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Adam L Shimer - One of the best experts on this subject based on the ideXlab platform.
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fluoroscopically guided facet Cyst Rupture rate of conversion to surgery and risk factor analysis
Clinical spine surgery, 2021Co-Authors: Joshua Bell, Manminder S Bhatia, Michael M Hadeed, Jose George, Andrew Hill, Wendy M Novicoff, Nicolas C Nacey, Adam L ShimerAbstract:Study design Retrospective case series at a single academic medical center. Objective The aim was to determine if specific clinical, radiologic, and procedural factors are associated with conversion to surgery after fluoroscopically guided Cyst Rupture. Summary of background data Percutaneous fluoroscopic Rupture of facet Cysts can often be the definitive treatment; however, it is unknown before the procedure who will ultimately proceed to formal surgical decompression. Differences in clinical, radiographic, and procedural factors of facet Cysts may relate to the difference in efficacy of fluoroscopically guided Cyst Rupture. Methods A continuous cohort of 45 patients who underwent fluoroscopically guided Cyst Rupture was evaluated. The primary outcome measured rate of conversion to surgery and of those that underwent surgery, the rate of decompression and fusion compared with fusion alone was noted. Secondary outcomes included analysis of clinical, radiologic, and procedural variables to determine if there were risk factors associated with conversion to surgery. Results Twenty-nine percent of patients eventually underwent a surgical procedure with an average interval to surgery of 95 days after attempted Rupture. Thirty-eight percent of patients that underwent surgery had a decompression and fusion. Failure of percutaneous Cyst Rupture trended toward significance for a future surgical decompression (P=0.08). Conclusions Percutaneous facet Cyst Rupture is potentially a definitive treatment for this condition; however, it is unknown ahead of time who will proceed to definitive surgical decompression. On the basis of the data in this study, less than one-third of patients who had a fluoroscopically guided facet Cyst Rupture went on to surgery. There were no clinical, radiographic, or procedural details which could be used to robustly predict failure of percutaneous treatment. At this time, it is recommended to continue to attempt this nonoperative treatment intervention when there is a clinical indication after discussion of the risks and benefits with the patient.
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wednesday september 26 2018 1 00 pm 2 00 pm interventional pain management 35 rate of conversion to surgery and risk factors analysis following fluoroscopically guided facet Cyst Rupture
The Spine Journal, 2018Co-Authors: Michael M Hadeed, Nicolas C Nacey, Adam L ShimerAbstract:BACKGROUND CONTEXT Facet Cysts are a common finding on magnetic resonance imaging (MRI) when evaluating a patient with back pain and radicular symptoms. Several different clinical and radiographic findings have been associated with this diagnosis. It is thought that these differences may relate to the difference in efficacy of fluoroscopically guided Cyst Rupture. PURPOSE The purpose of this study was to evaluate the rate of conversion to surgery following Cyst Rupture, and to assess for clinical, radiographic and procedural variables that were associated with that conversion. If specific clinical and radiographic risk factors can be elucidated which are associated with conversion to surgery, it may be possible to more effectively and efficiently counsel and treat patients. STUDY DESIGN/SETTING A retrospective review at an academic medical center. PATIENT SAMPLE All patients who underwent fluoroscopically guided facet Cyst Rupture from 2010 to 2016. OUTCOME MEASURES The primary outcome was conversion to surgery. For those who converted to surgery, the rate of decompression and fusion compared to fusion alone was recorded. Secondary outcomes included clinical, radiographic and procedural variable analysis to determine if there were risk factors associated with conversion to surgery. The clinical variables included sex, age, number of comorbidities, location (unilateral or bilateral), type of symptoms (pain, motor deficit, sensory deficit), and whether the pain was predominantly leg, back or combined. The radiographic variables included Cyst size, shape, Cyst signal, rim signal, level involved, laterality, presence of spondylolisthesis, whether there was canal or lateral recess stenosis, presence of facet joint fluid, bilateral fluid, facet bone edema and bone erosion. The procedural variables included Cyst opacification, successful Rupture and difference in pre and post procedure pain. METHODS Basic statistics, as well as single and multivariate analysis was performed. RESULTS Forty-nine patients met the inclusion criteria. Four were excluded because they had either no clinical notes or no MRI available for review. Twenty-nine percent of patients eventually underwent a surgical procedure to address their facet Cyst. The average interval to surgery was 95 days after Cyst Rupture. Of those who had a surgical intervention, 38% had a decompression and fusion. Of the clinical, radiographic and procedural variables evaluated, only the number of comorbidities and the MRI signal of the facet rim were associated with conversion to surgery, p=.03 and p=.05, respectively. CONCLUSIONS Facet Cysts have been recognized as a cause of spinal stenosis, but their optimal treatment is unknown. Typically, all nonoperative interventions are attempted prior to conversion to surgery, which often includes fluoroscopically guided facet Cyst Rupture. However, there is a significant percentage of patients in whom this treatment fails to provide durable relief, and eventually, patients undergo a surgical intervention. Despite the two associated risk factors, at this time, we would recommend continuing to attempt fluoroscopic guided facet Cyst Rupture with postprocedural clinical monitoring for all patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
D Pastel - One of the best experts on this subject based on the ideXlab platform.
