Introduction A degenerative lesion of the lumbar spine that often presents with radicular symptoms Epidemiology incidence rare location usually in lumbar spine 60% to 89% occur at the L4-L5 level (most mobile segment) Pathophysiology possible etiologies trauma (controversial) microinstability of the facet leading to extruded synovium through joint capsules myxoid degeneration of collagen tissue proliferation of fibroblasts with increased hyaluronic acid production Associated conditions degenerative spondylolisthesis Presentation Symptoms mechanical back pain radicular symptoms (leg pain) neurogenic claudication (buttock/leg pain with walking) Physical exam may see nerve root deficits at associated spinal levels Imaging Radiographs recommended views required AP lateral, lateral, flexion and extension of spine findings usually normal look for segmental instability MRI indications significant leg pain views best seen on T2 axial and sagittal images Treatment Nonoperative NSAIDS, rest, immobilization indications mild symptoms CT guided aspiration technically challenging and usually not effective Operative laminectomy with decompression indications classical first line for symptomatic intraspinal synovial cysts outcomes high incidence of recurrent back pain and cyst formation within two years facetectomy and instrumented fusion indications some consider first line of surgical treatment due to high recurrance rates symptomatic recurrance following laminectomy with decompression outcomes demonstrated to have the lowest risk of persistent back pain and recurrence of cyst formation in recent studies Complications Cyst recurrence high incidence of recurrence with resection alone new studies favor facetectomy and fusion as first line of operative treatment
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ12.167) 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 Review Topic QID: 4527 FIGURES: A Type & Select Correct Answer Type in at least one full word to see suggestions list 1 dense, compact concentric lamellae of fibrocollagenous tissue with occasional fibroblast-like chondrocytes 7% (271/3632) 2 semifluid gelatinous matrix with oval chondrocytes 33% (1211/3632) 3 ossified nidus surrounded by a radiolucent halo, in turn surrounded by dense, reactive osteosclerosis 2% (67/3632) 4 irregular fascicles of collagenous stroma with pleomorphic cells with foamy cytoplasm and marked atypia in a storiform pattern 8% (291/3632) 5 synovial cells covering a stroma with vascular granulation tissue 48% (1746/3632) L 4 Select Answer to see Preferred Response SUBMIT RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ04.139) 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? Review Topic QID: 1244 FIGURES: A B C Type & Select Correct Answer Type in at least one full word to see suggestions list 1 paracental disk herniation 3% (73/2372) 2 far lateral disk herniation 1% (34/2372) 3 facet synovial cyst 89% (2106/2372) 4 hypertrophic ligamentum flavum 0% (11/2372) 5 intradural tumor 6% (133/2372) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 3
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