|
1
|
Hinsen K, Huynh P, Shilling M, Luo H, Ehsanian R, Shin P. Contrast enhancing epidural fluid accumulation after percutaneous endoscopic lumbar discectomy: A case report of recurrent disc herniation within pseudocyst secondary to irrigation fluid. Int J Surg Case Rep 2024; 120:109884. [PMID: 38875830 PMCID: PMC11226958 DOI: 10.1016/j.ijscr.2024.109884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024] Open
Abstract
INTRODUCTION Percutaneous endoscopic lumbar discectomy (PELD) is increasingly being utilized to treat patients with lumbar disc herniation. PELD is unique in that it uses a single working port endoscope with constant irrigation of the surgical field to visualize pathology. The current report is of a case of postoperative epidural irrigation fluid accumulation presenting as peripherally enhancing epidural lesions, masking an underlying re-herniation. PRESENTATION OF CASE A patient with a Lumbar 5-Sacral 1 level disc herniation presenting with radiculopathy was treated using PELD. Following the operation, the patient experienced recurrent pain, prompting a repeat MRI of the lumbar spine. Multiple ring-enhancing lesions within the epidural space were observed, creating diagnostic dilemmas. The differential diagnoses included epidural abscess, pseudomeningocele from unintended durotomy, epidural hematoma, or trapped epidural fluid collection presenting as a pseudocyst with or without recurrent disc herniation. A repeat endoscopic discectomy was performed to confirm the diagnosis of pseudocyst, revealing a recurrent disc herniation. DISCUSSION Pseudocysts are not an uncommon complication of PELD, typically believed to be due to an inflammatory response to disc fragments. However, in this case, the epidural fluid collection was likely the result of trapped irrigation fluid from continuous irrigation during the procedure, which masked an underlying re-herniation on imaging. CONCLUSION With the increasing utilization of PELD, it is important to acknowledge unique complications such as fluid accumulation from irrigation within the epidural space. Fluid accumulation can lead to contrast-enhancing pseudocyst formation, which can theoretically lead to mass effect or increased intracranial and intraspinal pressure and may mask additional underlying pathology.
Collapse
Affiliation(s)
- Kristin Hinsen
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Pearl Huynh
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mark Shilling
- Department of Anesthesiology and Critical Care, University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Henry Luo
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Reza Ehsanian
- Department of Anesthesiology and Critical Care, University of New Mexico Hospitals, Albuquerque, NM, USA.
| | - Peter Shin
- Department of Neurosurgery, University of New Mexico Hospitals, Albuquerque, NM, USA
| |
Collapse
|
|
2
|
Badra M, Najjar E, Wardani H, Jamaleddine Y, Daccache E, Ezzeddine H, Moucharafieh R. Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review. Cureus 2024; 16:e60604. [PMID: 38894794 PMCID: PMC11185196 DOI: 10.7759/cureus.60604] [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: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
The main objective was to describe the different types and characteristics of lumbar spine extradural cysts and their optimal treatment options with a focus on endoscopic technique. We searched Pubmed, EMBASE, Medline, and Google Scholar for articles published between 1967 and 2020 using the keywords "Spinal Cyst," "Extradural Cyst," and "Lumbar Cyst." The various anatomical and histological types of the extradural cysts with their presentations, etiologies, imaging, and optimal treatment with a focus on endoscopic techniques were reviewed from the articles. Lumbar spinal cysts are relatively rare pathologies that might cause radicular symptoms similar to lumbar disc herniation. Spinal extradural cysts are classified either histologically based on the cyst lining tissues (synovial cysts or non-synovial, ganglion cysts) or anatomically based on the structure of origin (epidural cysts, ligamentum flavum cysts, discal cysts, post-discectomy pseudocysts, posterior longitudinal ligament cysts, facet cysts). Surgical excision is the recommended treatment of symptomatic cysts with endoscopic techniques being a viable option. Extradural lumbar cysts can be identified based on their histological structure or depending on their structure of origin. Regardless of their classification, they could all give similar clinical findings, and the optimal treatment would be surgical excision with endoscopic technique being a viable option with a satisfactory outcome.
