1
|
Saleemi M, Abrar S, Dherijha MSA, George KJ. A postoperative complication of lumbar discectomy: A discal/annular cyst. Surg Neurol Int 2022; 13:572. [PMID: 36600759 PMCID: PMC9805644 DOI: 10.25259/sni_947_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background A postoperative discal/annular cyst following lumbar discectomy may reproduce the symptoms/signs of a recurrent lumbar disc herniation (i.e., back pain and radiculopathy). Case Description A 21-year-old rugby player developed leg pain after an uncomplicated lumbar microdiscectomy. The repeat lumbar magnetic resonance imaging confirmed a postoperative lumbar annular/ discal cyst, for which he underwent repeat surgery. The diagnosis was further confirmed histopathologically at surgery. Conclusion Although rare, postoperative discal/annular cysts may be potential causes of recurrent postoperative pain and lumbar radiculopathy mimicking recurrent disc herniations.
Collapse
Affiliation(s)
- M Saleemi
- Corresponding author: M Saleemi, Department of Neurosurgery, Salford Royal Foundation Trust, Manchester, United Kingdom.
| | | | | | | |
Collapse
|
2
|
Muacevic A, Adler JR, Mohd Nasir N, Mohamed Ramlee FA, Lim TS, Mohd Nasir MN. Discal Cyst, a Physical Risk: A Case Report on Endoscopic Resection. Cureus 2022; 14:e32517. [PMID: 36654588 PMCID: PMC9838684 DOI: 10.7759/cureus.32517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Discal cysts are a rare diagnosis involving the formation of an intraspinal extradural cyst. They are a diagnostic challenge as it is difficult to differentiate discal cysts from other causes of back pain, neurological deficit, and radiculopathy. Due to its rarity, there is a lack of research-based evidence on the optimal management of the discal cyst. This case report aims to increase awareness of this diagnosis and to highlight a possible treatment option for this condition.
Collapse
|
3
|
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
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Manabe H, Higashino K, Sugiura K. A Rare Case of a Discal Cyst Following Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach. Int J Spine Surg 2019; 13:92-94. [PMID: 30805291 DOI: 10.14444/6012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A discal cyst is a rare lesion that causes low back pain and radiculopathy of the lower extremities. There are several reports of discal cysts occurring after surgery, but data are limited on their occurrence after percutaneous endoscopic discectomy (PED). A 21-year-old man with disc herniation at the L4-L5 disc level underwent PED via a transforaminal approach. The immediate postoperative course was uneventful and his symptoms were relieved. Six weeks after surgery, low back pain and mild pain in the left thigh recurred. Magnetic resonance imaging (MRI) revealed a cystic lesion adjacent to the left side of the L4-L5 intervertebral disc. Conservative treatment was ineffective, so we reoperated using PED with the same approach. Pain improved and MRI revealed disappearance of the cystic lesion. When symptoms relapse after PED, it is necessary to consider the occurrence of a cyst.
Collapse
Affiliation(s)
- Hiroaki Manabe
- Orthopedic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa, Japan
| | - Kosaku Higashino
- Orthopedic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa, Japan
| | - Kosuke Sugiura
- Orthopedic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa, Japan
| |
Collapse
|
6
|
Kim HS, Adsul N, Kapoor A, Siddiqui S, Jang IT, Oh SH. Redefining the Evolution of Spinal Discal Cyst Under Percutaneous Endoscopy: Report of Two Cases. Asian J Neurosurg 2019; 14:890-893. [PMID: 31497121 PMCID: PMC6703071 DOI: 10.4103/ajns.ajns_27_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Discal cyst has been recognized as a distinct cause of back pain and radiculopathy. The clinical features are similar to other pathologies as disc prolapse and stenosis. Various treatment modalities have been described, ranging from nerve blocks to surgical excision. There are scarce reports on the endoscopic appearance of discal cysts. The present paper based on two cases operated by transforaminal and interlaminar endoscopy at our institute demonstrates the explicit intraoperative view and different pathological components of discal cysts.
