528 THE JOURNAL OF BONE AND JOINT SURGERY A GANGLION ARISING FROM A LUMBAR ARTICULAR FACET

A thirty-three-year-old woman presented with a six-month history of low back pain and left sciatica. The onset was insidious, with no previous back trouble or spinal injury. The lumbar discomfort was increased by all forms of activity and relieved by rest. Three months before admission the leg pain became clearly radicular in an L.5 and S. 1 distribution and accompanied by paraesthesiae. The leg pain was not increased by coughing, sneezing or straining. The sphincters were intact. The clinical course had been progressive with periodic remissions. Conservative treatment, including sev-era! prolonged periods of bed rest with traction, as well as a course of exercises, failed to give lasting relief. On examination, there was a right lumbar scoliosis with moderate muscle spasm on forward flexion, which in-creased her pain. Lateral bending in both directions elicited left buttoc