Collapse
Affiliation(s)
- Mohammad Badra
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
| | - Elie Najjar
- Department of Orthopedics, Center for Spinal Studies and Surgery (CSSS) Queen's Medical Centee, Nottingham University Hospitals, Nottingham, GBR
| | - Hassan Wardani
- Department of Orthopedic Surgery, Faculty of Medicine, Lebanese University, Beirut, LBN
| | - Youssef Jamaleddine
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Elio Daccache
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Hady Ezzeddine
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
| | - Ramzi Moucharafieh
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedics and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
| |
Collapse
|
|
3
|
Patgaonkar PR, Kokate SK, Subith S, Borole PS. Postoperative discal pseudocyst: Report of A case with an unusual complication after microlumbar discectomy and successful treatment by transforaminal endoscopic lumbar decompression. Surg Neurol Int 2024; 15:56. [PMID: 38468674 PMCID: PMC10927204 DOI: 10.25259/sni_892_2023] [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: 11/05/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024] Open
Abstract
Background Lumbar discal pseudocysts are uncommon complications that can arise following lumbar spine surgery. It manifests as a fluid-filled sac near the intervertebral disc, causing pain and discomfort. Understanding its causes, symptoms, and management is crucial for patients and healthcare professionals involved in postoperative spinal care. Case Description A 35-year-old female developed a discal pseudocyst after undergoing laminectomy and discectomy for lumbar disc herniation. The patient presented with recurrent lower back pain, radiculopathy, and neurological deficit two months post-surgery. Imaging revealed a discal pseudo cyst causing compression of the traversing right L5 nerve root. Given the refractory nature of her symptoms, an endoscopic procedure was offered. Using the transforaminal endoscopic technique, the pseudo cyst was identified and removed, leading to immediate symptomatic relief. Conclusion This article reports the rare occurrence of discal pseudocyst and highlights the use of endoscopic techniques in its surgical management. Surgeons should be aware of the minimally invasive techniques, as they can offer less morbidity, shorter recovery times, and reduced healthcare costs compared to traditional open surgery.
Collapse
Affiliation(s)
- Prasad R Patgaonkar
- Department of Spine Surgery, Indore Spine Centre, Indore, Madhya Pradesh, India
| | - Sagar Kishor Kokate
- Department of Spine Surgery, Indore Spine Centre, Indore, Madhya Pradesh, India
| | - S Subith
- Department of Spine Surgery, Indore Spine Centre, Indore, Madhya Pradesh, India
| | - Pushkar S Borole
- Department of Spine Surgery, Indore Spine Centre, Indore, Madhya Pradesh, India
| |
Collapse
|
|
4
|
Gao K, Cao Y, Yu W, Liu W, Sun S, Wu Y. Postoperative discal pseudocyst caused by percutaneous endoscopic lumbar discectomy: two case reports and a literature review. J Int Med Res 2023. [DOI: 10.1177/03000605231158018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Postoperative discal pseudocyst (PDP) is a rare complication that can occur after percutaneous endoscopic lumbar discectomy (PELD), microendoscopic discectomy, and laminectomy. The PDP pathogenesis and pathological process remain unclear. We described two PDP cases following PELD, with long-term follow-up results. The first patient was an Asian male, 30 years old, who experienced unbearable low back pain with right lower limb radiating pain for 2 years. The second patient was also an Asian male, 21 years old, who experienced low back pain with bilateral lower limb numbness. Both patients were diagnosed with lumbar disc herniation, underwent PELD, and relapsed after discharge. The diagnosis was PDP in each case, and conservative treatment was initiated with oral anti-inflammatory drugs and rest. Eventually, the symptoms in both patients resolved. Magnetic resonance imaging showed that the discal cysts had disappeared. The follow-up of these two PDP cases after PELD showed good results, demonstrating that PDP may be a self-healing disease. Conservative treatment is effective, and surgery should be performed only in an emergency. These case reports and literature review can help improve the understanding of PDP.