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symptomatic lumbar facet synovial Cysts clinical outcomes following percutaneous ct guided Cyst Rupture with intra articular steroid injection
Journal of Vascular and Interventional Radiology, 2017Co-Authors: Steffen J Haider, Clifford J Eskey, Jessica G Fried, Natalie Y Ring, Mike Bao, D PastelAbstract:Abstract Purpose To evaluate clinical outcomes following percutaneous Rupture of symptomatic lumbar facet synovial Cysts (LFSCs) with intra-articular steroid injection. Materials and Methods In this retrospective review, 44 consecutive patients with symptomatic LFSCs received primary treatment with CT–guided synovial Cyst Rupture with intra-articular steroid injection. Outcomes questionnaires were obtained before and 1, 4, 26, and 52 weeks after LFSC Rupture. Assessment included pain medication use and numeric rating scale (NRS), Oswestry Disability Index (ODI), and 12-item short form health survey (SF-12) physical and mental composite scores (PCS and MCS). Clinical endpoint was 52-week survey response or surgery. Results LFSC Rupture was technically successful in 84% (37/44) of cases. Clinical endpoint was reached in 68% (30/44) of patients with 82% overall 1-year follow-up. Lumbar spine surgery was performed in 25% (11/44) of patients within 1 year after procedure. Mean NRS, ODI, and SF-12 PCS demonstrated significant improvement at all follow-up time points ( P P P = .006), and SF-12 PCS improved from 31 to 42 ( P P = .012). History of prior lumbar intervention was associated with poorer LFSC Rupture success ( P = .025) and ODI ( P = .047). Conclusions NRS, ODI, and SF-12 PCS indices improved and pain medication use decreased significantly at all time points over 1-year follow-up after percutaneous Rupture of symptomatic LFSCs with intra-articular steroid injection.
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lumbar facet joint synovial Cysts does t2 signal intensity predict outcomes after percutaneous Rupture
American Journal of Neuroradiology, 2013Co-Authors: S Cambron, J J Mcintyre, S J Guerin, Z Li, D PastelAbstract:BACKGROUND AND PURPOSE: Lumbar facet synovial Cysts are a cause of back pain and radiculopathy with facet joint degeneration, the most common cause for Cyst formation. Typically, LFSCs are T2 hyperintense on MR imaging, but the signal intensity is variable. Treatment options include percutaneous Rupture and surgical resection. This study evaluates the relationship between LFSC signal intensity on MR imaging and outcomes as it relates to percutaneous Rupture success and need for subsequent surgery. MATERIALS AND METHODS: A retrospective review of 110 patients who underwent CT fluoroscopic-guided Rupture of symptomatic LFSCs was performed. The LFSCs were characterized by their T2 signal intensity on MR imaging and divided into 3 groups: high, intermediate, and low T2 signal intensity. The rates of successful Cyst Rupture and need for subsequent surgery were recorded. RESULTS: Percutaneous LFSC Rupture was technically successful in 87% of all cases. Cyst Rupture was successful in 89% and 90% of high and intermediate signal intensity Cysts, respectively, and in 65% of low signal intensity Cysts (P = .017, .030). High signal intensity Cysts had lower postprocedural surgical rates (29%) when compared with intermediate and low signal Cyst as a group (P = .045). CONCLUSIONS: T2 hyperintense and intermediate signal intensity LFSCs are easier to Rupture, perhaps because the Cysts contain a higher proportion of fluid and are less gelatinous or calcified than T2 hypointense Cysts. Patients with T2 hyperintense LFSCs are less likely to need surgery.
Michael M Hadeed - One of the best experts on this subject based on the ideXlab platform.
