Disclosures: Amit Bhargava, MD, FAAPMR: Nothing to disclose

Case Description: IRB exemption was obtained. A 70-year-old male presented with complaints of right gluteal pain radiating to lateral aspect of the leg to the ankle for 3 weeks. He was referred for physical therapy. MRI revealed spondylosis and 4 mm cyst in the right lateral recess at L5-S1 adjacent to or compressing the right S1 nerve root. NCS/ EMG revealed acute right S1 radiculopathy, chronic right L5 radiculopathy, chronic left L4/L5 radiculopathy, bilateral sensory peripheral polyneuropathy. Patient had short-term pain relief after initial right S1 transforaminal injection and attempted bursting the cyst and injection of right L5-S1 facet joint injection. Two weeks later, right L5 transforaminal injection was performed and a second needle was inserted into the right L5-S1 facet joint. On injecting the facet joint, fluid was noted to exit from the needle in the L5 foramen. After injecting lidocaine, steroids were injected into the facet joint.

Setting: Medical outpatient office

Patient: A 70-year-old male with right lumbosacral radiculopathy.

Assessment/Results: At last conversation about 10 months after the injection, the patient did not have pain. Initial MRI of lumbar spine was again reviewed with the radiologist and on T2 axial images fluid-like structure was noted lateral to the facet joint in addition to the facet joint cyst, considered to be lateral extension of facet joint cyst.

Discussion: This is the first reported case, to our knowledge, of treatment of lumbar facet joint cyst with radiculopathy treated with injection of the extension of lumbar facet joint cyst lateral to the facet joint.

Conclusion: This case study illustrates the importance of looking for an extension of a lumbar facet joint lateral to the facet joint which may be easily and safely approachable by a needle.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rupture-of-lumbar-facet-joint-cyst-lateral-to-the-lumbar-facet-joint-in-a-patient-with-radiculopathy-a-case-report/