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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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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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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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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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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.
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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.
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Hyung-Jun K, Dae-Yong K, Tae-Ho K, Ho-Sang P, Jae-Sung K, Jae-Won J, Jung-Kil L. Lumbar discal cyst causing bilateral radiculopathy. Surg Neurol Int 2011; 2:21. [PMID: 21427789 PMCID: PMC3050063 DOI: 10.4103/2152-7806.77026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 01/03/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Discal cyst is a rare lesion that can result in clinical symptoms typical of disc herniation manifesting as a unilateral single nerve root lesion. To the best of the authors' knowledge, this is the first reported case of discal cyst resulting in bilateral radiculopathy. CASE DESCRIPTION A 48-year-old female presented with bilateral sciatica and neurogenic claudication for 3 months. Magnetic resonance imaging revealed an extradural cystic lesion compressing the ventral aspect of the thecal sac at the level of the L3-L4 intervertebral disc. The lesion showed low and high signal intensities on T1- and T2-weighted images, respectively. Total excision of the cyst was achieved after a left hemipartial laminectomy of L3, and an obvious communication with the disc space was found. Bilateral sciatica was immediately resolved after surgery, and was sustained at the two-year follow-up. The histological diagnosis was consistent with a discal cyst. CONCLUSIONS Although a discal cyst is extremely rare, the possibility of a discal cyst should be considered in differential diagnosis of patients with radiculopathy, particularly when encountering any extradural mass lesion ventral to the thecal sac. Surgical resection is the most employed therapeutic method for symptomatic lumbar discal cysts.
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Affiliation(s)
- Kwak Hyung-Jun
- Department of Neurosurgery, Dong Gwang Ju Woori Hospital, Gwangju, Korea
| | - Kim Dae-Yong
- Department of Neurosurgery, Dong Gwang Ju Woori Hospital, Gwangju, Korea
| | - Kim Tae-Ho
- Department of Neurosurgery, Gwang Ju Woori Hospital, Gwangju, Korea
| | - Park Ho-Sang
- Department of Neurosurgery, Gwang Ju Woori Hospital, Gwangju, Korea
| | - Kim Jae-Sung
- Department of Neurosurgery, Gwang Ju Woori Hospital, Gwangju, Korea
| | - Jang Jae-Won
- Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea
| | - Lee Jung-Kil
- Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea
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Dasenbrock HH, Kathuria S, Witham TF, Gokaslan ZL, Bydon A. Successful treatment of a symptomatic L5/S1 discal cyst by percutaneous CT-guided aspiration. Surg Neurol Int 2010; 1. [PMID: 20847922 PMCID: PMC2940101 DOI: 10.4103/2152-7806.68338] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 07/14/2010] [Indexed: 12/04/2022] Open
Abstract
Background: Discal cysts are a rare cause of lumbar radiculopathy. Benefits of percutaneous computed tomography (CT)-guided aspiration of the cyst include decreased rate of infection, avoidance of general anesthesia, and quicker recovery. However, since the publication of a case of cyst recurrence after CT-guided aspiration, few have utilized this potentially valuable technique. Case Description: We present a patient with a discal cyst arising from the L5/S1 disc causing right S1 radiculopathy. He underwent percutaneous CT-guided aspiration with substantial improvement in his radicular pain with 19 months of follow-up. His improvement was measured quantitatively using the Japanese Orthopedic Association scale: 6/15 pre-procedure, 15/15 post-procedure. Conclusion: Percutaneous CT-guided aspiration of discal cysts may be a valid initial treatment option for this condition. Patients who do not respond or who have a recurrence can subsequently be treated by surgical excision.
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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.
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Affiliation(s)
- Sabri Aydin
- Department of Neurosurgery, VKV American Hospital, Istanbul, Turkey.
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