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fluoroscopically guided facet Cyst Rupture rate of conversion to surgery and risk factor analysis
Clinical spine surgery, 2021Co-Authors: Joshua Bell, Manminder S Bhatia, Michael M Hadeed, Jose George, Andrew Hill, Wendy M Novicoff, Nicolas C Nacey, Adam L ShimerAbstract:Study design Retrospective case series at a single academic medical center. Objective The aim was to determine if specific clinical, radiologic, and procedural factors are associated with conversion to surgery after fluoroscopically guided Cyst Rupture. Summary of background data Percutaneous fluoroscopic Rupture of facet Cysts can often be the definitive treatment; however, it is unknown before the procedure who will ultimately proceed to formal surgical decompression. Differences in clinical, radiographic, and procedural factors of facet Cysts may relate to the difference in efficacy of fluoroscopically guided Cyst Rupture. Methods A continuous cohort of 45 patients who underwent fluoroscopically guided Cyst Rupture was evaluated. The primary outcome measured rate of conversion to surgery and of those that underwent surgery, the rate of decompression and fusion compared with fusion alone was noted. Secondary outcomes included analysis of clinical, radiologic, and procedural variables to determine if there were risk factors associated with conversion to surgery. Results Twenty-nine percent of patients eventually underwent a surgical procedure with an average interval to surgery of 95 days after attempted Rupture. Thirty-eight percent of patients that underwent surgery had a decompression and fusion. Failure of percutaneous Cyst Rupture trended toward significance for a future surgical decompression (P=0.08). Conclusions Percutaneous facet Cyst Rupture is potentially a definitive treatment for this condition; however, it is unknown ahead of time who will proceed to definitive surgical decompression. On the basis of the data in this study, less than one-third of patients who had a fluoroscopically guided facet Cyst Rupture went on to surgery. There were no clinical, radiographic, or procedural details which could be used to robustly predict failure of percutaneous treatment. At this time, it is recommended to continue to attempt this nonoperative treatment intervention when there is a clinical indication after discussion of the risks and benefits with the patient.
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wednesday september 26 2018 1 00 pm 2 00 pm interventional pain management 35 rate of conversion to surgery and risk factors analysis following fluoroscopically guided facet Cyst Rupture
The Spine Journal, 2018Co-Authors: Michael M Hadeed, Nicolas C Nacey, Adam L ShimerAbstract:BACKGROUND CONTEXT Facet Cysts are a common finding on magnetic resonance imaging (MRI) when evaluating a patient with back pain and radicular symptoms. Several different clinical and radiographic findings have been associated with this diagnosis. It is thought that these differences may relate to the difference in efficacy of fluoroscopically guided Cyst Rupture. PURPOSE The purpose of this study was to evaluate the rate of conversion to surgery following Cyst Rupture, and to assess for clinical, radiographic and procedural variables that were associated with that conversion. If specific clinical and radiographic risk factors can be elucidated which are associated with conversion to surgery, it may be possible to more effectively and efficiently counsel and treat patients. STUDY DESIGN/SETTING A retrospective review at an academic medical center. PATIENT SAMPLE All patients who underwent fluoroscopically guided facet Cyst Rupture from 2010 to 2016. OUTCOME MEASURES The primary outcome was conversion to surgery. For those who converted to surgery, the rate of decompression and fusion compared to fusion alone was recorded. Secondary outcomes included clinical, radiographic and procedural variable analysis to determine if there were risk factors associated with conversion to surgery. The clinical variables included sex, age, number of comorbidities, location (unilateral or bilateral), type of symptoms (pain, motor deficit, sensory deficit), and whether the pain was predominantly leg, back or combined. The radiographic variables included Cyst size, shape, Cyst signal, rim signal, level involved, laterality, presence of spondylolisthesis, whether there was canal or lateral recess stenosis, presence of facet joint fluid, bilateral fluid, facet bone edema and bone erosion. The procedural variables included Cyst opacification, successful Rupture and difference in pre and post procedure pain. METHODS Basic statistics, as well as single and multivariate analysis was performed. RESULTS Forty-nine patients met the inclusion criteria. Four were excluded because they had either no clinical notes or no MRI available for review. Twenty-nine percent of patients eventually underwent a surgical procedure to address their facet Cyst. The average interval to surgery was 95 days after Cyst Rupture. Of those who had a surgical intervention, 38% had a decompression and fusion. Of the clinical, radiographic and procedural variables evaluated, only the number of comorbidities and the MRI signal of the facet rim were associated with conversion to surgery, p=.03 and p=.05, respectively. CONCLUSIONS Facet Cysts have been recognized as a cause of spinal stenosis, but their optimal treatment is unknown. Typically, all nonoperative interventions are attempted prior to conversion to surgery, which often includes fluoroscopically guided facet Cyst Rupture. However, there is a significant percentage of patients in whom this treatment fails to provide durable relief, and eventually, patients undergo a surgical intervention. Despite the two associated risk factors, at this time, we would recommend continuing to attempt fluoroscopic guided facet Cyst Rupture with postprocedural clinical monitoring for all patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Jay Rivacambrin - One of the best experts on this subject based on the ideXlab platform.
