Discal Cyst of the Lumbar Spine: Case Report of a Rare Clinical Entity

@#Being a rare clinical entity, discal cyst presents indistinguishably from other causes of lower back pain and radiculopathy. It is an extremely rare pathology with unclear pathogenesis, indeterminate natural history with no consensus on the ideal management of the condition. We report a rare case of discal cyst in a patient who presented to our centre with localised low back pain and subsequently left sided radicular pain. With the aid of MRI and with clear surgical indication we proceeded with endoscopic removal of the cyst and intraoperatively confirmed its origin from the adjacent disc. The patient had immediate relief of his symptoms and no postoperative complications. We recommend that endoscopic surgery can be an effective alternative to conventional open surgery for discal cyst of the lumbar spine.

Diagnóstico diferencial de hernia discal / Diagnostic differences for disc herniation

Disc herniation is a frequent pathology in the radiologist's daily practice. There are different pathologies that can simulate a herniated disc from the clinical and especially the imaging point of view that we should consider whenever we report a herniated disc. These lesions may originate from the vertebral body (osteophytes and metastases), the intervertebral disc (discal cyst), the intervertebral foramina (neurinomas), the interapophyseal joints (synovial cyst) and from the epidural space (hematoma and epidural abscess).

La hernia discal es una patología frecuente en la práctica diaria del radiólogo. Hay distintas patologías que pueden simular una hernia discal desde el punto de vista clínico y especialmente imagenológico que debemos considerar cada vez que informamos una hernia discal. Estas lesiones pueden provenir del cuerpo vertebral (osteofitos y metástasis), del disco intervertebral (quiste discal), de los forámenes intervertebrales (neurinomas), de las articulaciones interapofisiarias (quiste sinovial) y desde el espacio epidural (hematoma y absceso epidural).

Successful Treatment of a Symptomatic Discal Cyst by Percutaneous C-arm Guided Aspiration

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.

Discal cysts of the cervical spine in two dogs

Discal cysts, which lie directly over intervertebral discs, are rare. Two old dogs with tetraparesis were referred to our facility. In both animals, magnetic resonance imaging revealed intraspinal extradural cystic mass lesions that were dorsal to degenerative intervertebral discs at the C3-C4 level. These lesions had low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. A ventral slot approach was used to perform surgical decompression, after which the symptoms improved remarkably. Discal cysts should be included in the differential diagnosis of dogs with cervical pain and tetraparesis. One effective treatment for discal cysts is surgical intervention.

Intraoperative Discography for Detecting Concealed Lumbar Discal Cysts

Lumbar discal cyst is a rare cause of radiculopathy. Their exact pathogenesis and the optimal treatment modality remain unidentified. Depending on their location, discal cysts cannot always be easily identified intraoperatively. We describe 2 patients with discal cysts and introduce an intraoperative discography technique for discal cyst location. Both patients were treated with surgical excision; with intraoperative discography, the cystic lesions could easily be detected and removed.

Clinical Analysis of Microscopic Removal of Discal Cyst

OBJECTIVE: The purpose of this study was to evaluate the clinical presentation and surgical outcome in patients with symptomatic discal cyst. METHODS: The authors reviewed consequent 9 patients in whom microscopic excision of the discal cyst with or without additional discectomy for discal cyst from 2005 to 2012. Diagnostic imagings including simple radiographs, computed tomography with discogram and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and related complications. RESULTS: In all patients, discal cyst was located in the lumbar region and they presented with back pain and unilateral radiating pain. The preoperative magnetic resonance images (MRI) and computed tomography (CT) scan with discogram showed a connection between the cyst and the involved intervertebral disc. All patients obtained immediate relief of symptoms after microscopic excision of discal cyst. There were no recurrent lesions during follow-up period. The mean preoperative visual analogue scale (VAS) was 7.8 when compared with 2.6 in preoperative assessment. All patients obtained excellent or good outcome according to modified MacNab's criteria. CONCLUSION: Discal cysts are rare lesions that can lead to back pain and refractory sciatica. Microscopic excision of the cyst can achieve remarkable improvement of symptoms.

