It’s amazing how a pea-sized facet cyst pressing on a nerve can cause a great deal of havoc. Those who have this problem know the symptoms can be disabling, and yet for some patients, it causes no symptoms at all. If it’s the former, surgery has likely been offered, but let’s explore facet cyst treatment beyond the knife.
The anterior (front) of the spinal column is made up of bones called vertebrae and the cushioning pads between each vertebre are called intervertebral discs. The posterior (back) part of these vertebrae are spinous processes (which you can feel if you run your fingers down your back), and on either side of these, connecting one vertebra to the next, are finger-joint-sized articulations called the facet joints. When you bend backward, these joints become compressed, and when you bend forward, they open up. The short video above provides some good visuals of what the facet joints look like and how they fit into the structure of the spine.
Facet joints allow for and limit to a certain degree, movement in the spine. For example, your cervical facet joints allow you to turn your neck about 180 degrees but prevent it from turning any farther. Just like any other joint in the body, facet joints can become arthritic or they can get injured via trauma, such as a car accident. When damage or arthritis occurs, facet joints can become chronically painful and uncomfortable, especially with movement.
When a facet joint gets arthritic and swollen, it can produce a facet cyst. This is nothing more than a fluid-filled expansion of the covering of the joint (called the capsule). The joint can balloon out in a few common places and one of those can put pressure on the nerves in the spinal canal, causing pain in the spine or anywhere along the branch of the affected nerve (e.g., in the leg if the cyst is in the lumbar, or lower, spine). Facets cysts are the most common in the lower back.
There are a number of treatment options for a facet cyst. Let’s explore those a bit. Facet cysts can be
Popping the cyst with an injection can sometimes work. In this procedure, the doctor injects the facet joint under fluoroscopic guidance and purposefully injects too much liquid. This can cause the facet cyst to fill up like a water balloon and sometimes it will pop. The positive for this type of treatment is that no muscles are destroyed (which is common with surgery). The negative is that sometimes the cyst won’t pop. In addition, based on a recent study, this is effective about 70% of the time, with 40% of patients needing to have the cyst popped again, and about 30% needing surgery to remove the cyst.
A steroid shot is a high dose anti-inflammatory that can be very effective at reducing inflammation. In this procedure, the physician usually drains the cyst after placing the needle in the facet joint with guidance. Then steroid is injected. However, steroid injections can harm and damage the cartilage in the joint, so despite this being a popular approach, we generally avoid these injections.
Another newer option is to pop or drain the cyst and inject PRP or stem cells. These are substances that may be able to initiate some repair of the damaged joint or at least turn the toxic environment in the joint into a better one that won’t swell. This is because the swelling in the joint causing the cyst is being maintained by the joint’s inability to fully heal itself.
Surgical excision is another option. Here, the surgeon makes a tunnel to get to the joint and then commonly removes some bone (laminectomy) to be able to access the spinal canal. Then the cyst is excised. However, the nature of the surgery will damage some of the muscles that stabilize the area, so I would only recommend this one as a very last resort.
Following along with the video above, let’s look more in depth at a specific patient’s facet cyst treatment. Be sure to watch the video for details and images.
A facet cyst treatment at the L4–5 level via injection is shown in the video above. Contrast has been injected into the facet joint and it has gone into the facet cyst. You will see my first needle, positioned in the facet joint, and my second needle, positioned in the facet cyst itself which is in the back of the spinal canal. Once both needles are in the proper position, as the movie in the video shows, you will see the fluid being injected into the facet joint through the first needle that then that fluid goes into the facet cyst and then finally out the second needle.
The upshot? Facet cysts can be a big deal if they put pressure on a nerve. There are several options for facet cyst treatment, but you should try to stay away from a few of those as they either involve drugs like high dose steroids that will kill off joint cartilage, or, surgery that will essentially be a bull in the China shop of your spine!
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…