Collapse
Affiliation(s)
- Kun Gao
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yafei Cao
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Weiji Yu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Weidong Liu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Shufen Sun
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yihong Wu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| |
Collapse
|
|
5
|
Postoperative discal pseudocyst: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
|
6
|
Wang H, Wang S, Yu H, Chen Y, Zheng L, Ma J. Surgical treatment of recurrent postoperative discal pseudocyst: A case report and literature review. Medicine (Baltimore) 2022; 101:e31756. [PMID: 36397328 PMCID: PMC9666085 DOI: 10.1097/md.0000000000031756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Postoperative discal pseudocyst (PDP) is rare. Few studies have reported on the recurrence of PDPs, and there is a lack of understanding of their clinical features and treatment methods. This study discusses the clinical characteristics and treatment of recurrent PDPs. PATIENT CONCERNS A 25-year-old man presented with radiating pain and numbness in the lateral left calf and dorsum of the foot. DIAGNOSIS Postoperative discal pseudocyst. INTERVENTIONS He underwent lumbar discectomy, which provided immediate postoperative relief. However, the symptoms recurred 45 days later. Magnetic resonance imaging (MRI) showed a lesion compressing the dura and nerve roots at the site of the previous surgery. The lesion appeared hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging. The patient was treated conservatively for 1 month without significant relief. He then underwent lumbar discectomy and cyst removal, which immediately relieved his symptoms. However, 27 days later, the patient again developed the same symptoms. MRI examination showed recurrence of PDP. As 1 month of conservative treatment failed to relieve the patient's symptoms, we performed posterior instrumented lumbar fusion and cyst removal. OUTCOMES The patient's symptoms disappeared, and have not recurred for 1 year at the time of writing. CONCLUSIONS PDP is a rare complication of lumbar discectomy. Repeat lumbar discectomy can effectively treat PDP, but the cyst can recur. We, for the first time, used posterior instrumented lumbar fusion to successfully treat recurrent PDP.
Collapse
Affiliation(s)
- Hong Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Junxiong Ma
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
- * Correspondence: Junxiong Ma, Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China (e-mail: )
| |
Collapse
|
|
7
|
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: 0.3] [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.
Collapse
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.
| |
Collapse
|
|
8
|
Wang S, Yang Y, Yu X, Chang Z. Postoperative discal pseudocyst after percutaneous endoscopic transforaminal discectomy treated by drainage: Case report. Medicine (Baltimore) 2022; 101:e30204. [PMID: 36042650 PMCID: PMC9410605 DOI: 10.1097/md.0000000000030204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
RATIONALE This article reports 2 cases of symptomatic postoperative discal pseudocysts (PDP), a rare complication of percutaneous endoscopic transforaminal lumbar discectomy (PELD). In this report, we propose a possible mechanism of PDP and introduce an effective therapeutic strategy. To our knowledge, there have been no reports of the use of indwelling drainage techniques for the PDP treatment after PELD. PATIENT CONCERNS Herein, we report 2 cases of PDP after PELD in our hospital. Both patients had disc herniation at the L4/5 level, and the symptoms of low back pain and radiculopathy were significantly relieved after PELD. However, the signs in both 2 cases recurred 20 days after surgery. MRI indicated PDP in both 2 patients with high intensity on T1- and T2-weighted imaging in the primary surgical area. INTERVENTIONS Given the progressive symptoms in both cases, PELD was performed again and 3-lumen drainage catheters were placed at the surgical site for adequate drainage. OUTCOMES The patient's symptoms were significantly relieved after adequate drainage and disappeared 3 months after surgery. There was no clinical or MRI recurrence at the 6-month follow-up. CONCLUSION According to operative findings, we found that PDP symptoms may not be attributable mainly to cyst compression but to the excessive accumulation of local inflammatory factors. Treatment of PELD combined with indwelling drainage is feasible and effective in treating PDP.
