• Alexa Strohm, Michael Braun, Christopher Kloth, Nico Sollmann, Yigit Ozpeynirci, Andrej Pala, Meinrad Beer, Bernd L Schmitz, and Johannes Rosskopf.
• Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.
• Pain Med. 2023 Feb 1; 24 (2): 158164158-164.

ObjectiveTo evaluate effectiveness and safety of computed tomography (CT)-guided cyst rupture with intraarticular contrast-enhanced injection of steroid and local anesthetic as first choice therapy in patients with facet joint cyst-induced radicular pain.DesignRetrospective data set analysis.SettingUniversity hospital.SubjectsOne hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included.MethodsThe rate of patients without following surgery was assessed and defined as surrogate to measure effectiveness. Patients' characteristics, procedure-associated complications, technical aspects, and imaging findings on magnetic resonance imaging (MRI) were analyzed. A subgroup of 65 patients (54%) underwent telephone interview to assess pain relief and clinical outcome measured by Numeric Rating Scale and Oswestry Disability Index. Analyses between the groups with and without surgery were performed by Fisher exact test and two-sample unpaired t-test, respectively.ResultsThe effectiveness of CT-guided cyst rupture was found to be 66.1%. Procedure-induced pain yielded in premature abort in two cases (1.7%). The detection of epidural contrast agent was statistically significantly associated with no need for surgery (P = .010). The cyst level was associated with the status of following surgery (P = .026), that is, cysts at lower lumbar spine were easier to rupture than cysts at other locations (cervical, thoracic, or upper lumbar spine). No further significant association was found.ConclusionsCT-guided cyst rupture as the first-choice therapy in patients with cyst-induced radicular pain was safe and effective. Successful cyst rupture was associated with no need for surgery. Cysts at lower lumbar spine revealed the highest success rate.© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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