A novel technique for managing symptomatic spinal cysts using epiduroscopic neural laser decompression: technical note and preliminary results

Abstract

BackgroundBenign spinal cysts are relatively common, but can cause significant pain. However, consensus regarding the best method for treating these cysts has not been established. We aimed to examine the usefulness of epiduroscopic neural laser decompression (ENLD), a novel percutaneous treatment, for treating lumbo-sacral cysts.MethodsTen patients (6 men, 4 women; mean age 45.5 years) with benign lumbo-sacral cysts underwent ENLD. The lumbo-sacral cysts were caused by multiple pathophysiologies and displayed different characteristics. Cysts were evaluated using a recorded epiduroscopic procedure video, magnetic resonance imaging (MRI), and electronic medical records. In all patients, MRI identified cysts with well-defined margins that were compressing the nerves in the lumbo-sacral region and were associated with the pain symptoms of the patients. Retrospectively, we reviewed a series of consecutive patients who underwent surgery (two with discal cysts, four with facet cysts, and four with Tarlov cysts). Low back/leg pain was evaluated using a 1–10 visual analog scale. Functional improvement was evaluated using Oswestry Disability Index scores. Outcomes were evaluated pre- and post-operatively and 1 year post-surgery.ResultsPatients were examined between May 2016 and August 2017. Average pain scores improved from 4.7 pre-surgery to 1.8 post-surgery (low back; p < .001) and from 5.8 pre-surgery to 1.6 post-surgery (leg; p < .001). Disability scores decreased from 27.2% pre-surgery to 14.6% post-surgery.ConclusionCurrently, no standard treatment strategy for symptomatic spinal cysts exists. These results show that ENLD using a Holmium: YAG laser can be useful in treating symptomatic benign spinal cysts.Trial registrationNot applicable as this is a retrospective chart review.

Clinical Outcomes of Trans-Sacral Epiduroscopic Laser Decompression (SELD) in Patients with Lumbar Disc Herniation

“…After the United States Food and Drug Administration approval of epiduroscopy, the concept of SELD was developed, and the literatures reported the clinical outcomes of SELD in not only disc herniation but also in spinal stenosis, adhesion, chronic low back pain, failed back syndrome, and cystic lesions in the lumbosacral spine [7-15, 19, 20]. However, considering the principles of SELD, the distinctive difference from conventional procedures of drug injection or adhesiolysis like epidural neuroplasty is the effect of laser ablation on hydrated soft tissue [17][18][19][20][21]. In other words, whereas the function of drug delivery or adhesiolysis could create a transient effect as in other procedures, laser ablation of soft disc herniation could lead to the permanent effect of decompression [22][23][24].…”

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

“…According to previous studies, the clinical or surgical outcomes of SELD were found to be favorable in various lumbar spine diseases [3][4][5][6][7][12][13][14][15][16][17]. In particular, several recent papers regarding the clinical outcome of SELD for disc herniation have reported that the clinical outcome was favorable as there was signi cant improvement in low back pain or radiating leg pain, patient satisfaction rate of more than 70%, and low rates of surgical failure or recurrence [8,[18][19][20][21].…”

Symptomatic Lumbar Discal Cyst: A Rare Entity that Can Mimic Other Lumbar Cystic Lesions

“…The average postoperative follow-up period was after 12 months. They reported resolution of the symptoms with regression of LDC on the follow-up MRI [18]. The reports discussed in this article demonstrate some variability in the development, presentation, and response to different treatment strategies of LDC.…”