Collapse
Affiliation(s)
- Heun Sung Kim
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, South Korea
| | - Nitin Adsul
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, South Korea
| | - Ankur Kapoor
- Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, South Korea
| | - Shiblee Siddiqui
- Department of Orthopedics, Korea University Guro Hospital, Seoul, South Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
| | - Seong-Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, South Korea
| |
Collapse
|
7
|
Yu HJ, Park CJ, Yim KH. Successful Treatment of a Symptomatic Discal Cyst by Percutaneous C-arm Guided Aspiration. Korean J Pain 2016; 29:129-35. [PMID: 27103969 PMCID: PMC4837119 DOI: 10.3344/kjp.2016.29.2.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 01/05/2023] Open
Abstract
Although discal cysts are a rare cause of low back pain and radiculopathy. Currently, surgical excision is usually the first-line treatment for discal cysts. However, alternative treatment methods have been suggested, as in some cases symptoms have improved with interventional therapies. A 27-year-old man presented with an acute onset of severe pain, and was found to have a discal cyst after an open discectomy. The patient underwent cyst aspiration and steroid injection through the facet joint under C-arm guidance. After the procedure, the patient's pain improved to NRS 0-1. On outpatient physical examination 1 week, and 1 and 3 months later, no abnormal neurological symptoms were present, and pain did not persist; thus, follow-up observation was terminated. When a discal cyst is diagnosed, it is more appropriate to consider interventional management instead of surgery as a first-line treatment, while planning for surgical resection if the symptoms do not improve or accompanying neurologic deficits progress.
Collapse
Affiliation(s)
- Hyun Jeong Yu
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Chan Jin Park
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyoung Hoon Yim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Korea
| |
Collapse
|
8
|
Abstract
Lumbar discal cysts are rare entities causing radicular pain with unknown etiologies. We report a case of a 42-year-old man who developed radiculopathy secondary to a lumbar discal cyst. Our case sheds some light on anatomy, possible etiological association and clinical course which can help management.
Collapse
Affiliation(s)
- Newton Cho
- a Division of Neurosurgery , Sunnybrook Health Science Centre, University of Toronto , Toronto , Ontario , Canada
| | - Julia Keith
- b Division of Neuropathology , Sunnybrook Health Science Centre, University of Toronto , Toronto , Ontario , Canada
| | - Fahard Pirouzmand
- a Division of Neurosurgery , Sunnybrook Health Science Centre, University of Toronto , Toronto , Ontario , Canada
| |
Collapse
|
9
|
Jha SC, Tonogai I, Higashino K, Sakai T, Takata Y, Goda Y, Abe M, Nagamachi A, Fukuta S, Sairyo K. Postoperative discal cyst: An unusual complication after microendoscopic discectomy in teenagers. Asian J Endosc Surg 2016; 9:89-92. [PMID: 26781537 DOI: 10.1111/ases.12227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/26/2015] [Accepted: 08/04/2015] [Indexed: 01/09/2023]
Abstract
Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4-5 and L5-S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2-weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware of this postoperative complication when operating on young individuals with HNP.
Collapse
Affiliation(s)
- Subash C Jha
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Ichiro Tonogai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yuichiro Goda
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Mitsunobu Abe
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Shoji Fukuta
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| |
Collapse
|
10
|
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.
Collapse
|
11
|
Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst. Case Rep Orthop 2015; 2015:273151. [PMID: 26357581 PMCID: PMC4556867 DOI: 10.1155/2015/273151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Arslan E, Demirci İ, Şimşek G, Kılınçaslan MO, Güreşci S, Hacıfazlıoğlu Ç. Which treatment method should be preferred for lumbar discal cysts? A case report and a review of the literature. Neurol Neurochir Pol 2014; 48:71-5. [PMID: 24636774 DOI: 10.1016/j.pjnns.2013.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Abstract
Discal cysts are extremely rare pathologies that occur most often in the lumbar region. The clinical symptoms of discal cysts are indistinguishable from those of a lumbar disc herniation. The aetiology and pathogenesis of discal cysts remain unknown. The optimal treatment of discal cysts also remains controversial. Most cases of lumbar discal cysts are treated surgically, while some cases regress spontaneously. In this article, we report a case of a lumbar discal cyst treated surgically by microdiscectomy. We discuss the treatment options for discal cysts in the context of the literature.
