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.

Spinal Extradural Meningeal Cyst: Case Report

The case of a 30-year-old woman with a spinal extradural meningeal cyst in the thoracolumbar region is reported. The cyst was detected in the retromedullary space between vertebra T12 and L3. A Dural defect was found in the operation field and through the defect, there was communication between the cystic cavity and the subarachnoid space. Closure of the defect, with partial resection of the cystic wall, was sufficient to obliterate the cystic cavity.

Lumbar intraspinal Extradural Cysts: 2 cases report / 대한정형외과학회잡지

The term juxta-facet cyst has been used to characterize two types of periarticular cystic alterations, synovial and ganglion, that can occur in the paraspinal region. Synovial cysts arise from synovial outpouchings through the weakened or destroyed capsular tissue.Ganglion cysts are commonly found about the wrist and hand.But theoretically they can occur at any site in the body where periarticular connective tissue is present. In spinal canal these cysts may cause pressure on adjacent nerve root to produce a variety of neurological symptoms. The clinical features indicated an acute onset of symptoms favoring a diagnosis of disc herniation, so differential diagnosis is important.We have experienced two cases of the intraspinal extradural cysts connected to posterior longitudinal ligament by a sheath, causing nerve root compression. those were managed with excision of the cyst, and no recurrence has been identified during follow up evaluation.

An Extradural Cyst of Lumbar Spine(Associated with Ruptured Intervertebral Disc): Report of One Case

We experienced a case of an extradural cyst of lumbar spine associated with a freshly ruptured intervertebral disc on L3-4 intervertebral space. A 22-years old Korean female was admitted to hospital because of low back pain radiating to the both legs for about 7 weeks, after mild trauma in the running bus. The low back pain and bilateral sciatic pain had aggravated by coughing and sneezing, similar to the protruded intervertebral disc. Neurological examination revealed the signs similar to those of the protruded intervertebral disc. Simple X-ray films of lumbar spine revealed scoliosis, stretching of lumbar lordotic curve. Myelography showed a complete block from lower one third of L3 vertebral body to upper one fourth of L4 vertebral body by spinal puncture of L2-3 and L5-S1 interspace, respectively. We performed a total laminectomy of L3-4 for the above lesion. The operative finding showed an extradural cyst adhesive with L3 nerve root sheath and freshly ruptured intervertebral disc on L3-4 interspace. The extradural cyst was 2.0x1.5x0.5cm in size and its surface was not smooth but coarse. The contents of cyst was yellowish brown fluid(xanthochromic). We removed the extradural cyst completely and the ruptured(tiny tagged) contents of nucleus pulposus. The post-operative course was satisfactory, dramatically. The microscopic findings of the extradural cyst showed a simple cyst including a profuse pigments of hemosiderin, highly suggested one formed from and epidural hematoma by trauma.