A 64 year old male presented with a one year history of pain extending from the buttock to the outside of the thigh and stopping outside the ankle. He experienced numbness in the same distribution with weakness noted in the ankle. His symptoms were increasingly bothersome and impairing his ability to walk.
His previous non-operative treatment had included: formal physical therapy, chiropractic manipulation, anti-inflammatory medications, narcotic medications and a series of epidural steroid injections.
On examination, he was found to have restricted lumbar range of motion with pain on extension and weakness in his great toe and hip musculature on single leg stance (muscles affected by the L5 nerve root). His sensation was diminished down the right leg and sciatic nerve stretch testing was positive.
He was diagnosed by MRI with arthritis of the facet joint with a large right-sided L4-L5 facet cyst. The cyst was resulting in severe compression of the right L5 nerve root, manifesting in pain, numbness, and weakness.
He underwent a microsurgical right L4-L5 laminotomy and neurologic decompression with removal of the facet cyst utilizing minimally invasive techniques.
The patient was discharged the same day of his surgical procedure. He subsequently followed up two weeks later for his post-operative appointment and was pain free. His strength and sensation had significantly improved.