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Wang C, Zhang L, Chen Y, Xu D, Wu X, Ma X. A rare discal cyst with concurrent double-level isthmic lumbar spondylolisthesis: a case report and literature review. Br J Neurosurg 2023; 37:1311-1314. [PMID: 33349066 DOI: 10.1080/02688697.2020.1864294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
We presented a 47-year old male diagnosed as a discal cyst with concurrent isthmic lumbar spondylolisthesis, which was not reported in the literature previously. A cystectomy with two-segmental transforaminal lumbar interbody fusion and instruments was performed. The association between concurrent discal cyst and isthmic spondylolisthesis may be illuminated by excessive strain and focal degeneration of the disc. Preoperative discography is probably unnecessary when surgical resection and histopathology are indicated for the patient.
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Affiliation(s)
- Chao Wang
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Department of Medical Research Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunqing Chen
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Derong Xu
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaolin Wu
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
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2
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Pertile ME, de Assunção Bicca Y, Maccari PM, Neto OR, Quintas DP, Bertani R, Batista S, Koester SW, Rusafa E, Flores de Barros Vasconcelos Fernandes Serra MV. Advancing Education in Endoscopic Spinal Navigation: Novel Methods and Technical Note. Cureus 2023; 15:e37017. [PMID: 37143617 PMCID: PMC10153653 DOI: 10.7759/cureus.37017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
This report aims to demonstrate how to teach anatomy and understanding of spinal endoscopic vision and navigation using mnemonics. The authors present a new surgical technique for teaching endoscopic spinal navigation in a didactic manner with tips such as the "rule of the hand" and decomposition of the endoscopic navigation movement. We demonstrate how the surgery is seen and illustrate how images are projected onto the screen, then divide the navigation into spatial orientation and self-navigation. The article describes the proper puncture technique, how to introduce the working portal, and how to assimilate this new anatomical vision using the "rule of the hand." The surgeon projects their hand on the video screen to guide themselves when starting the navigation and uses the same technique to localize regions of interest during surgery. Finally, the authors break down the navigational movement into three components: forceps positioning, triangulation, and joystick motion. One of the biggest challenges when learning spinal endoscopic surgery is understanding the anatomy seen through the endoscope. By decomposing movements required for navigation, one can understand how to make proper use of the equipment as well as improve their knowledge of this "new anatomy." The learning methods taught in this article have the potential to decrease the learning curve and radiation exposure to those that are still acquainting themselves to spinal endoscopic navigation. We recommend that further studies measure and quantify the impact of these methods on surgical practice.
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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.
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Tang J, Li Y, Wu C, Xie W, Li X, Gan X, Lu Q. Clinical efficacy of transforaminal endoscopic lumbar discectomy for lumbar degenerative diseases: A minimum 6-year follow-up. Front Surg 2022; 9:1004709. [PMID: 36189389 PMCID: PMC9520066 DOI: 10.3389/fsurg.2022.1004709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Transforaminal Endoscopic Lumbar Discectomy (TELD) is widely applied for lumbar degenerative disease (LDDs) and satisfactory short-term outcomes have been achieved. However, the mid-term and long-term follow-up of this technique is still lacking. Objective To retrospectively analyze the mid-term clinical efficacy of TELD for single-level LDD and its effect on intervertebral disc degeneration with a minimum of 6-year follow-up. Methods 64 patients with single-level LDDs (lumbar disc herniation, lumbar spinal stenosis) who underwent TELD under local anesthesia in our department from December 2014 to December 2015 were observed. Visual analog scale (VAS), Japanese Orthopaedic Association evaluation treatment (JOA) score and Oswestry Disability Index (ODI) were calculated and compared before operation, 3 months after operation, 6 months after operation, 1 year after operation and at the last follow-up. Disc Height (DH), disc range of motion (ROM) and disc degeneration on standard lumbar lateral radiographs before operation and at the last follow-up were determined. Recurrence rate and operation-related complications during follow-up were recorded. Results 64 cases were followed up for 6.4 ± 0.1 years. There were no complications such as infection, epidural hematoma and nerve root injury. 1 patient (1.67%) was found to have dural rupture and cauda equina hernia during the operation. There were significant differences in VAS, JOA, ODI between preoperative and postoperative 3 months, 6 months, 1 year and last follow-up (P < 0 01), VAS, JOA, ODI at 3 months after operation were different from 6 months after operation (P < 0 05), and there were significant differences compared with preoperative, 1 year after operation and last follow up (P < 0 01). VAS, JOA and ODI at 6 months after operation were significantly different from those before operation (P < 0.01), but not significantly different from those at 1 year after operation and the last follow-up (P > 0.05). There was no significant difference in DH, ROM and the Pfirrmann grade of intervertebral disc preoperative and the last follow-up. During the follow-up period, 3 patients (4.69%) were recurrent, 13 patients (20.31%) had various degrees of postoperative dysesthesia (POD), and 3 patients (4.69%) had various degrees of muscle weakness. Conclusion TELD has a satisfactory mid-term efficacy, and has no significant effect on the DH, the stability of the intervertebral disc space, or on intervertebral disc degeneration. However, as expected, TELD was associated with some complications including recurrent disc herniation and POD.
