The L5-S1 zygapophyseal bursa is the most commonly symptomatic lumbar facet bursa, located at the junction between the L5 inferior articular process and the S1 superior articular process. Its coronal orientation and high mechanical loading make it the most frequent site of facet synovial cyst formation in the lumbar spine.
L5-S1 facet bursitis and synovial cysts are a major cause of L5 and S1 radiculopathy in patients over 50 with facet arthrosis. The cyst projects into the lateral recess and compresses the descending L5 or S1 nerve root. Fluoroscopic rupture via intra-articular steroid injection resolves approximately 50% of cases. Surgical cyst excision and decompression is indicated for progressive neurological deficit or failed injection.
Facet bursal distension projecting into the lateral recess at L5-S1, producing unilateral leg pain and radiculopathy indistinguishable from disc herniation, confirmed by MRI showing a cystic structure adjacent to the facet joint.
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