• Anan Shtaya, Ahmed-Ramadan Sadek, Mark Walker, and Ali Nader-Sepahi.
• Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom. Electronic address: ashtaya@sgul.ac.uk.
• World Neurosurg. 2017 Oct 1; 106: 1055.e1-1055.e3.

BackgroundJuxtafacet spinal cysts are cystic synovial lesions that often are indistinguishable clinically or radiologically and require histopathology analysis to confirm the diagnosis. Lumbar synovial cysts usually arising from the synovium of the facet joints. They have been described posterolaterally or rarely in the posterior midline. However, we describe the first synovial cyst ventral to the dural sac.Case DescriptionWe report a lumbar 3-4 lesion causing cauda equina compression in a 57-year-old man who presented with a 3-month history of low back pain and bilateral sciatica, intermittent urinary incontinence, and erectile dysfunction. Preoperative magnetic resonance imaging suggested prolapsed disc, after decompression, histological analysis of the fragment confirmed a synovial cyst.ConclusionsHitherto synovial cysts have not been reported anterior to the dural sac. We describe a lumbar ventral cystic mass with cauda equina compression that mimicked a disc prolapse due to synovial metaplasia. The patient had urgent decompression with subsequent resolution of the symptoms.Copyright © 2017 Elsevier Inc. All rights reserved.

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