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Affiliation(s)
- Jin Tang
- Department of Orthopaedics, Hubei 672 Orthopaedics Hospital of Integrated Chinese / Western Medicine, Wuhan, China
- Wuhan Sports University, Wuhan, China
| | - Ying Li
- Department of Orthopaedics, Hubei 672 Orthopaedics Hospital of Integrated Chinese / Western Medicine, Wuhan, China
| | - Congjun Wu
- Department of Orthopaedics, Hubei 672 Orthopaedics Hospital of Integrated Chinese / Western Medicine, Wuhan, China
| | - Wei Xie
- Department of Orthopaedics, Hubei 672 Orthopaedics Hospital of Integrated Chinese / Western Medicine, Wuhan, China
| | - Xugui Li
- Department of Orthopaedics, Hubei 672 Orthopaedics Hospital of Integrated Chinese / Western Medicine, Wuhan, China
| | - Xuewen Gan
- Department of Orthopaedics, Hubei 672 Orthopaedics Hospital of Integrated Chinese / Western Medicine, Wuhan, China
| | - Qilin Lu
- Department of Orthopaedics, Hubei 672 Orthopaedics Hospital of Integrated Chinese / Western Medicine, Wuhan, China
- Wuhan Sports University, Wuhan, China
- Correspondence: Qilin Lu
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Zhu B, Shang L, Han X, Li X, Wang H, Sang P, Lv C, Li J, Liu X. Revision surgery for symptomatic postoperative pseudocyst following full-endoscopic lumbar discectomy: clinical characteristics and surgical strategies. BMC Musculoskelet Disord 2022; 23:835. [PMID: 36057592 PMCID: PMC9440536 DOI: 10.1186/s12891-022-05791-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A symptomatic postoperative pseudocyst (PP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to worse symptoms. Some minority patients who developed PP experienced rapidly aggravating symptoms and could not be treated by any kind of conservative treatment. However, no clinical studies have evaluated the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after full-endoscopic lumbar discectomy (FELD). This study aimed to demonstrate the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after FELD. METHODS We retrospectively analyzed the data of patients who received FELD revision surgeries due to symptomatic PP formation between January 2016 and December 2021. Common characteristics, time intervals of symptom recurrence and revision surgery, strategies for conservative treatment and revision surgery, operative time, imaging characteristics, numeric rating scale (NRS) score, Oswestry disability index (ODI) and overall outcome rating based on modified MacNab criteria were analyzed. RESULTS Fourteen patients (males = 10, females = 4), with a mean age of 24.4 years, were enrolled. The mean time intervals of symptom recurrence and revision surgery were 43.5 and 18.9 days respectively. While the patients were conservatively managed with analgesics and physical therapy, pain persisted or progressively worsened. In comparison to the initial herniated disc, the PP was larger in 11 cases, and up- or down-migrated in four cases. The PP location included the lateral recess (n = 12), foraminal (n = 1), and centrolateral (n = 1) zones. One of the two cases treated by percutaneous aspiration (PA) was eventually treated by FELD as pain was not relieved. Follow-ups revealed an improved mean NRS score from 7.1 to 1.4, mean ODI from 68.6 to 7.9% and promising overall surgical outcomes. CONCLUSIONS The progressively severe pain experienced due to PP might be a result of its enlargement or migration to the lateral recess and foraminal zones. As complete removal of capsule is the goal, we recommend FELD instead of PA.
