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Ishibashi K, Segawa T, Kaneko T, Takano Y, Iwai H, Inanami H, Koga H. A multilocular discal cyst extending from the spinal canal to the extraforaminal region: A case report. J Orthop Sci 2023:S0949-2658(23)00202-6. [PMID: 37541920 DOI: 10.1016/j.jos.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Lumbar discal cysts are intraspinal extradural cysts communicating with the intervertebral disc. The usual location and morphology are in the caudal ventrolateral epidural space of the spinal canal, without extension to the neural foramen or crossing the midline and described as a well-defined homogeneous oval or spherical cyst on low and high signal intensities observed in lumbar lesions on T1- and T2-weighted magnetic resonance imaging, respectively. We report an unusual lumbar discal cyst in terms of the lesion location and morphology. CASE PRESENTATION A 33-year-old-man presented with lower back and right anterior thigh pain. Magnetic resonance imaging revealed multilocular cystic lesions in the cranial ventrolateral epidural space at L2-L3 with low and high signal intensities on T1- and T2-weighted magnetic resonance imaging, respectively. We performed a full-endoscopic transforaminal cystectomy under general anesthesia. CONCLUSION Lumbar discal cysts should be considered a differential diagnosis for multilocular intraspinal cystic lesion.
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Affiliation(s)
- Katsuhiko Ishibashi
- Department of Orthopaedics, Iwai Orthopaedic Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; Department of Neurosurgery, Iwai FESS Clinic, 8-18-4 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan.
| | - Tomohide Segawa
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Takeshi Kaneko
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Yuichi Takano
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Hiroki Iwai
- Department of Orthopaedics, Iwai Orthopaedic Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; Department of Neurosurgery, Iwai FESS Clinic, 8-18-4 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Hirohiko Inanami
- Department of Orthopaedics, Iwai Orthopaedic Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; Department of Neurosurgery, Iwai FESS Clinic, 8-18-4 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; Department of Neurosurgery, Iwai FESS Clinic, 8-18-4 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan
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Fu CF, Tian ZS, Yao LY, Yao JH, Jin YZ, Liu Y, Wang YY. Postoperative discal pseudocyst and its similarities to discal cyst: A case report. World J Clin Cases 2021; 9:1439-1445. [PMID: 33644213 PMCID: PMC7896671 DOI: 10.12998/wjcc.v9.i6.1439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative discal pseudocyst (PDP) is a rare condition that presents after surgery for lumbar disc herniation. Due to the lack of information, the diagnosis and treatment of PDP remain controversial. Herein, we report a PDP case that occurred following percutaneous endoscopic lumbar discectomy and received conservative treatment. Additionally, we review all the published literature regarding PDP and propose our hypothesis regarding PDP pathology.
CASE SUMMARY A 23-year-old man presented with a relapse of low back pain and numbness in his left lower extremity after undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation. Repeat magnetic resonance imaging demonstrated a cystic lesion at the surgical site with communication with the inner disc. The patient was diagnosed as having PDP. The patient received conservative treatment, which resulted in rapid improvement and spontaneous regression of the lesion, and had a favorable outcome in follow-up.
CONCLUSION PDP and discal cyst (DC) exhibit similarities in both histological and epidemiological characteristics, which indicates the same pathological origin of PDP and DC. The iatrogenic annular injury during discectomy might accelerate the pathological progression of DC. For patients with mild to moderate symptoms, conservative treatment can lead to great improvement, even inducing spontaneous regression. However, surgical cystectomy is necessary in patients with neurological deficits and where conservative treatment is ineffective.
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Affiliation(s)
- Chang-Feng Fu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhi-Sen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Li-Yu Yao
- Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ji-Hang Yao
- Department of Traumatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yuan-Zhe Jin
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ying Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yuan-Yi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
- Department of Spine Surgery, Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun 130021, Jilin Province, China
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Choi HS, Lee SH, Lee YJ, Ha IH. Nonsurgical integrative Korean Medicine treatment of discal cyst: A case report and a retrospective chart review analysis. Medicine (Baltimore) 2019; 98:e16189. [PMID: 31277125 PMCID: PMC6635264 DOI: 10.1097/md.0000000000016189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Discal cysts are rare lesions characterized by pain caused by neurogenic compression with similar symptoms as those of disc herniation. This study aims to report the spontaneous regression of discal cyst achieved through nonsurgical integrative Korean Medicine treatment and the clinical epidemiological features of discal cyst cases collected from 4 institutions. PATIENT CONCERNS A 31-year-old woman had low back pain and radiating pain equivalent to a numeral rating scale (NRS) of 8 and had limitations in daily work and activities. DIAGNOSES The patient was diagnosed as having discal cysts that compressed the left S1 based on findings of L-spine magnetic resonance imaging (MRI) performed at our hospital. INTERVENTIONS The patient received nonsurgical Korean Medicine treatment and after 24 days of treatment in the hospital, she underwent 16 additional treatments as an outpatient. OUTCOMES Spontaneous regression was confirmed in the L-spine MRI follow-up at 36 days and 99 days after the initial test, and the patient underwent once-a-week follow up to examine NRS, Oswestry Disability Index (ODI), EuroQol-5 Dimensions (EQ-5D), and fear-avoidance beliefs questionnaire (FABQ) after 4 weeks, and 2, 3, and 6-month follow-ups after that. The patient was discharged in a painless condition, and she was able to carry on for 5 months without increased pain. LESSONS Discal cysts are more rapid progress than disc herniation, it seems valid to attempt nonsurgical treatment. Epidemiologically, this is the first study to present the clinical epidemiological characteristics of discal cysts, it would provide valuable information to clinicians who treat and study discal cysts.
