Lumbar zygapophyseal joint cyst aspiration: a case report & systematic review of literature

Lumbar zygapophyseal joint cysts are an uncommon cause of unilateral radicular pain but the treatment of conservative versus surgical approach remains controversial. A 68 year old female presented to clinic with complaints of 3 month history of left lumbar radicular pain and objective findings of left L4-L5 lumbar zygapophyseal joint cyst on MRI. The patient underwent a lumbar zygapophyseal joint cyst aspiration and left L4-L5 transforaminal epidural steroid injection under fluoroscopic guidance. The patient had 100% resolution of left lumbar radicular pain for 7 months after cyst aspiration but began to develop similar symptoms once again. Repeat MRI of the lumbar spine showed evidence of a left L4-L5 lumbar zygapophyseal joint cyst and the patient underwent a second lumbar cyst aspiration with a left L4-L5 transforaminal epidural steroid injection under fluoroscopic guidance. A review of literature was conducted to assess the efficacy of lumbar zygapophyseal joint cyst aspiration as a conservative treatment. A search from 2000-2011 was conducted using OVID, PubMed, and Scopus which resulted in five papers that assessed the long term clinical outcomes of lumbar zygapophyseal joint cyst aspiration. Among the papers identified there was no evidence that fluoroscopically guided zygapophyseal joint cyst aspiration resulted in reduction of the need for surgical cyst excision. Though there was evidence of successful pain relief after cyst aspiration the review of literature did not show a significant reduction in lumbar zygapophyseal joint cyst recurrence. In conclusion fluoroscopically guided lumbar zygapophyseal joint cyst aspiration has proven short term pain relief benefit but has not been proven to reduce cyst recurrence or the need for eventual surgical excision.