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Affiliation(s)
- Bin Zhu
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Lanpu Shang
- Pain Medicine Centre, Peking University Third Hospital, Beijing, China
| | - Xiao Han
- Department of Spine, Beijing Jishuitan Hospital, Beijing, China
| | - Xingchen Li
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hongchen Wang
- Department of Orthopaedics, Beijing Renhe Hospital, Beijing, China
| | - Peiming Sang
- Department of Orthopaedics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Chaoliang Lv
- Department of Orthopaedics, Jining NO.1 People's Hospital, Jining, Shandong, China
| | - Jian Li
- Department of Orthopaedics, Jinan Central Hospital, Jinan, Shandong, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, People's Republic of China.
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Jadhav N, Sivakumar L, Talibi SS, Momoh P, Rasul F, Hussain R, Shad A. Lumbar discal cyst and post-operative discal pseudocyst: a case series. J Surg Case Rep 2022; 2022:rjac239. [PMID: 35665395 DOI: 10.1093/jscr/rjac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
Four cases of lumbar cyst (2 discal cysts and 2 post-operative discal pseudocysts) who presented predominantly with features of sciatica without any motor, sensory or sphincteric disturbances. The patients were treated conservatively, and the management was aimed to avert any untoward surgical intervention taking into consideration patient safety and care. Two had previous lumbar decompressive discectomy. During the mean follow-up period of 13 months, there was progressive recovery of symptoms in all our 4 patients. All our patients were successfully managed by conservative approach. An intervertebral disc cyst should be considered in young patients in the differential diagnosis of any extradural intraspinal mass ventral to the thecal sac, notwithstanding its rarity. Alongside, conservative management can be offered as first line of management with appropriate patient selection that is absence of any motor/sensory/sphincteric disturbances. Facetal micro-instability could be one of the aetiologies of this pathology which necessitates further study.
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Affiliation(s)
- Neha Jadhav
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Lawrence Sivakumar
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Sayed Samed Talibi
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Pearl Momoh
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Fahid Rasul
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Rahim Hussain
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Amjad Shad
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
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Takamatsu N, Yamashita K, Sugiura K, Manabe H, Tezuka F, Takata Y, Sakai T, Maeda T, Sairyo K. Successful Full Endoscopic Surgery for L5 Radiculopathy Due to L4-5 Discal Cyst and Disc Herniation in a Professional Baseball Player. NMC Case Rep J 2022; 8:189-194. [PMID: 35079462 PMCID: PMC8769379 DOI: 10.2176/nmccrj.cr.2020-0144] [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: 05/12/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
Discal cysts are rare intraspinal extradural cysts that communicate with the corresponding intervertebral discs, and the diagnosis is difficult to distinguish from other causes of low back pain and radiculopathy. Optimal management for this type of cyst has not been determined because of its rarity. Here, we report successful treatment of a discal cyst and lumbar disc herniation using full endoscopic surgery in a professional baseball player with a chief complaint of weakness in his left lower leg. He had been treated conservatively but symptoms did not improve. Discography helped us to differentially diagnose discal cyst from other cystic lesions. Conventional surgical treatment would have resulted in considerable loss of baseball playing time for the patient. We opted to perform minimally invasive transforaminal full endoscopic surgery under local anesthesia to treat the discal cyst and lumbar disc herniation simultaneously without resection of bone and ligament handling. We removed the discal cyst and disc herniation, which released tension on the left nerve root at the L5 level, and then performed thermal annuloplasty to avoid recurrence. Postoperative course was good and he returned to play baseball at his original competitive level 3 months later. To our knowledge, there have been no previous reports of successful full endoscopic surgery for discal cyst and lumbar disc herniation performed simultaneously in a professional baseball player. It can be difficult to decide on the proper treatment for discal cysts, but full endoscopic surgery for symptomatic discal cyst might be one good option especially for elite athletes.
