MR imaging of lumbar facet joint synovial cysts

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.