Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst

Abstract

Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.

Percutaneous Endoscopic Surgery for Lumbar Discal Cyst: Two Case Reports

“…However, it is reported that there is still the possibility of recurrence after CT-guided puncture and aspiration Discal Cyst of the Lumbar Spine J Med Cases. 2020;11(6):178-181 [3,12]. Therefore, we prefer to perform radical resection of discal cysts.…”

“…has not yet been established [2][3][4]. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical technique, especially to preserve paraspinal structures and avoid back muscle damage [5].…”

Trans-Sacral Epiduroscopic-Assisted 1,414-nm Nd:YAG Laser Decompression for Lumbar Discal Cyst: A Report of 9 Cases

“…Currently, most discal cysts are managed by partial hemi laminectomy and microscopic resection of the cyst under general anesthesia. CT-guided aspiration is another minimally invasive option, but it is associated with a high recurrence rate and requires radical excision of the intraspinal cyst 6,10,19) .…”

“…Other reports have completed resection by percutaneous endoscopic surgery, but the recurrence rate with percutaneous C-arm guide aspiration is not yet known. Recurrence has been reported by Lee et al and Kang et al after surgical removal of a discal cyst, but no studies have assessed recurrence after treatment with the 1,414-nm Nd:YAG laser 1,5,6,[9][10][11]17,19,20) .…”

“…Discal cysts are a rare cause of low back and radiating pain, and they usually occur in relatively young individuals. Discal cysts are characterized by distinct interface with their corresponding intervertebral disc 5,6,15,19) . Although conventional surgery is the gold standard for treatment of discal cysts, it can lead to complications, such as tissue disruption, bleeding, and fibrosis.…”