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This is a patient who had nonspecific back

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pain that was bilateral and a little bit worse

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on the left side than the right side.

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As you scroll through the

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sagittal STIR images,

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what strikes me is a little bit of narrowing

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of the spinal canal at the L4-L5 level,

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with some element of decreased

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signal intensity within the disc.

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There may be a slight anterolisthesis

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of L4 with respect to L5.

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However, as you go further laterally,

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you come to the facet joint.

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And what one identifies here is high signal

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intensity in the synovium of the facet joint

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with something which is projecting posteriorly

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from that facet joint.

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If we look on the contralateral side,

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we see the same phenomenon.

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High signal intensity between the superior facet of

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L5 and the inferior facet of L4,

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which appears to communicate with

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a cystic area more posteriorly.

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These two are synovial cysts.

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They are posteriorly projecting synovial cysts.

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So just as you can have a synovial cyst that

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will go anteriorly and potentially indent the

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thecal sac and/or the exiting nerve roots,

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you can have synovial cysts that project posteriorly.

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On the axial scan, if I do the localizer again

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and we come to that level,

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you'll notice the bright signal intensity

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synovium of the facet joint,

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the overlying thickened ligamentum flavum.

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Again, which sort of begs the question,

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how can that synovial cyst get through that

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thick ligamentum flavum?

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In this case, however,

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what we are seeing are bright signal intensity

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cysts that are projecting posterior to the

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facet joint, again, associated with,

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as you saw, with a connection here, with that

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synovium and extending posteriorly.

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This is through the left side.

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So this is a source of back pain.

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It is something that should and could

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be treated. They could be drained.

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You can do facet blocks and reduce the

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irritation or inflammation, or pain associated

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with the inflamed facet joints.

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But it is something that's worth reporting

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because this, as I said,

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could be that source of back pain as opposed

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to focusing too much on the disc bulges or

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disc herniations in this individual.