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Complaint : 36Y, Male c/o backache & pain in the lower limbs -  one year


 MRI :  Posterio-lateral extradural round cystic mass communicating with facet joint on Left side at L3/L4 level & causing   mass effect on thecal sac.

Lt.L3/L4 Synovial facet cyst.

Differential Diagnosis :

Extruded disc fragment

  • Not contiguous facet joint
  • Usually anterior epidural
  • Posterolateral uncommon
  • Not as hyperintense on T2 WI

Ganglion cyst

  • Likely from ligamentum flavum
  • Difficult to distinguish by imaging
  • Different pathologically
  • Contains myxoid material
  • Lined by fibrous connective tissue capsule

Nerve sheath tumor

  • Intradural extramedullary most common
  • “Dumbbell” lesion less common
  • Intense post – contrast – enhancement

Septic facet arthritis

  • Abscess extending out from facet joint
  • Simulating synovial cyst
  • Surrounding soft tissue edema and enhancement
  • Adjacent marrow edema

Asymmetric ligamentum flavum hypertrophy

  • Hypointense on T2Wi
  • More broad-based contour
  • Diffuse ligamentum flavum thickening/

REFERENCE : Jeffrey S. Ross,  Diagnostic Imaging, Spine 1st edition, 2004.


                              DR. D. PRASAD REDDY. DMRD.


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