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A 55-year-old man presents with low back pain that has progressed over the last year. He reports the pain is worse with activity, especially when bending forward and lifting objects. He denies any pain in the buttocks or lower extremities. On physical he has age-appropriate motion in the lumbar spine. He is neurologically intact in the lower extremities. Figure A shows his axial and sagittal T2-weighted MRI scans. A histological sample of this lesion would most likely show
dense, compact concentric lamellae of fibrocollagenous tissue with occasional fibroblast-like chondrocytes
semifluid gelatinous matrix with oval chondrocytes
ossified nidus surrounded by a radiolucent halo, in turn surrounded by dense, reactive osteosclerosis
irregular fascicles of collagenous stroma with pleomorphic cells with foamy cytoplasm and marked atypia in a storiform pattern
synovial cells covering a stroma with vascular granulation tissue
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A 58-year-old man returns to your clinic complaining of 2 months right-sided buttock and lateral thigh and leg pain. He previously underwent lumbar laminectomy for similar symptoms. Figure A shows his T2 axial MRI sequence obtained prior to his initial surgery. He is scheduled for new MRI tomorrow. If his new MRI shows similar pathology, what is the most appropriate treatment at this time?
NSAIDs and physical therapy
Cyst aspiration and epidural steroid injection
Revision lumbar laminectomy
Revision lumbar laminectomy with right-sided foraminotomy
Revision lumbar laminectomy and instrumented fusion
A 60-year-old male has right leg radicular pain with hip abductor and EHL weakness. An MRI is shown in figures A-C. What is the source of this patient's symptoms?
paracental disk herniation
far lateral disk herniation
facet synovial cyst
hypertrophic ligamentum flavum