intraspinal juxtafacet cysts ( commonly , synovial or ganglion cyst ) can be an uncommon cause of lower and radicular pain , neurogenic claudication , and cauda equina syndrome2,9,10,13 ) .
spinal synovial cysts generally arise from a degenerated facet joint and often presenting as a gradual onset of back pain and potentially , chronic progressive radiculopathy
is a much less common occurrence , and patients may present with acute onset of symptoms3,13 ) .
we describe a case in which hemorrhage into a right l2 - 3 facet synovial cyst caused acute back pain and radiculopathy and required surgical excision .
a 72-year - old - woman with a past history of hypertension presented to the clinic with acute back pain radiating to the anterior surface of the right thigh and leg .
the right straight - leg - raise test elicited pain in the leg at 30 which was exacerbated further by ankle dorsiflexion .
magnetic resonance imaging ( mri ) revealed the presence of a cystic formation in the right l2-l3 facet joint with arthritis compressing the l3 right root and the dural sac ( fig .
, the mri displayed a hyperintense abnormality on t1-weighted images and hypointense on t2-weighted images consistent with hemorrhage .
the posterior elements from l1 to l3 were exposed and right l2-l3 laminectomy and facetectomy were performed .
a brownish mass was found in continuity with the right l2-l3 facet joint adherent to the dural sac .
the extradural hematoma was visualized and evacuated , effectively decompressing the right 2 nerve root and sacral sac .
microscopically , there was a synovial cyst with synovial cell lining , neovascularization , hemosiderin microdeposits , and blood ( fig .
one month after the operation , the patient had no symptoms in her lower back and leg .
spinal synovial cyst can be defined as a soft tissue mass located extradurally along the medial border of a degenerated facet joint , especially l4 - 5 level1,4,8,11,12 ) .
these cysts are filled with clear or xanthochromic fluid and have a synovial - like epithelial lining with a demonstrable connection to a joint capsule3,11 ) .
if the synovial cell lining and the communication with a joint capsule are absent , the cyst is classified as ganglion11 ) .
intraspinal synovial cysts are rare but have been documented with increasing frequency because of the improvement of neuroradiological imagings4 ) .
an mri is considered a good modality for diagnosis . on mri , cysts appear as well - circumscribed , epidural mass lesions that are hypo- and hyper - intense on t1 and t2 weighted images , respectfully . bleeding into a synovial cyst may cause a sudden expansion of the cyst leading to compression of the epidural space result in root compression symptoms .
hemorrhage into a synovial cyst results in an acute increase in pain and radicular symptoms , including neurological deficits12 ) .
hemorrhagic presentation can be caused by anticoagulation treatment , trauma , disc herniation , vascular anomaly , and neoangiogenesis in the cyst4 ) .
in addition , high vascularization of the cyst can cause hemorrhage in spite of minor trauma or just spinal instability .
synovial cyst hemorrhagic events in some cases can occur despite the absence of trauma or coagulopathy13 ) . as a result ,
other yet to be determined risk factors for synovial cyst hemorrhage occurrence exist prompting the need for more studies .
non - hemorrhagic synovial cysts are occasionally treated by percutaneous aspiration with successful resolution of symptom6 ) .
the injection of corticosteroid agents into the facet joint may be an treatment option . despite conservative treatment , recurrence of cyst with symptoms
the natural history of spinal synovial cysts is unknown , but spontaneous remissions of a synovial cyst on follow up imaging with improved symptoms have been reported5 )
however , pain can be treated with steroid injections and bed rest in substantial number of patients .
we report of a case in which hemorrhage into a right l2 - 3 facet synovial cyst causing an acute back pain and radiculopathy .
treatment by resection of the cyst and evacuation of the hematoma led to complete neurological recovery .
synovial cysts of the lumbar spine are an uncommon cause of back and radicular pain .
rarely , these cysts can go through hemorrhagic transformation by trauma , anti - coagulopathic state , or for unknown reasons .
hemorrhage into a cyst is an uncommon occurrence that can lead to acute symptom . in most cases , surgery is the treatment of choice for symptomatic hemorrhagic synovial cysts .
surgery involving the evacuation of the hematoma and/or cyst can result in complete resolution of acute symptoms and neurologic deficit .
 synovial cysts of the lumbar spine are an uncommon cause of back and radicular pain . 
 these cysts most frequently present as back pain , followed by chronic progressive radiculopathy or gradual onset of symptoms secondary to spinal canal compromise . 
 although less common , they can also present with acute spinal cord or root compression symptoms . 
 we report of a case in which hemorrhaging into a right l2 - 3 facet synovial cyst caused an acute onset of back pain and radiculopathy , requiring surgical excision . 