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occipital aneurysmal bone Cyst Rupture following head trauma case report
Journal of Neurosurgery, 2015Co-Authors: Sarah T Garber, Jay RivacambrinAbstract:Aneurysmal bone Cysts (ABCs) are benign, expansile, osteolytic lesions that represent 1%–2% of primary bone tumors. Cranial ABCs are even more rare and represent 3%–6% of these unique lesions. The authors describe the case of a 3-year-old girl who presented with an acute posterior fossa epidural hematoma after minor trauma. Imaging workup revealed a previously undiagnosed suboccipital ABC that appeared to have Ruptured as a result of her trauma, leading to a life-threatening hemorrhage. To the authors' knowledge, a Ruptured ABC has never before been presented in the pediatric literature. In this case report, the authors review the imaging findings, natural history, clinical course, and treatment of these rare lesions.
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risk factors for pediatric arachnoid Cyst Rupture hemorrhage a case control study
Neurosurgery, 2013Co-Authors: Marshall C Cress, John R W Kestle, Richard Holubkov, Jay RivacambrinAbstract:BACKGROUND As the availability of imaging modalities has increased, the finding of arachnoid Cysts has become common. Accurate patient counseling regarding physical activity or risk factors for Cyst Rupture or hemorrhage has been hampered by the lack of definitive association studies. OBJECTIVE This case-control study evaluated factors that are associated with arachnoid Cyst Rupture (intraCystic hemorrhage, adjacent subdural hematoma, or adjacent subdural hygroma) in pediatric patients with previously asymptomatic arachnoid Cysts. METHODS Patients with arachnoid Cysts and intraCystic hemorrhage, adjacent subdural hygroma, or adjacent subdural hematoma treated at a single institution from 2005 to 2010 were retrospectively identified. Two unRuptured/nonhemorrhagic controls were matched to each case based on patient age, sex, anatomical Cyst location, and side. Risk factors evaluated included arachnoid Cyst size, recent history of head trauma, and altitude at residence. RESULTS The proportion of imaged arachnoid Cysts that presented either originally or subsequently with a Rupture or hemorrhage was 6.0%. Larger Cyst size, as defined by maximal Cyst diameter, was significantly associated with Cyst Rupture/hemorrhage (P < .001). When dichotomized with a 5-cm cutoff, 9/13 larger Cysts Ruptured and/or hemorrhaged, whereas only 5/29 smaller Cysts Ruptured/hemorrhaged (odds ratio = 16.5 (confidence interval [2.5, ∞]). A recent history of head trauma was also significantly associated with the outcome (P < .001; odds ratio = 25.1 (confidence interval [4.0, ∞]). Altitude was not associated with arachnoid Cyst Rupture or hemorrhage. CONCLUSION This case-control study suggests that larger arachnoid Cyst size and recent head trauma are risk factors for symptomatic arachnoid Cyst Rupture/hemorrhage.
Nicolas C Nacey - One of the best experts on this subject based on the ideXlab platform.
