Posterior thecal lumbar disc herniation mimicking synovial cyst

We describe a 70 year-old-patient with a rare, misleading presentation of lumbar disc prolapse, which on CT mimicked a synovial cyst. The whole nucleus pulposus had herniated, become sequestrated, and migrated behind the theca adjacent to the L4-5 facet joint. There was no continuity of the disc material with the intervertebral space. A fenestration was performed and the sequestrated disc material was found free of adhesions, and removed completely without difficulty. Histopathological examination confirmed the diagnosis. The patient had complete relief from his pain.