Collapse
Affiliation(s)
- Erhan Arslan
- Department of Neurosurgery, Giresun University School of Medicine, Giresun, Turkey.
| | - İrşadi Demirci
- Department of Neurosurgery, Giresun University School of Medicine, Giresun, Turkey
| | - Gülçin Şimşek
- Department of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey
| | | | - Servet Güreşci
- Department of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Çiğdem Hacıfazlıoğlu
- Department of Radiology, Keçiören Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
14
|
Kwon YK, Choi KC, Lee CD, Lee SH. Intraoperative discography for detecting concealed lumbar discal cysts. J Korean Neurosurg Soc 2013; 53:255-7. [PMID: 23826485 PMCID: PMC3698239 DOI: 10.3340/jkns.2013.53.4.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022] Open
Abstract
Lumbar discal cyst is a rare cause of radiculopathy. Their exact pathogenesis and the optimal treatment modality remain unidentified. Depending on their location, discal cysts cannot always be easily identified intraoperatively. We describe 2 patients with discal cysts and introduce an intraoperative discography technique for discal cyst location. Both patients were treated with surgical excision; with intraoperative discography, the cystic lesions could easily be detected and removed.
Collapse
Affiliation(s)
- Yoon-Kwang Kwon
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
| | | | | | | |
Collapse
|
15
|
Simão MN, Helms CA, Richardson WJ. Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative microdiscectomy patients. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000400005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. MATERIALS AND METHODS: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. RESULTS: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. CONCLUSION: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified.
Collapse
|
16
|
Ha SW, Ju CI, Kim SW, Lee S, Kim YH, Kim HS. Clinical outcomes of percutaneous endoscopic surgery for lumbar discal cyst. J Korean Neurosurg Soc 2012; 51:208-14. [PMID: 22737300 PMCID: PMC3377877 DOI: 10.3340/jkns.2012.51.4.208] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/26/2012] [Accepted: 04/15/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. METHODS All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. RESULTS All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25±0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25±2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. CONCLUSION The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.
Collapse
Affiliation(s)
- Sang Woo Ha
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | | | | | | | | | | |
Collapse
|
17
|
Bilateral discal cysts managed by partial hemilaminectomy and microscopic resection of hemilateral cyst. Spine (Phila Pa 1976) 2011; 36:E1655-8. [PMID: 21301393 DOI: 10.1097/brs.0b013e3182134b77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report. OBJECTIVE The objective of this article was to report a case of bilateral lumbar discal cysts and discuss the clinical, radiological, and surgical findings. SUMMARY OF BACKGROUND DATA Discal cysts are rare lesions and to our knowledge there has been no report on multiple discal cysts at one disc level. METHODS The patient's history, clinical examination, imaging findings, and treatment were reported. RESULTS We reported on the case of a 33-year-old woman with left lower back and lower extremity pain. Neurological imagings demonstrated bilateral cysts at the L4-L5 disc level. She underwent left partial hemilaminectomy at the L4-L5 level and microscopic resection of the left cyst. The cyst contained bloody serous fluid. A connection between the cyst wall and the L4-L5 intervertebral disc and a small laceration in the annulus fibrosus were identified. Histologic examination revealed a cyst lined by fibrous connective tissue without synovium. Her symptoms improved remarkably immediately after surgery. Follow-up imaging 3 months after the operation showed that the bilateral cysts had completely disappeared. CONCLUSION This is the first reported case of bilateral discal cysts at one disc level. Magnetic resonance images demonstrated rounded cysts on both sides of the posterior longitudinal ligament, which suggests that the discal cysts in our case were unlikely to have developed from an epidural hematoma. Partial hemilaminectomy and microscopic resection of the left cyst lead to complete regression of the bilateral cysts. This suggests that there was a communication between the two cysts via the intervertebral disc and that the content of the right cyst passed from the cyst to the disc.