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Affiliation(s)
- Nobutoshi Takamatsu
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
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Fukunaga T, Sasaki M, Bamba Y, Utsugi R, Matsumoto K, Umegaki M. A rare case of lumbar disc herniation mimicking lumbar discal cyst after percutaneous endoscopic lumbar discectomy. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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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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Chen S, Suo S, Li C, Wang Y, Li J, Zhang F, Zhang W. Clinical Application of Percutaneous Transforaminal Endoscopic Surgery in Lumbar Discal Cyst. World Neurosurg 2020; 138:e665-e673. [PMID: 32194264 DOI: 10.1016/j.wneu.2020.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Discal cyst is very rare and can cause intractable low back pain and radiating leg pain. Symptoms are hard to distinguish from lumbar disc herniation. The best treatment for discal cyst is controversial. Most lumbar discal cysts are treated surgically, while most studies of percutaneous transforaminal endoscopic surgery are case reports. This study investigated the clinical value of percutaneous transforaminal endoscopic surgery for lumbar discal cyst. METHODS A retrospective study was conducted in 9 patients with a discal cyst from June 2016 to November 2018. All patients had been treated by percutaneous transforaminal endoscopic surgery via a superior vertebral pedicle notch approach. Surgical outcomes were evaluated preoperatively and postoperatively using a visual analog scale for leg pain and the Oswestry Disability Index. At the final follow-up, patients were evaluated for clinical efficacy using modified Macnab criteria. RESULTS All 9 patients had remission of symptoms after removal of discal cysts. Postoperative magnetic resonance imaging showed that all patients had complete excision of discal cysts and complete decompression of the treated segment. There were no recurrent lesions during follow-up. Mean operative time was 68.67 ± 14.02 minutes. Mean hospitalization time was 4.22 ± 1.64 days. Preoperative visual analog scale and Oswestry Disability Index score improved significantly after surgery. Visual analog scale leg score improved from 7.88 ± 1.05 preoperatively to 1.78 ± 0.66 at final follow-up (P < 0.05), and ODI score improved from 53.65 ± 12.46 to 16.25 ± 8.76 (P < 0.05). According to the modified Macnab criteria, 5 patients (55.6%) were rated excellent, 3 patients (33.3%) were rated good, and 1 patient (11.1%) was rated fair at final follow-up, with an overall excellent and good rate of 88.9%. There were no serious complications during follow-up. CONCLUSIONS Percutaneous transforaminal endoscopic surgery could be a safe, minimally invasive surgical treatment for discal cyst, particularly suitable for patients who cannot undergo general anesthesia.
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Affiliation(s)
- Song Chen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China; Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Shiqi Suo
- Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Chengli Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunxia Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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11
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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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12
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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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13
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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.
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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
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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.
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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
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15
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Wang YP, Zhang W, Li BL, Sun YP, Ding WY, Shen Y. Suprapedicular Foraminal Endoscopic Approach to Lumbar Lateral Recess Decompression Surgery to Treat Degenerative Lumbar Spinal Stenosis. Med Sci Monit 2016; 22:4604-4611. [PMID: 27890911 PMCID: PMC5142585 DOI: 10.12659/msm.901686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To discuss the strategy of suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression and evaluate the safety and effectiveness of this strategy. MATERIAL AND METHODS Complete clinical information of 52 cases of lumbar lateral recess decompression with therapy of suprapedicular foraminal endoscopic approach were analyzed during the period from February 2010 to April 2014 in the Third Hospital of Hebei. All patients were followed up for 24 months, and VAS, JOA, ODI, and LRD were compared between preoperative and postoperative therapy and changes of FA. Intraoperative and postoperative complications were recorded and the safety of the surgery was evaluated. The surgical "excellent" and "good" rates were evaluated using MacNab score. RESULTS VAS scores for lumbago and leg pain at 3, 6, 12, and 24 months after surgery were significantly lower than before surgery (p<0.05). JOA scores at 12 and 24 months after surgery were significantly higher than before surgery (p<0.05). ODI at 12 and 24 months after surgery were significantly lower than before surgery (p<0.05). LRD after surgery was higher (p<0.05), and FA was lower than before surgery. CONCLUSIONS Use of the suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression is safe and effective, and this minimally invasive treatment can achieve satisfactory results, especially for elderly patients with complicated underlying diseases.
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Affiliation(s)
- Ya-Peng Wang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wei Zhang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Bao-Li Li
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Ya-Peng Sun
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wen-Yuan Ding
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yong Shen
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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16
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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.
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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
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17
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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.
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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
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18
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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.
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19
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A lumbar discal cyst in a professional athlete. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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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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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.
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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
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Abstract
Discal cyst is an intraspinal cyst with a distinct communication with the corresponding intervertebral disc. It is a rare condition and could present with radiculopathy similar to that caused by lumbar disc herniation. We present a patient with a large discal cyst in the ventrolateral epidural space of the 5th lumbar vertebral (L5) level that communicated with the adjacent 4th lumbar and 5th lumbar intervertebral disc, causing L5 radiculopathy. We alleviated the radiating pain with selective transforaminal epidural blocks.
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Affiliation(s)
- Sae Young Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Daegu, Korea
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