Discal Cyst of the Lumbar Spine: A Case Report

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.

Discal Cyst of the Lumbar Spine: A Case Report

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.

Comparative Study of the Outcomes of Percutaneous Endoscopic Lumbar Discectomy and Microscopic Lumbar Discectomy Using the Tubular Retractor System Based on the VAS, ODI, and SF-36

OBJECTIVE: Percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy with the microscope endoscopic tubular retractor system(METRx-MD) are considered popular minimally invasive surgery (MIS) methods for the treatment of lumbar disc herniation. Many authors have also reported good clinical outcomes of these methods, but there are few comparative studies of them. This report compares the clinical outcomes of PELD and METRx-MD for lumbar disc herniation as MIS methods and discusses the efficacy of PELD. METHODS: Seventy-two patients who had undergone single-level unilateral discectomy using two different methods, PELD and METRx-MD, between 2009 and 2011 were given a follow-up examination prospectively. Thirty-seven of these patients underwent discectomy using PELD, and the remaining 35 patients underwent discectomy using METRx-MD. In addition to the general parameters, clinical outcomes were assessed as specific parameters using the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI), the Short-form 36 (SF-36), and the return-to-work time. RESULTS: Sixty-seven percent (25/37) of the patients in the PELD group and 74%(26/35) in the METRx-MD group were included in follow-up more than 6 months post-operatively. The mean improvements in the VAS scores for the back pain, leg pain, and ODI were 2.6, 4.8, and 30.1% for the PELD group and 2.8, 4.6, and 33.2% for the METRx-MD group, respectively. The SF-36 physical health component subscale score improved from 40.6 pre-operatively to 68.3 at the last follow-up for the PELD group post-operatively, and from 48.5 to 65.1 in the mental component subscale (METRx-MD group: from 34.4 to 66.5 and from 44.87 to 56.7). Complications occurred in 3/37 patients in the PELD group and in 2/35 patients in the METRx-MD group in the peri-operative period. The mean return-to-work times were 37.5 days in the PELD group and 42.5 days in the METRx-MD group. CONCLUSION: The outcomes for the PELD group are comparable to those for the METRx-MD group. It can thus be concluded that PELD for lumbar disk herniations may be performed safely and effectively. Also, PELD can be considered one of the treatment modalities of lumbar disk herniation.

Three-Dimensional Digital Subtraction Angiographic Evaluation of Aneurysm Remnants after Clip Placement

OBJECTIVE: The aneurysm remnants rate was evaluated via three-dimensional digital subtraction angiography (3D-DSA) in the postoperative evaluation of clipped aneurysms. METHODS: Data on surgically clipped aneurysms of anterior circulation obtained via postoperative 3D-DSA from February 2007 to March 2009 were gathered. The results of the postoperative 3D-DSA and of two-dimensional digital subtraction angiography (2D-DSA) for the detection of aneurysm remnants were compared, and an investigation was performed as to why 2D-DSA had missed some aneurysm remnants that were detected in the 3D-DSA. Various surgical factors that revealed aneurysm remnants in the 3D-DSA were also evaluated. RESULTS: A total of 39 neck remnants of 202 clipped aneurysms (19.3%) were confirmed in 3D-DSA, and these were classified according to Sindou's classification of aneurysm remnants. Patients with only a neck remnant found in the 3D-DSA represented 17.3% (35/202 aneurysms) of the whole series, and those with a residuum of neck plus sac found in the 3D-DSA represented 1.9% (4/202 aneurysms). The causes of aneurysm remnants were no full visualization (14/39, 35.9%), parent and perforator artery protection (10/39, 25.6%), clip design problems (8/39, 20.5%), and broad-necked aneurysm (7/39, 17.9%). CONCLUSION: Patients with < or = 2 mm aneurysm remnants showed an increased risk of undetectable aneurysm remnants in the 2D-DSA. The most frequent location of the missed aneurysm in 2D-DSA was the anterior communicating artery. 3D-DSA showed more aneurysm remnants than what is indicated in the existing literature, the 2D-DSA.

Spinal Drop Metastasis from a Posterior Fossa Choroid Plexus Papilloma

Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP.