, Teixera MJ, Fonoff ET. Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2012 Mar-Apr;15(2):E115-29. PMID: 22430658.
[7] Parlier-Cuau C, Wybier M, Nizard R, Champsaur P, Le Hir P, Laredo JD. Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long-term follow-up in 30 patients. Radiology. 1999 Feb;210(2):509-13. doi: 10.1148/radiology.210.2.r99fe60509. PMID: 10207437.
[8] Martha JF, Swaim B, Wang DA, Kim DH, Hill J, Bode R, Schwartz CE. Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients. Spine J. 2009 Nov;9(11):899-904. doi: 10.1016/j.spinee.2009.06.010. Epub 2009 Aug 6. PMID: 19664971.
[9] Eshraghi Y, Desai V, Cajigal Cajigal C, Tabbaa K. Outcome of Percutaneous Lumbar Synovial Cyst Rupture in Patients with Lumbar Radiculopathy. Pain Physician. 2016 Sep-Oct;19(7):E1019-25. PMID: 27676672.
[10] Amoretti N, Huwart L, Foti P, Boileau P, Amoretti ME, Pellegrin A, Marcy PY, Hauger O. Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections. Eur Radiol. 2012 Dec;22(12):2836-40. doi: 10.1007/s00330-012-2533-z. Epub 2012 Jun 12. PMID: 22688130.
[11] Haider SJ, Na NR, Eskey CJ, Fried JG, Ring NY, Bao MH, Pastel DA. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT-Guided Cyst Rupture with Intra-articular Steroid Injection. J Vasc Interv Radiol. 2017 Aug;28(8):1083-1089. doi: 10.1016/j.jvir.2017.04.021. Epub 2017 May 24. PMID: 28549711.
[12] Shah VN, von Fischer ND, Chin CT, Yuh EL, Amans MR, Dillon WP, Hess CP. Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts. AJNR Am J Neuroradiol. 2018 Jan;39(1):193-198. doi: 10.3174/ajnr. A5428. Epub 2017 Nov 9. PMID: 29122762; PMCID: PMC7410714.

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