Achados de ressonância magnética em cistos epidurais de origem discal em pacientes não operados e após microdiscectomia / Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative microdiscectomy patients

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.

OBJETIVO: Demonstrar os achados de imagem em cinco casos de cisto discal em pacientes sem cirurgia prévia e após microdiscectomia. MATERIAIS E MÉTODOS: Cinco cistos discais em quatro pacientes submetidos a exames de ressonância magnética foram identificados após procura em nossos sistemas de dados e por referência de um cirurgião ortopédico especialista em coluna. Exames de tomografia computadorizada também estavam disponíveis em dois casos e discografia por tomografia computadorizada em um caso. RESULTADOS: Três pacientes não tinham história prévia de cirurgia lombar e o outro paciente, que tinha dois cistos discais, apresentava recorrência dos sintomas após laminectomia parcial e microdiscectomia. Todos os cistos mostravam aspecto ovalado e estavam localizados no espaço epidural anterior, sendo quatro ventrolaterais, e o outro estava posicionado na região central do espaço epidural anterior. A discografia por tomografia computadorizada, disponível em um caso, demonstrou continuidade do cisto com o disco. Três foram submetidos a ressecção cirúrgica. CONCLUSÃO: A ressonância magnética pode facilmente identificar um cisto epidural e o diagnóstico de cisto discal deve ser considerado quando uma imagem cística homogênea, localizada no espaço epidural anterior, ventrolateral, e em contato com um disco parcialmente degenerado for identificada.

Clinical Outcomes of Percutaneous Endoscopic Surgery for Lumbar Discal Cyst

OBJECTIVE: Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. METHODS: All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. RESULTS: All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25+/-0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25+/-2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. CONCLUSION: The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.

Clinical Outcomes of Percutaneous Endoscopic Surgery for Lumbar Discal Cyst

OBJECTIVE: Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. METHODS: All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. RESULTS: All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25+/-0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25+/-2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. CONCLUSION: The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.

Discal Cyst of Lumbar Spine: A Case Report

STUDY DESIGN: This is a case report. OBJECTIVE: We present here a patient who had a discal cyst of the lumbar spine along with neurological symptoms. SUMMARY OF THE LITERATURE REVIEW: Discal cysts are intraspinal cysts that communicate with an adjacent intervertebral disc, and these are rare lesions that can cause lumbar radiculopathy. Because they are very rare, their natural history and the details of the therapeutic guidelines for the treatment of these cysts are still unknown. MATERIAL AND METHODS: The patient complained of moderate lumbar pain and right lower extremity radiculopathy and he was administered conservative treatment for 5 months. But the radiculopathy became aggravated and he then underwent a hemilaminectomy, cyst decompression and discectomy. RESULTS: The radiculopathy disappeared and any signs of recurrence were not found on the follow up performed at 1 year. CONCLUSION: Discal cyst is rare, but it can be treated successfully.

Discal Cyst of the Lumbar Spine

Discal cysts are rare lesions that can cause radiating leg pain. Because they are very rare, their natural history and the details of the therapeutic guidelines for the treatment of these cysts are still unknown. A 30-year-old male patient presented to our institute with radiating pain in his left leg and mild back pain. Magnetic resonance imaging (MRI) revealed an intraspinal extradural cystic mass with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images at the L5-S1 level. The partial hemilaminectomy and cyst resection were performed. We report a patient with low back pain and radiating leg pain caused by a lumbar discal cyst and discuss the treatment of this cyst.

Discal Cyst Diagnosed by Radiologic Finding

Discal cyst is a very rare lesion that can result in refractory low back pain and leg radiating pain. Because they are so uncommon, their exact origin and pathophysiology are still unknown. A 31-year-old man visited our institute due to low back pain and severe left leg radiating pain. Magnetic resonance images (MRI) revealed spherically shaped extradural cystic lesion at L2-L3 level. Computed tomography (CT) discography demonstrated obvious communication between the intervertebral disc and the cyst. The patient underwent posterior decompression and excision of cyst. The symptoms were remarkably improved immediately after surgery.