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Age: 77

Sex: Male

Indication: Bilateral lower extremity weakness and pain

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Case #20


Findings

  • Lumbarization of the S1 vertebral body
  • 5 mm T2/STIR hyperintense extradural structure on the right at the level of L1-L2 extending medially from the facet joint, which results in severe spinal canal stenosis and mass effect on the conus
  • Increased T2/STIR signal centrally in the conus at the level of L1-L2
  • Multilevel broad-based disc bulges, facet hypertrophy, ligamentum flavum thickening, and epidural lipomatosis contribute to advanced spinal canal stenosis at L3-L4 and L4-L5, moderate spinal canal stenosis at L2-L3 and L5-S1, and varying degrees of multilevel neural foraminal stenosis, which is severe on the right at L1-L2, on the right at L4-L5, and bilaterally at L5-S1
  • Trace anterolisthesis at L5-S1
  • Distended urinary bladder


Diagnosis

  • Synovial cyst with cord compression

Sample Report

Transitional lumbosacral anatomy with lumbarization of the S1 vertebral body.

5 mm synovial cyst on the right at L1-L2 which severely narrows the spinal canal and exerts mass effect on the conus. T2/STIR signal hyperintensity in the conus at this level concerning for edema.

Multilevel broad-based disc bulges, facet hypertrophy, ligamentum flavum thickening, and epidural lipomatosis contribute to advanced spinal canal stenosis at L3-L4 and L4-L5, moderate spinal canal stenosis at L2-L3 and L5-S1, and varying degrees of multilevel neural foraminal stenosis, which is severe on the right at L1-L2, on the right at L4-L5, and bilaterally at L5-S1.


Discussion

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Images

T2/STIR hyperintense structure along the medial aspect of the right L1-L2 facet joint (red arrows) with associated cord compression, concerning for a synovial cyst.



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