Stephen Newman, MD Family Practice Case Review Stephen Newman, MD Family Practice

June 2016 52 yo Af Am male- presented to ED debilitating left pelvic pain radiating form the hip. Progressive for 5 months Insidious onset/no trauma/ no previous LBP No bowel/bladder dysfunction Pain increased with walking

PMHx was found to have untreated HTN at the time of his presentation Social married attorney who enjoys golf No cig/ETOH abuse No past surgery/medications/hospitalizations FH positive for HTN/diabetes/prostate cancer ROS no constitutional sx

Positive exam findings Hypertension and pain with hip flexion Pelvic MRI negative Llumbar MRI diffuse annular buldge L4-5 L5-S1 Small annular tear L4 Question of cyst L4

Treatment Over the next several months symptoms waxed and waned with OMM/NSAIDS/Baclofen/stretching

9 months Symptoms returned unable to play golf or sit or stand for prolonged periods pain relieved with constantly changing position Further evaluation for neuropathy LLE confirmed electrophysiological evidence of bilateral S1 and left L5 radiculopathy

Repeat MRI cyst again noted L4 nerve root Likely synovial cyst with severe left neural foraminal narrowin L4-5 Spine consult with Drs. Rumery and Suzman resulted in a left ESI which gave 80-100% pain relief for a period of time

Currently Pain waxes and wanes Influenced by activity Relief with gabapentin/baclofen Limited ability to golf and stand for prolonged periods Considering surgical intervention