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Pain

1311 - Lumbar Compression Fracture With Severe Right L5-S1 Foraminal Stenosis Due to Lumbar Synovial Facet Cyst in an Elderly Male Treated With Vertebral Augmentation and Cyst Rupture: A Case Report

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Lumbar Compression Fracture With Severe Right L5-S1 Foraminal Stenosis Due To Lumbar Synovial Facet Cyst

Case Description: An 88-year-old male presented with acute low back and right posterolateral leg pain consistent with L5/S1 radiculitis. Imaging demonstrated an acute L5 vertebral compression fracture (VCF) and severe right L5-S1 foraminal stenosis. Bipedicular L5 vertebral augmentation was performed utilizing expandable titanium implants. The patient’s axial back pain resolved, though radicular symptoms persisted. Transforaminal epidural steroid injection at L5-S1 did not yield significant relief. A small, anteriorly-projecting synovial cyst arising from the right L5-S1 facet joint was noted on repeat MRI. Fluoroscopically-guided percutaneous cyst rupture with epidural steroid injection yielded complete resolution of the patient’s radicular pain.

Discussions: This case highlights the complexity of managing lumbar radiculitis in the setting of concurrent acute VCFs. Radicular symptoms are a relative contraindication to vertebral augmentation, but surgical options in the elderly, osteoporotic population are limited. Considering stenosis location, biomechanical changes associated with height loss, and approach to vertebral augmentation may yield options for non-surgical pain relief. The L5 segment height loss was thought to contribute to foraminal stenosis at L5-S1 creating stress on posterior elements. Vertebral augmentation using expandable titanium implants was chosen to restore height to the vertebral body, stabilize the fracture, and redistribute forces across the columns. Subsequent cyst decompression relieved the patient’s radicular symptoms, but changes in force distribution associated with vertebral augmentation yielded more durable results for a procedure that typically risks a 50% cyst recurrence rate.

Conclusions: The combined use of expandable titanium implant vertebral augmentation and facet cyst rupture with epidural steroid injection addressed both axial and radicular pain, leading to complete symptom resolution. This highlights the critical importance of thorough imaging review, analysis of biomechanical factors, and procedural risk associated with varying approaches to vertebral augmentation.