Abstract
Symptomatic synovial lumbar facet cysts are a relatively rare cause of radiculopathy and spinal stenosis. This case and brief review of the literature, details a patient who presented with acutely symptomatic bilateral spontaneously infected synovial facet (L4/5) cysts. This report highlights diagnostic clues for identifying infection of a facet cyst.
Introduction
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| Figure 1. Advanced degenerative changes of the L4/5 facets are seen on these AP radiograph and CT scan images. (1A, B and D) Note the subchondral sclerosis and cystic changes. The axial T2 MRI image shows a focal fluid-like collection in bilateral L4/5 facet joints with contiguous extension into the midline dorsal epidural space (dotted line) (1C). Additionally, there is heterogeneous increased signal in the paravertebral muscles. There is no evidence of spondylodiscitis or paravertebral muscle abcess. |
Lumbar facet cysts are a less common but well documented cause of compressive radiculopathy and lumbar spinal stenosis, with approximately 500 total cases reported in the literature1-5. The lumbar facet is a synovial-lined zygoaphophyseal joint, comprising the articulation between the inferior and superior articulating processes of the spinal vertebrae. The facet joint, like synovial lined joints of the appendicular skeleton, are prone to cyst