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

Abstract

Lumbar discal cyst (LDC) is a rare clinical entity with unclear etiology. Three theories have been proposed to describe the pathogenesis of this condition: (i) a reaction to spinal epidural hematoma; (ii) a pseudomembrane formation that follows the focal annular tear and disc degeneration; and (iii) an inflammatory reaction to the herniated disc fragment. It usually presents with radicular symptoms. Radiographically, LDC can mimic other cystic lesions of the lumbar spine. Imaging nuances such as scalloping of the vertebral body, contrast filling with discography, and MRI signal intensity on different sequences can help to establish a diagnosis of LDC. However, there are no clear guidelines on the best treatment approach. Several treatment options have been prescribed to treat LDC with good outcomes. Here we describe a case of LDC that presented with left-sided radicular symptoms for several months and had not undergone any initial conservative management. The patient was treated successfully with microscopic resection of the cyst with complete resolution of the symptoms.

Lumbar Discal Cyst: Is it a Rare Consequence in Lumbar Disc Disease Spectrum? Short Case Series with Review of Literature and Hypothesis Regarding Etiopathogenesis

“…8,14 The diagnostic tools employed to diagnose discal cysts include MRI and CT discography. 1,13 MRI is a non-invasive tool to differentiate a discal cyst from other intraspinal cysts. Discal cyst shows characteristic isointense T1 and hyperintense T2 images with peripheral rim enhancement on contrast images.…”

“…So far, most cases have been reported from the Asian continent. [1][2][3][4][5] A few cases have been reported in the pediatric age group. 6 Bilateral occurrence of discal cyst has also been reported.…”

“…3 Histologically, discal cyst contains fibrous connective tissue without specific epithelial lining cells, and sometimes, hemosiderin deposits are seen due to old hemorrhage. 1,2 The correlation of clinical features, MRI findings, operative details, and histological characteristics help exclude other differential diagnoses of spinal extradural cysts such as arachnoid cysts, synovial cysts, ligamentum flavum cysts, and ganglion cysts. [9][10][11][12] Concerning management, if conservative treatment fails, controversy hinges on whether surgical cyst excision should be combined with or without discectomy.…”

Discal cyst: a rare cause of low back pain and sciatica

“…Clinically, they cause low back pain and sciatica, thus being indistinguishable from disc herniation [2] . Magnetic resonance imaging (MRI) is crucial to make the correct diagnosis as they appear as cystic formation with fluid content whose signal is variable based on the amount of blood within it [3] .…”