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Affiliation(s)
- Hee-seung Choi
- Jaseng Hospital of Korean Medicine
- Department of Medical Science of Meridian, Graduate School, Kyung Hee University
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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Cultrera F, Nuzzi D, Panzacchi R, Cataldi ML, Lofrese G. A proposal of degenerative anterior epidural cysts of the lumbar spine. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Park JW, Lee BJ, Jeon SR, Rhim SC, Park JH, Roh SW. Surgical Treatment of Lumbar Spinal Discal Cyst: Is It Enough to Remove the Cyst Only without Following Discectomy? Neurol Med Chir (Tokyo) 2019; 59:204-212. [PMID: 31068543 PMCID: PMC6580042 DOI: 10.2176/nmc.oa.2018-0219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Discal cysts are a rare cause of low back pain and radiculopathy with unknown pathophysiologic mechanism. Associated symptoms are difficult to distinguish from those caused by extruded discs and other spinal canal lesions. Most discal cysts are treated surgically, but it is unclear whether the corresponding intervertebral disc should be excised along with cyst. We conducted a retrospective clinical review of 27 patients who underwent discal cyst excision at our institution between 2000 and 2017. The mean follow-up period was 63.6 months. We recorded symptoms, radiographs, operative findings, postoperative complications, and short- and long-term outcomes. Structured outcome assessment was based on Numeric Rating Scale (NRS) for pain intensity, Oswestry disability index, and Macnab classification. All patients underwent partial hemilaminectomy and microscopic cyst resection without discectomy. All patients had preoperative back or leg pain. Other preoperative clinical features included motor weakness, neurogenic intermittent claudication, and cauda equina syndrome. After surgery, NRS scores of back and leg pain decreased. The other symptoms also improved. During long-term follow-up, patients reported no restrictions on daily life activities, and were satisfied with our intervention. There were no cases of cyst recurrence. We conducted a review of the literature on lumbar discal cysts published before January, 2018. Including our cases, 126 patients were described. We compared two surgical modalities—cystectomy with and without discectomy—to elucidate both effectiveness and long-term complications. We found that microsurgical cystectomy without corresponding discectomy is an effective surgical treatment for lumbar discal cysts, and is associated with a low recurrence rate.
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Affiliation(s)
- Jung Won Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center
| | - Sang-Ryong Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Seung-Chul Rhim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung Woo Roh
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
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Abstract
Our patient, a 22-year-old starting wide receiver for an NCAA Division I football team, presented with low back pain and sciatica. A lumbar-spine MRI without contrast demonstrated findings suspicious for discal cyst. The patient was referred for surgery, and the lesion was resected. The rarity of discal cyst makes it difficult to diagnose because most radiologists are not aware of the entity. An organized approach to diagnosis can facilitate appropriate management.
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Certo F, Visocchi M, Borderi A, Pennisi C, Albanese V, Barbagallo GMV. Lumbar intervertebral discal cyst: a rare cause of low back pain and radiculopathy. Case report and review of the current evidences on diagnosis and management. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:141-8. [PMID: 25364328 PMCID: PMC4212701 DOI: 10.1055/s-0034-1387806] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/02/2014] [Indexed: 12/21/2022]
Abstract
Study Design Case Report and review of the literature. Objective The objective of the article is to report an illustrative case successfully treated by microsurgery and to review the literature on the current evidence on diagnosis and management of lumbar discal cysts. Methods A 43-year-old male patient presented with severe back pain, radiating down to the right leg, as well as with paraesthesias in the right L3 and L4 dermatomes. Magnetic resonance imaging of the lumbar spine revealed an intraspinal, extradural space-occupying lesion at the L3–L4 disc level, causing compression of the neural structures. The lesion was surgically removed and a diagnosis of lumbar discal cyst was made. Postoperatively, symptoms improved and the patient was discharged with no complications. A systematic review of pertinent articles published up to February 2014 was performed. Key articles were searched to identify studies describing the diagnosis and management modalities of lumbar discal cysts and the comparative effectiveness and safety of microsurgery versus endoscopic treatment. Conclusions Discal cysts are rare causes of low back pain and radiculopathy. Few cases have been reported; however, conclusive information about their natural history is not available and the best mode of treatment remains controversial. We submit that lumbar intervertebral disc cysts, with their peculiar radiological and anatomic features, should be considered in the differential diagnosis among rare causes of low back pain and radiculopathy.
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Affiliation(s)
- Francesco Certo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | | | - Alessandro Borderi
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | - Claudia Pennisi
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | - Vincenzo Albanese
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | - Giuseppe M V Barbagallo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy
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