PagE CONTENT:
What is a facet cyst ?
Which are the complaints caused by a facet cyst ?
What is the difference with a disk herniation ?
How is a facet cyst treated ?
What is a facet cyst ?
On both sides at the back of each vertebral link there is a facet joint. This joint mainly serves to limit certain movements of the back. They can show (premature) wear and tear (osteoarthritis) due to prolonged overuse. Rarely does a joint cyst occur in this area as a reaction to the osteoarthritis. A facet cyst is a benign 'soft' protrusion of the capsule of the facet joint.
Facet cysts that provoke complaints are rather rare. If they cause complaints, it is radiation.
Which are the complaints caused by a facet cyst ?
SOMS Beenpijn:
A symptomatic facet cyst causes painfull radiation to the lower limb buttock and leg. These symptoms are then only present in one leg.
The complaints are similar to those of leg pain caused by a disk herniation. The difference between the two causes can actually only be made by a CT or MRI scan.
“Symptomatic facet cystcausses dominat PAIN IN THE LEG”
The severity of the symptoms depends on how much pressure the cyst causes on the nerve. In addition to leg pain, reduced strength in the leg and sensory disturbances such as tingling, burning or deafness can also be caused by a hernia. With very large cysts the radiation can be present in both legs with sometimes walking disorders and in extreme cases there can be loss of urine or bowel controll.
NO BACK PAIN:
The back pain in a facet cyst is usually not directly caused by the cyst but by the (sometimes advanced) wear and tear of the lower back. A facet cyst can also protrude without suppressing a nerve. Often there is a story of years of chronic low back pain, which is not caused by the cyst itself but by the facet arthrosis.
What is the difference with a disk herniation ?
The complaints with painfull radiations to the leg are identical
Anatomically, the side of nerve compression is opposite. A disk herniation presses on the nerve at the front, a cyst at the back.
Facet cyst
The facet cyst presses on the back side of the nerve. If the facet cyst protrudes into the spinal cord canal or into the nerve opening there, radiating leg pain occurs. A facet cyst protruding away from the nerves does not cause any symptoms.
Disk herniation
A disc herniation presses on the nerve from the front.
How is a facet cyst treated ?
“Treatment of a facet cyst is also here focused on the RADIATING leg pain.
IT IS SIMILAR TO THAT OF A DISC HERNIATED DISC.
”
The treatment is at first almost always 'conservative', which means as much as therapy without surgery. An attempt is made to help reduce or eliminate the pain symptoms as quickly as possible. The main target of this therapy are the complaints in the leg.
After thorough examination of the patient, a treatment plan is drawn up.
Transforaminal infiltrations may be prescribed. Under local anaesthetic, a cocktail of analgesic and anti-inflammatory drugs is injected through the lateral ventricles (the "foramina"). The aim of this is to reduce swelling of the cyst and nerve, so that the pinching of the leg nerve and thus the leg pain disappears. Usually two transforaminal infiltrations are given over a period of three weeks.
If these treatments doe not help or in case of paralysis symptoms, it is sometimes decided that an operation becomes necessary. In our department these are all done endoscopically with a keyhole surgery: the full endoscopic cyst resection. These surgeries are the least invasive procedures possible that efficiently remove the cyst without tissue damage.