Collapse
Affiliation(s)
- Shuai Wang
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong, PR China
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong, PR China
| | - Yang Yang
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong, PR China
| | - Xiuchun Yu
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong, PR China
| | - Zhengqi Chang
- Department of Orthopedics, 960th Hospital of PLA, Jinan 250031, Shandong, PR China
- *Correspondence: Zhengqi Chang, Department of Orthopedics, the 960th hospital of PLA, Jinan 250031, Shandong, PR China (e-mail: )
| |
Collapse
|
|
9
|
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.
Collapse
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
| |
Collapse
|
|
10
|
Sequential endoscopic and robot-assisted surgical solutions for a rare fungal spondylodiscitis, secondary lumbar spinal stenosis, and subsequent discal pseudocyst causing acute cauda equina syndrome: a case report. BMC Surg 2022; 22:34. [PMID: 35090437 PMCID: PMC8800316 DOI: 10.1186/s12893-022-01493-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/22/2022] [Indexed: 01/21/2023] Open
Abstract
Background Fungal spondylodiscitis is a rare infectious disease. The secondary lumbar spinal stenosis and postoperative discal pseudocyst were even rarer. The surgical interventions were disputed, yet endoscopic and robot-assisted techniques may be helpful under different circumstances. Case presentation A 62-year-old female was diagnosed as infectious spondylodiscitis at the L4/5 level and a posterolateral endoscopic debridement was performed after invalid conservative therapy. Causative organism culture revealed a rare fungus, Candidatropicalis. A secondary spinal stenosis with refractory radiculopathy occurred almost 3 years after the first surgery and a successful endoscopic surgery was implemented aiming to decompress the nerve in a minimally invasive way. However, 2 months later, the patient manifested severe acute cauda equina syndrome and radiological examinations suggested a rare postoperative discal pseudocyst. A laminectomy followed by a pseudocystectomy was applied to achieve thorough decompression. An innovative double trajectory system (simultaneous traditional pedicle screw and cortical bone trajectory screw) accompanied by posterolateral fusion was designed and executed by the professional robot-assisted system. Conclusion Endoscopic and robot-assisted techniques may provide alternative solutions for fungal spondylodiscitis and accompanied sequelae.
Collapse
|
|
11
|
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: 7] [Impact Index Per Article: 1.8] [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.
Collapse
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
| |
Collapse
|
|
12
|
Xu WB, Wu DJ, Chen C, Zhao X, Hu ZJ, Fan SW, Fang XQ. Symptomatic Postoperative Discal Pseudocyst After Percutaneous Endoscopic Interlaminar Discectomy: Case Report and Literature Review. Orthop Surg 2020; 13:347-352. [PMID: 33331078 PMCID: PMC7862141 DOI: 10.1111/os.12863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 01/05/2023] Open
Abstract
Background A postoperative discal pseudocyst (PDP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to recurrence or even worse symptoms. To our knowledge, to date, there is no research focusing specifically on PDP following percutaneous endoscopic interlaminar discectomy (PEID). Case presentation We present the case of a 27‐year‐old man with L5S1 intervertebral disc herniation who was treated with PEID after failed conservative treatment. His leg pain was relieved immediately but reoccurred on the 40th day. MRI showed a PDP. Because loxoprofen and bedrest were ineffective and the patient was anxious, we performed a cystectomy. The patient's symptoms were significantly relieved, and a 6‐month follow up showed no recurrence both clinically and on MRI. Conclusion A PDP is more likely to form using the interlaminar approach than the transforaminal approach. For patients with mental stress, severe pain, and neurological symptoms, surgery is suggested to remove the cyst. Discectomy cannot be performed when disc degeneration is mild.
Collapse
Affiliation(s)
- Wen-Bin Xu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan-Ju Wu
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Chen
- Department of Orthopaedics, Yuhuan People's Hospital, Taizhou, China
| | - Xing Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Jun Hu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang-Qian Fang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
|
13
|
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.
