Lumbar discal cyst: Diagnostic discography followed by therapeutic computed tomography-guided aspiration and injection

Transforaminal percutaneous endoscopic discectomy for symptomatic gas-filled discal cysts-report of three cases and literature review

OBJECTIVE

The aim of this retrospective study is to review our experience in the diagnosis and role of transforaminal percutaneous endoscopic discectomy (TPED) for symptomatic gas-filled discal cysts.

METHODS

Between May 2014 and June 2017, 3 patients from Lishui Center Hospital (Lishui China), who underwent TPED for symptomatic gas-filled discal cysts, were analyzed. The clinical features, imaging findings, operative findings, and treatment outcomes are presented. In addition, relevant literature regarding gas-filled discal cysts was searched using PubMed, and their characteristics, clinical features, therapeutic strategies, and survival outcomes were reviewed.

RESULTS

The median age of the patients was 56.7 years (range, 55-60 years). In all patients, a discal cyst was located in the lumbar region, and the patients presented with backache and numbness in the lower extremities. The diagnosis was made by lumbar 3-dimensional computed tomography (3D-CT) or magnetic resonance imaging (MRI). All patients underwent TPED. All patients recovered successfully and were eventually discharged. Eighteen articles were identified from the searches of the database, and a total of 42 patients were included. There were 28 males and 14 females. The mean age was 56.8 years, ranging from 27 to 85 years. Lower back pain was the major symptom. Twenty-two patients underwent surgery, 4 patients underwent percutaneous needle aspiration, 2 patients underwent drug therapy, 13 patients received nonoperative treatment, and 1 patient was unknown.

CONCLUSION

TPED for gas-filled discal cysts is feasible, effective, and successful, although it should be performed by an experienced surgeon with awareness of the potential risk of severe nerve root injury.

Symptomatic postoperative discal pseudocyst following percutaneous endoscopic lumbar discectomy: A case report and review of the literature

RATIONALE

Percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment for lumbar disc herniation and postoperative discal pseudocyst (PDP) can rarely develop after PELD.

PATIENT CONCERNS

A 30-year-old man experienced low back pain and pain in the right lower extremity for 1 month, which aggravated for 3 days.

DIAGNOSES

Preoperative CT and MRI showed lumbar disc herniation at the L4/5 level. Then the patient underwent PELD under local anesthesia and his symptoms disappeared immediately after surgery. After 37 days of PELD, the patient complained of recurrent low back pain on the right side, and pain on the outer side of his lower leg. MR imaging revealed cystic mass with low signal on T1-weighted images (T1WI), and high signal on T2-weighted images (T2WI). The patient was diagnosed with a symptomatic PDP after PELD.

INTERVENTIONS

Initially, the patient was treated with conservative treatment, including administration of aescin and mannitol by intravenous infusion, physical therapy, sacral canal injection. Then he underwent discography at L4/5 and ozone ablation under local anesthesia.

OUTCOMES

The patient's condition improved significantly after 1 week of surgery and was discharged. One-year and 3-month follow-up revealed no recurrence of low back pain and leg pain.

LESSONS

PDP is one of the rare complications of PELD, usually occurs in young patients. Patients with PDP have a low signal intensity on T1WI and high signal intensity on T2WI, which can be treated by conservative treatment, interventional therapy, and surgical treatment.