MR imaging of lumbar facet joint synovial cysts

Abstract

The increasing application of magnetic resonance (MR) imaging of the spine has raised the awareness of lumbar facet synovial cysts (LFSC). This well recognised, yet uncommon condition, presents with low back pain and radiculopathy due to the presence of an extradural mass. The commonest affected level is L4/5 with a mild degenerative spondylolisthesis a frequent associated finding. MR imaging is the technique of choice to detect and diagnose a LFSC. This pictorial essay, drawing on experience of 43 cases seen in 40 patients, illustrates the spectrum of appearances that can be encountered and suggest differing causes for the variable signal characteristics exhibited. Computed tomography (CT) can be of value in some cases to aid interpretation of the MR images. In addition, CT facet arthrography by injection of air or iodinated non-ionic contrast medium may be used to confirm the diagnosis in doubtful cases as well as noting whether the patients presenting symptoms can be provoked. A comprehensive review of the existing literature is presented.

Spinal Epidural Hemangiomas: Various Types of MR Imaging Features with Histopathologic Correlation

“…In our study, 2 cases demonstrated sudden onset myelopathy caused by an epidural hematoma in the background of a cavernous hemangioma. This finding was similar to that of Carlier et al 22 The differential diagnosis of spinal epidural hemangiomas included herniated disks, synovial cysts, granulomatous infections, neurogenic tumors, lymphomas, meningiomas, angiolipoma, pure epidural hematoma, and epidural extramedullary hematopoiesis depending on the MR types 5,8,11,[14][15][16][17][18][19] (On-line Table 2). In type A or B, spinal epidural hemangiomas were seen as a cystlike mass with peripheral enhancement.…”

“…5,8,11,[14][15][16][17][18][19] Because of the high vascularization of hemangiomas, this misinterpretation may result in unexpected intraoperative hemorrhage. Incomplete surgical removal of a spinal epidural hemangioma because of diffuse bleeding or minimal exposure during disk surgery might result in the persistence of clinical symptoms or recurrence.…”

Diagnosis and conservative management of degenerative lumbar spondylolisthesis

“…Jayakumar et al [28] in case series have shown that axial loaded MRI identified occult dynamic DS, which correlated with the clinical picture but was not shown on initial conventional MRI or plain radiography. The presence of facet joint synovial cysts (facet ganglia), which have a recognized association with degenerative spondylolisthesis, can also cause narrowing of the lateral recesses and are well shown on MRI [3].…”

Lumbar Synovial Cysts: Experience With Nine Cases

“…11) The incidence of lumbar synovial cysts is 0.65-2.3% according to the diagnostic method. 3,7) Magnetic resonance (MR) imaging has increased detection compared to older methods of myelography and computed tomography (CT) in patients with low back pain and radicular pain. 18,28) The overall prevalence of anterior and posterior facet joint cysts are 2.3% and 7.3%, respectively, and back pain is the primary symptom for cysts located posterior to the facet joint, possibly because the ligamentum flavum (LF) acts as a mechanical barrier against the formation of anterior cysts.…”