Discal cysts of the lumbar spine

Abstract

<jats:p>✓Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25–38 years). All patients suffered from lower-extremity pain and the results of the straight leg–raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance—symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T<jats:sub>1</jats:sub>- and T<jats:sub>2</jats:sub>-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.</jats:p>

Discal cysts of the lumbar spine: report of five cases and review of the literature

“…Histologically, intraspinal cysts of the facet and the ligamentum flavum are referred as ganglion or synovial cysts [22]. The difference between discal cysts and other intraspinal cysts is based on the presence of lining cells; however, their imaging and clinical features are similar [21].…”

“…Moreover, in cases of doubtful diagnosis, surgery is performed to relieve the compression of the neural structures, as surgical treatment leads to symptom improvement, regardless of its origin [8,18]. In addition, intraoperative findings of the apparent connection between the corresponding disc and the cyst are also possible to differentiate discal cysts from other intraspinal cysts [8,21]. For these reasons mentioned above, we did not perform discography, and MRI was satisfactory for the management of the patients in our series.…”

“…Discal cysts are defined as intraspinal extradural cysts with a distinct communication with the corresponding intervertebral discs [2,21]. These lesions are extremely rare pathologies of the spine, which are difficult to distinguish from other causes of low back pain and radiculopathy.…”

Removal of discal cyst using percutaneous working channel endoscope via transforaminal route

“…In our series, symptoms and signs were indistinguishable from a lumbar disc herniation, causing sciatica and nerve root tension because the cyst was located ventro-medially to the nerve root, compressing the root dorso-laterally. Because the differential diagnosis between discal cysts and other intraspinal cysts is based on the presence of lining cells surrounding the connective tissue, Nabeta et al emphasized any strict distinction between the two in the clinical diagnosis is not need [12]. Another literature by Chiba et al reported the importance of discography by which communication between the cyst and the corresponding disc was detected in their most cases [1].…”

“…Discal cysts arise from spinal discs [1,2,10,12]. As the cyst grows, particularly when it arises due to degenerative disc changes, it could cause radiculopathy, such as lumbar disc herniation.…”