Question: Hi,

I recently got an MRI of the lumbrosacral spine for severe pain radiating down my left side (sciatica), & these were the findings which I'm confused about.

The conus medullaris & cauda equina are normal. There is a hemangioma formation noted in the L3, L2, T1 & T12 vertebraes. There is normal disc height. There is decreased disc signal at L4-L5 & L5-S1.

At L5-S1, there is grade 1 anterior spondylolisthesis. Associated at this level is a large synovial cyst significantly stenosing the right aspect of the canal & extending in the midline. This prominent synovial cyst has an AP measurement of 9.6mm & transverse measurement of 7.4mm. There is extensive facet arthropathy with facet effusions noted at this level. There is uncovering of the disc with anterolisthesis. The disc has an AP measurement of 6mm complicating the facet synovial cyst. Secondary to the elongation, there is moderate to severe foraminal stenosis.
Addendum:
L5-S1 demonstrates a left large synovial cyst from the facet joint extending into the left aspect of the canal significantly stenosing the lateral aspect of the canal. This complicates grade 1 anterior spondylolisthesis & associated disc herniation. Severe bilateral foraminal stenosis is seen at this level.


At L4-L5 level, there is an annular tear in the right lateral recess. There is a disc herniation broad-based in configuration. The disc has an AP measurement of 4mm. The herniation has some increased signal centerally.

At L-3-L4 level, there is disc bulging. There is no focal herniation. There is mild narrowing of the posterolateral recess secondary facet configuration.

L2-L3 & L1-L2 have normal in disc height & disc signal

Impression:
1. L3-L4 disc bulging with narrowing of the posterolateral recesses.
2. L4-L5 broad-based disc herniation, largest in the right lateral recess & foraminal region. Mild facet arthropathy. Annular tear in the right lateral recess
3. L5-S1 grade 1 anterior spondylolisthesis, extensive facet arthropathy with large left lateral recess synovial cyst with significant stenosis as a result.

Dr.
I've done some research on outcome of synovial cyst removeable, & reviews were mixed on the amount of pain relief given. I'm wondering if you can give me any indication the likelyhood of success with surgery. Since I've been seeing a chripractor, & using back strengthening excercises, I dramatically reduced my pain level. Can this be a long term alternative to surgery. Thank you .