When a cyst develops on a facet joint on the spinal column (hence its name, “facet cyst”), it can be painful and even debilitating for many patients. However, in some patients, they may not even know even know they have a facet cyst as they experience no symptoms whatsoever. If you’re in the former category, and your cyst has been wreaking havoc in your back, your physician may be throwing out the S word—surgery.
Facet cyst surgery is certainly the most invasive option, but is it the only option? Today, we’re going to explore this, but, first, let’s learn more about the facet joint and facet cysts.
Facet Joints and How They Develop Cysts
The front of the spinal column consists of many vertebrae (bones) stacked one on top of the other in a flexible, movable column. Between each vertebra is an intervertebral disc, which is a shock-absorbing and cushioning structure that pads one vertebra from another. In the back of the spinal column, these vertebrae form spinous processes. The bony prominences you can feel when you run your fingers down your back are these spinous processes. The vertebrae are connected along the back of the spinal column via multiple finger-joint-sized facet joints. Watch the brief video below to get a more in-depth look at the facet joints and how they function.
Arthritis or traumatic injuries can damage facet joints, and with arthritis, chronic pain can make facet joint spine movement very uncomfortable. Additionally, arthritis in the facet joint can cause a facet cyst, which is about pea-sized and fluid-filled and forms in the capsule (the connective-tissue covering) of the joint. The most common area for a facet cyst to form is in the lumbar spine, or lower back. When a cyst forms there, the ballooning out of the capsule can affect the surrounding spinal nerves as pressure on these structures can cause pain in the spine or referring this pain somewhere else along the affected nerve branch (e.g., hip, knee, ankle, etc.).
So once a facet cyst is diagnosed, how do you get rid of it? Let’s review the options.
Treatment Options for a Facet Cyst
Treatment options for a facet cyst involve injections or surgery. One option is to pop the cyst by injecting it with a needle. Options your traditional physician might be fond of are steroid injections or surgery, but both of these are riddled with risks. Finally, an interventional orthopedic physician can inject orthobiologics, such as platelet-rich plasma (PRP) or stem cells. Let’s review each of these.
Popping the Facet Cyst via Injection
Popping the cyst can be effective in many cases. Your doctor will inject the facet joint under guidance and overfill the cyst with liquid. The idea is that overfilling the cyst will expand it like a balloon being filled with water and it will eventually pop. Pros to this treatment: surgery is not required, so no muscles are destroyed to access the site. Cons: In some cases, the cyst simply won’t pop. One study found this technique to be successful 70% of the time, though in 40% of these patients, the cyst will reform and need to be popped again.
Injecting the Facet Cyst with a Steroid
Steroids are anti-inflammatories, and a high-dose steroid injection may temporarily reduce inflammation. Your doctor will first drain the cyst with the injection needle and then inject the steroid. This might be an effective technique were it not for the extreme side effects associated with steroid injections, particularly on joint cartilage. Steroids are toxic to the cartilage in the joint, so while you might be solving one problem (the facet cyst), you’re creating another (destroying cartilage in the joints). The cartilage issue aside, steroids have been linked to a very long list of additional side effects (see more at this link). Due to this, we certainly recommend steering clear of steroid injections.
Injecting the Cyst with PRP or Stem Cells
PRP or stem cells are orthobiologics that may be able to jumpstart repair of the damaged joint. The interventional orthopedic physician will inject the patient’s own stem cells or PRP, using precise guidance, into the cyst. This may also improve the toxic environment in the joint, which may eliminate inflammation. This inflammation in the facet joint, which is causing the cyst, is actually thriving due to the facet joint’s inability to fully heal on its own, and PRP or stem cells will initiate this healing. The pros to this treatment is the patient’s own PRP or stem cells are injected, and there is no surgery and no dangerous steroids required. Watch Dr. Centeno’s video above as he walks us through a facet cyst treatment.
Surgical Excision for Facet Cyst
Surgical excision involves invasively cutting out the cyst. The surgeon will create a tunnel to access the joint and likely perform a laminectomy (removing some bone). Once this is accomplished, the surgeon will access the spine and cut out (excise) the cyst. Pros: no more cyst. Cons: damage to the stabilizing muscles as the site is accessed, longer recovery, and generally unnecessary except perhaps in very extreme circumstances where the benefits are sure to outweigh the risks.
If you have a facet cyst that is putting pressure on a spinal nerve, you know how painful these cysts can be. Steroids or surgery come with many complications and side effects, so when considering facet cyst treatment, if at all possible, keep these options off your list.