To describe two patients with lumbar facet synovial cysts causing sciatica and progressive neurological deficit. 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. 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. 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.

J Can Chiropr Assoc. 2012 Sep;56(3):173-8. Arthur B, Lewkonia P, Quon JA, Street J, Bishop PB. 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.

by Joyce-Anne Locking

This is the time of your life whether or not you find ways to enjoy each minute of the day or take the time to express the direction of your dearest dreams. Today is the day you begin again to solve whatever problems are holding you back from doing the things you were meant to do. Plan your life in a way that expects you to succeed. Things happen to work out for the better when you focus on goals that encourage progress by offering you rewards at the end. When you keep your mind set to the intention of achieving your goal, you will find it much easier to enjoy the moment.

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Careful study of the posttraumatic stress disorder and hypnosis literatures reveals some parallels between posttraumatic flashbacks and responses to posthypnotic suggestions. Highly susceptible subjects can slip into hypnosis spontaneously and accept and respond to implied or inadvertent suggestions, some of which may operate in a manner equivalent to posthypnotic suggestions. Later, exposure to appropriate cues may trigger an intrusive revivification of the hypnotic state in which the suggestion occurred. This sequence of events closely resembles the sequence of reactions that some individuals have to trauma that ultimately leads to flashbacks. Thus, flashbacks may be conceived of as intrusive posttraumatic revivifications of trauma-induced hypnosis-like states that are reactivated by trauma-reminiscent cues operating similarly to posthypnotic signals. Implications of viewing flashbacks in this way, especially if this view is supported by future research, could include significant changes in how posttraumatic stress disorder is conceptualized and treated.

J Trauma Dissociation. 2012 Oct;13(5):568-81. Lovern J. Department of Applied Social Sciences , Allan Hancock College , Santa Maria , California , USA.