Collapse
|
18
|
Tsuchie H, Nishi T, Tani T, Maekawa S, Shimada Y. Lumbar diskal cyst containing intervertebral disk materials. Orthopedics 2011; 34:e784-7. [PMID: 22049966 DOI: 10.3928/01477447-20110922-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The diskal cyst is a relatively new clinical entity and develops clinical symptoms of a unilateral single nerve root lesion. Although many cases of diskal cyst have been reported, the pathogenesis of diskal cyst remains unclear, and several theories regarding the pathogenesis have been proposed. This article presents 2 cases of diskal cyst communicating with an adjacent herniated disk. Magnetic resonance imaging findings showed diskal cysts in the epidural space of the lumbar spine. Surgical resection was performed, and apparent connections between the corresponding disk and cysts were found. Histopathologic examinations of the cyst wall demonstrated cartilaginous tissue including nucleus pulposus and annulus fibrosis. These patient's symptoms improved remarkably postoperatively, and there was no recurrence of diskal cyst.The hypothesis supported by many authors is hemorrhage from the epidural venous plexus. Diskal cysts arise first from an underlying intervertebral disk injury that causes an annulus fibrosis fissure in the posterior intervertebral disk. Hemorrhage from the epidural venous plexus with a rich blood flow then occurs in the space between the peridural membrane and vertebral body. However, in our cases, we confirmed that the diskal cyst could have developed from the resorption process of an intervertebral disk herniation. Only 5 cases of diskal cyst demonstrating the presence of cartilaginous tissue in the cyst have been reported. Our 2 cases are rare and support the hypothesis of resorption of intervertebral disk herniation.
Collapse
Affiliation(s)
- Hiroyuki Tsuchie
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | | | | | | | | |
Collapse
|
19
|
Ansari S, Heavner JE, McConnell DJ, Azari H, Bosscher HA. The Peridural Membrane of the Spinal Canal: A Critical Review. Pain Pract 2011; 12:315-25. [DOI: 10.1111/j.1533-2500.2011.00510.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
20
|
Aydin S, Abuzayed B, Yildirim H, Bozkus H, Vural M. Discal cysts of the lumbar spine: report of five cases and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1621-6. [PMID: 20364391 DOI: 10.1007/s00586-010-1395-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 03/17/2010] [Accepted: 03/21/2010] [Indexed: 12/20/2022]
Abstract
Discal cysts are rare causes of low back pain and radiculopathy. Only few reports in the literature describe these pathologies. In this article, the authors report five cases (3 males and 2 females) of lumbar discal cysts treated surgically by microdiscectomy. These patients were admitted with a history of back pain and/or sciatalgia. Magnetic resonance imaging of the lumbar spine of all patients revealed lumbar discal cysts, causing compression to the spinal dura and roots. All patients were treated by partial hemilaminectomy and microscopic cyst resection. Postoperatively, the complaints showed improvement, and the patients were discharged with no complications. The cases of lumbar discal cysts are described in the literature as individual case reports, therefore; the authors performed a wide systemic review of all these cases published in PubMed and MedLine, including the patients in the present report. The data of all patients were analyzed to obtain statistically based estimated information about the incidence, the epidemiology, the natural history and the optimum management of these lesions.
Collapse
Affiliation(s)
- Sabri Aydin
- Department of Neurosurgery, VKV American Hospital, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
21
|
Hwang JH, Park IS, Kang DH, Jung JM. Discal cyst of the lumbar spine. J Korean Neurosurg Soc 2008; 44:262-4. [PMID: 19096689 DOI: 10.3340/jkns.2008.44.4.262] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 08/18/2008] [Indexed: 11/27/2022] Open
Abstract
Discal cysts are rare lesions that can cause radiating leg pain. Because they are very rare, their natural history and the details of the therapeutic guidelines for the treatment of these cysts are still unknown. A 30-year-old male patient presented to our institute with radiating pain in his left leg and mild back pain. Magnetic resonance imaging (MRI) revealed an intraspinal extradural cystic mass with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images at the L5-S1 level. The partial hemilaminectomy and cyst resection were performed. We report a patient with low back pain and radiating leg pain caused by a lumbar discal cyst and discuss the treatment of this cyst.
Collapse
Affiliation(s)
- Jae Ha Hwang
- Department of Neurosurgery, Gyeongsang National University, School of Medicine, Jinju, Korea
| | | | | | | |
Collapse
|