Percutaneous resolution of lumbar facet joint cysts as an alternative treatment to surgery: a meta-analysis

Abstract

Purpose: A comprehensive review of the literature in order to analyze data about the success rate of percutaneous resolution of the lumbar facet joint cysts as a conservative management strategy.

Methods: A systematic search for relevant articles published during 1980 to May 2014 was performed in several electronic databases by using the specific MeSH terms and keywords. Most relevant data was captured and pooled for the meta-analysis to achieve overall effect size of treatment along with 95% confidence intervals.

Results: 29 studies were included in the meta-analysis. Follow-up duration as mean ± sd (range) was 16±10.2 (5 days to 5.7 years). Overall the satisfactory results (after short- or long-term follow-up) were achieved in 55.8 [49.5, 62.08] % (pooled mean and 95% CI) of the 544 patients subjected to percutaneous lumbar facet joint cyst resolution procedures. 38.67 [33.3, 43.95] % of this population underwent surgery subsequently to achieve durable relief. There existed no linear relationship between the increasing average duration of follow-up period of individual studies and percent satisfaction from the percutaneous resolutions procedure.

Conclusion: Results shows that the percutaneous cyst resolution procedures have potential to be an alternative to surgical interventions but identification of suitable subjects requires further research.

Figure 1. Flowchart of study screening and selection process.

Figure 2. Spinal level of cysts diagnosed in the patients included in the meta-analysis.

Figure 3. Forest plot showing effect sizes of satisfactory results of percutaneous treatments of the LFJCs after short- or long-term follow-up in individual studies (closed circles) and the overall effect size achieved in meta-analysis (diamond).

CR 1 (follow-up 1 mo): Braza et al., 2005; Casselman et al., 1985; Chang, 2009; Foley, 2009; Imai et al., 1998; Kozar & Jeromal, 2014; Lutz and Shen, 2002; Rauchwerger et al., 2011/CR 2 (follow-up 6 month): Boissier et al., 2013; Hong et al., 1995; Shin et al., 2012/CR 3 (follow-up 1 year or more): Gishen et al., 2001; Lim et al., 2001; Lin et al., 2014; Melfi and Aprill, 2005.

Figure 4. Forest plot showing effect sizes of subjects underwent surgical treatments subsequent to failure of percutaneous treatments of the LFJCs in individual studies (closed circles) and the overall effect size achieved in meta-analysis (diamond).

CR 1/CR 2/CR 3 as given in Figure 2.

Figure 5. Scatter plot showing relationship between percent satisfaction of the subjects of percutaneous resolution procedures and follow-up duration in months.