title: Acute sciatica and progressive neurological deficit secondary to facet synovial cysts: A report of two cases.
abstract: OBJECTIVE
  To describe two patients with lumbar facet synovial cysts causing sciatica and progressive neurological deficit.
  
  
  METHODS
  A 52-year-old female with bilateral sciatica and a neurological deficit that progressed to a foot drop; and a 54-year-old female with worsening sciatica and progressive calf weakness were seen at a major tertiary care centre. Diagnostic imaging studies revealed the presence of spinal nerve root impingement by large facet synovial cysts.
  
  
  RESULTS
  Activity modification, gabapentinoid and non-steroidal anti-inflammatory medications were unsuccessful in ameliorating either patient's symptoms. One patient had been receiving ongoing lumbar chiropractic spinal manipulative therapy despite the onset of a progressive neurological deficit. Both patients eventually required surgery to remove the cyst and decompress the affected spinal nerve roots.
  
  
  CONCLUSIONS
  Patients with acute sciatica who develop a progressive neurological deficit while under care, require prompt referral for axial imaging and surgical consultation. Primary care spine clinicians need to be aware of lumbar facet synovial cysts as a possible cause of acute sciatica and the associated increased risk of the patient developing a progressive neurological deficit.
authors.affiliation: Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Division of Spine, Department of Orthopaedics & I.C.O.R.D. (International Collaboration on Repair Discoveries), University of British Columbia, Vancouver, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Arthur
authors.forename: Peter
authors.initials: P
authors.lastname: Lewkonia
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Quon
authors.forename: John
authors.initials: J
authors.lastname: Street
authors.forename: Paul B
authors.initials: PB
authors.lastname: Bishop