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fluoroscopically guided facet Cyst Rupture rate of conversion to surgery and risk factor analysis
Clinical spine surgery, 2021Co-Authors: Joshua Bell, Manminder S Bhatia, Michael M Hadeed, Jose George, Andrew Hill, Wendy M Novicoff, Nicolas C Nacey, Adam L ShimerAbstract:Study design Retrospective case series at a single academic medical center. Objective The aim was to determine if specific clinical, radiologic, and procedural factors are associated with conversion to surgery after fluoroscopically guided Cyst Rupture. Summary of background data Percutaneous fluoroscopic Rupture of facet Cysts can often be the definitive treatment; however, it is unknown before the procedure who will ultimately proceed to formal surgical decompression. Differences in clinical, radiographic, and procedural factors of facet Cysts may relate to the difference in efficacy of fluoroscopically guided Cyst Rupture. Methods A continuous cohort of 45 patients who underwent fluoroscopically guided Cyst Rupture was evaluated. The primary outcome measured rate of conversion to surgery and of those that underwent surgery, the rate of decompression and fusion compared with fusion alone was noted. Secondary outcomes included analysis of clinical, radiologic, and procedural variables to determine if there were risk factors associated with conversion to surgery. Results Twenty-nine percent of patients eventually underwent a surgical procedure with an average interval to surgery of 95 days after attempted Rupture. Thirty-eight percent of patients that underwent surgery had a decompression and fusion. Failure of percutaneous Cyst Rupture trended toward significance for a future surgical decompression (P=0.08). Conclusions Percutaneous facet Cyst Rupture is potentially a definitive treatment for this condition; however, it is unknown ahead of time who will proceed to definitive surgical decompression. On the basis of the data in this study, less than one-third of patients who had a fluoroscopically guided facet Cyst Rupture went on to surgery. There were no clinical, radiographic, or procedural details which could be used to robustly predict failure of percutaneous treatment. At this time, it is recommended to continue to attempt this nonoperative treatment intervention when there is a clinical indication after discussion of the risks and benefits with the patient.
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wednesday september 26 2018 1 00 pm 2 00 pm interventional pain management 35 rate of conversion to surgery and risk factors analysis following fluoroscopically guided facet Cyst Rupture
The Spine Journal, 2018Co-Authors: Michael M Hadeed, Nicolas C Nacey, Adam L ShimerAbstract:BACKGROUND CONTEXT Facet Cysts are a common finding on magnetic resonance imaging (MRI) when evaluating a patient with back pain and radicular symptoms. Several different clinical and radiographic findings have been associated with this diagnosis. It is thought that these differences may relate to the difference in efficacy of fluoroscopically guided Cyst Rupture. PURPOSE The purpose of this study was to evaluate the rate of conversion to surgery following Cyst Rupture, and to assess for clinical, radiographic and procedural variables that were associated with that conversion. If specific clinical and radiographic risk factors can be elucidated which are associated with conversion to surgery, it may be possible to more effectively and efficiently counsel and treat patients. STUDY DESIGN/SETTING A retrospective review at an academic medical center. PATIENT SAMPLE All patients who underwent fluoroscopically guided facet Cyst Rupture from 2010 to 2016. OUTCOME MEASURES The primary outcome was conversion to surgery. For those who converted to surgery, the rate of decompression and fusion compared to fusion alone was recorded. Secondary outcomes included clinical, radiographic and procedural variable analysis to determine if there were risk factors associated with conversion to surgery. The clinical variables included sex, age, number of comorbidities, location (unilateral or bilateral), type of symptoms (pain, motor deficit, sensory deficit), and whether the pain was predominantly leg, back or combined. The radiographic variables included Cyst size, shape, Cyst signal, rim signal, level involved, laterality, presence of spondylolisthesis, whether there was canal or lateral recess stenosis, presence of facet joint fluid, bilateral fluid, facet bone edema and bone erosion. The procedural variables included Cyst opacification, successful Rupture and difference in pre and post procedure pain. METHODS Basic statistics, as well as single and multivariate analysis was performed. RESULTS Forty-nine patients met the inclusion criteria. Four were excluded because they had either no clinical notes or no MRI available for review. Twenty-nine percent of patients eventually underwent a surgical procedure to address their facet Cyst. The average interval to surgery was 95 days after Cyst Rupture. Of those who had a surgical intervention, 38% had a decompression and fusion. Of the clinical, radiographic and procedural variables evaluated, only the number of comorbidities and the MRI signal of the facet rim were associated with conversion to surgery, p=.03 and p=.05, respectively. CONCLUSIONS Facet Cysts have been recognized as a cause of spinal stenosis, but their optimal treatment is unknown. Typically, all nonoperative interventions are attempted prior to conversion to surgery, which often includes fluoroscopically guided facet Cyst Rupture. However, there is a significant percentage of patients in whom this treatment fails to provide durable relief, and eventually, patients undergo a surgical intervention. Despite the two associated risk factors, at this time, we would recommend continuing to attempt fluoroscopic guided facet Cyst Rupture with postprocedural clinical monitoring for all patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
