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Right Leg Pain And Weakness With Prior Lumbar Fusion


Consult Page

73M with history of prior lumbar surgery with right leg pain and thigh weakness. MRI shows synovial cyst. Please evaluate.

Initial Imaging

Fig. 39.1, Sagittal (A) and axial (B) views of a T2-weighted MRI of the lumbar spine demonstrate bilateral facet hypertrophy contributing to severe L3-L4 canal stenosis and a right-sided synovial cyst (arrow) at this level with associated lateral recess and foraminal stenosis. There is artifact seen from the patient’s prior L4-L5 fusion hardware. These imaging findings are consistent with adjacent segment degeneration.

Walking Thoughts

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    What is the patient’s neurological exam?

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    What other symptoms does the patient have (e.g. mechanical back pain, bowel or bladder symptoms, saddle anesthesia)?

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    How long have the symptoms been bothering him?

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    What was the patient’s prior lumbar surgery? When was the surgery? What were the patient’s preoperative symptoms, and did they resolve after surgery?

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    Are his current symptoms similar to or different from those that he had before surgery?

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    What nonoperative measures, if any, has he tried?

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    What are the patient’s medical comorbidities?

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