I would say (I'm young btw) out of about 10 facet cysts I tried to aspirate despite good needle placement (confirmed of course with good IA spread of small amount of contrast) I have successfully aspirated fluid that was straw colored, not clear, about 3 times. Percutaneous puncture of zygapophysial joint synovial cyst with fluoroscopic guidance. Fluoroscopic percutaneous lumbar zygapophyseal joint cyst rupture: a clinical outcome study.
Martha JF, Swaim B, Wang DA, Kim DH, Hill J, Bode R, Schwartz CE. Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients. IT COULD JUST FILL LIKE A WATER BALOON AND CAUSE A CAUDA EQUINA.ġ. SOMETIMES CAPSULES ARE EXPANSILE SO YOU GOTTA THINK TWICE ABOUT RUPTURE. Do the patient a favor and block the nerve that runs past the cyst prior to attempted rupture. Better to puncture the capsule three or four times and then CAREFULLY try to rupture it with omnipaque.
Often times the cysts are covered with a dark calcified cap that wont rupture. And furthermore, jello and water look the same on a T2 MRI.
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