Collapse
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
| |
Collapse
|
|
14
|
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
|
|
15
|
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: 9] [Impact Index Per Article: 1.5] [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
|
|
16
|
Shiboi R, Oshima Y, Kaneko T, Takano Y, Inanami H, Koga H. Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy. JOURNAL OF SPINE SURGERY 2017; 3:233-237. [PMID: 28744506 DOI: 10.21037/jss.2017.05.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive treatment for lumbar disc herniation (LDH). This report focused on one of the rare complications of PELD: symptomatic postoperative discal pseudocyst (PDP). A 27-year-old male patient (case 1) presented with recurrent radiculopathy in his left leg. Twenty days previously, he had undergone PELD for left L4/5 LDH and his symptoms temporarily improved. A 14-year-old female patient (case 2) also developed recurrent pain in her left leg. Thirty days previously, she had undergone PELD for left L4/5 LDH and her symptoms disappeared. On the basis of the finding of an expandable round lesion at the evacuated sites of LDH on magnetic resonance imaging (MRI), with low intensity of T1-weighted imaging and high intensity on T2-weighted imaging, we predicted symptomatic PDP in both cases. Given the progressive leg pain in both cases, surgical treatments were adopted (case 1: microendoscopic discectomy, case 2: PELD). During the operation, we confirmed that case 1 was a simple recurrence of LDH and case 2 was symptomatic PDP. Previous studies on symptomatic PDP included cases diagnosed without operative findings. Therefore, it should be carefully considered that such cases might be a simple recurrence of LDH.
Collapse
Affiliation(s)
- Ryutaro Shiboi
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo 140-0002, Japan
| | - Yasushi Oshima
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo 140-0002, Japan.,Department of Orthopaedic Surgery, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takeshi Kaneko
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo 140-0002, Japan
| | - Yuichi Takano
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo 140-0002, Japan
| | - Hirohiko Inanami
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo 140-0002, Japan
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo 140-0002, Japan
| |
Collapse
|
|
17
|
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: 1.1] [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
|
|
18
|
Ma XL. A new pathological classification of lumbar disc protrusion and its clinical significance. Orthop Surg 2015; 7:1-12. [PMID: 25708029 DOI: 10.1111/os.12152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022] Open
Abstract
Lumbar disc protrusion is common. Its clinical manifestations and treatments are closely related to the pathological changes; however, the pathological classification of lumbar disc protrusion is controversial. This article introduces a new pathological classification comprising four types of lumbar disc protrusion according to intraoperative findings. The damage-herniation type is probably caused by injury and is characterized by soft herniation, the capsule can easily be cut and the broken disc tissue blocks overflow or is easily removed. The broken disc substances should be completely removed; satisfactory results can be achieved by minimally invasive endoscopic surgery. The degeneration-protrusion type is characterized by hard and tough protrusions and the pathological process by degeneration and proliferative reaction. The nerve should be decompressed and relaxed with minimally invasive removal of the posterior wall; the bulged or protruded disc often need not be excised. The posterior vertebral osteochondrosis with disc protrusion type is characterized by deformity of the posterior vertebral body, osteochondral nodules and intervertebral disc protrusion. The herniated and fragmented disc tissue should be removed with partially protruding osteochondral nodules. Intervertebral disc cyst is of uncertain pathogenesis and is characterized by a cyst that communicates with the disc. Resection of the cyst under microscopic or endoscopic control can achieve good results; and whether the affected disc needs to be simultaneously resected is controversial. The new pathological classification proposed here is will aid better understanding of pathological changes and pathogenesis of lumbar disc protrusion and provides a reference for diagnosis and treatment.
Collapse
Affiliation(s)
- Xin-long Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| |
Collapse
|
|
19
|
Tan TL, Borkowski SL, Sangiorgio SN, Campbell PA, Ebramzadeh E. Imaging Criteria for the Quantification of Disc Degeneration. JBJS Rev 2015; 3:01874474-201502000-00002. [DOI: 10.2106/jbjs.rvw.n.00056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|