The lumbar zygapophyseal (facet) joint spaces are paired synovial joints between the superior and inferior articular processes of adjacent lumbar vertebrae, oriented in the sagittal plane in the lumbar spine to allow flexion-extension while resisting rotation. Each joint has a synovial membrane, articular cartilage, and a fibrous capsule.
The lumbar facet joint space is the target for diagnostic medial branch blocks and therapeutic facet injections. CT fluoroscopy or X-ray guidance allows direct intra-articular injection. Facet joint capsular tears and synovial cysts are identified on MRI as periarticular fluid collections. Facet arthropathy with joint space narrowing and osteophyte formation is the most common spinal degenerative change.
Synovial cyst herniating from the lumbar facet joint capsule into the spinal canal producing radicular symptoms, identified on MRI as a T2-hyperintense periarticular mass and managed by aspiration, steroid injection, or surgical excision.
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