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Surgery: Facet Synovial Cyst

My wife had a 6 mm synovial cyst in her facet joint. She is 65 and in otherwise good health. It causes great, but not intolerable, pain. According to the MRI, there is also Level 1 (minimal) stenosis in L4-L5. So far, she's had an aspiration and steroid injection, and, a few weeks later, an epidural. No help.

We don't know what to do next. She as seen physicians at four respected teaching hospitals.

The first neurosurgeon suggested excision fusing L5-S1 and L4-L5. He said he would, if we wanted, remove only the cyst without fusion, but he didn't recommend that.

The second recommended excising the cyst and fusing L5-S1.

The third prescribed Lyrica and coming back in six weeks if that didn't help. It hasn't. We go back in four weeks.

A fourth, a physiatrist, not a neurosurgeon, recommended injecting fluid into the cyst to burst it. He said a neurosurgeon would have to stand by in
case it didn't work or of there were another a problem.

What should we do? How do we know what the right choice is?



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