melwind1ParticipantDecember 3, 2019 at 1:27 pmPost count: 2
In your opinion, what is the best to treat L3L4 facet synovial inflammatory cyst is causing severe radicular symptoms in a 55 year old male with DJD of lumbar spine. Epidural injection made it worse, L4L5 injection did not help at all. The doctor he is seeing is wanting to inject the next level with injection of the cyst, instead of removing the cyst which we are convinced is causing most of his debilitating symptoms after studying the literature. We understand that removal (with or without fusion) has a 95% success rate while injection/fenestration has a 50% success/failure rate. We are impressed with your book, and want to know what your strategy would be given that information. Thank you sincerely, Melanie.Donald Corenman, MD, DCModeratorDecember 4, 2019 at 7:41 amPost count: 8468
Typically, a ganglion or synovial cyst is associated with a degenerative spondylolisthesis at the same level. If there is no significant slip or instability (which can be determined by flexion-extension X-rays), the cyst can be removed surgically with about a 90% success rate. The recurrence rate is about 10%. If there is instability or a significant slip, the surgery would be a TLIF with the same success rate and 0% recurrence rate.
There is nothing wrong with fenestration attempts but it is rare to have a cyst not recur with that technique.
Dr. Corenmanmelwind1ParticipantDecember 5, 2019 at 8:27 amPost count: 2
I cannot thank you enough for the rapid reply with such good information. Read your very explanatory articles you referred us to. My husband has seen two different spine surgeons and the interventionist (radiology), had a general epidural and bilateral L4L5 facet joint injections, with worsening symptoms. Not one has done flexion extension X-rays or explained that Degenerative Spondylolisthesis is most likely the problem given his symptoms which seem to exactly correlate with the ones you listed. He is calling his GP today to obtain flexion extension X-rays and we will be sending these along with the MRI and an EOS imaging scan, and paying for your opinion regarding these. Again, thank you so very much. Melanie and Jim.
- You must be logged in to reply to this topic.