Symptomatic Post-Discectomy Pseudocyst after Endoscopic Lumbar Discectomy

Abstract

Objective : The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them. Methods : Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI). Results : Among 1,503 cases of all male soldiers, the MRIs showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach (p=0.001). The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP. Conclusion : Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach.

Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy

“…The onset of recurrent LDH is expected to be acute; however, the leg pain gradually increased in case 1 ( Table 1). A short duration of symptom improvement may indicate the possibility of recurrent LDH, and the duration of case 1 was within the extent of the previously reported cases (20 vs. 9-118 days) (4,5). Spontaneous regression of the lesion may occur in both pathological conditions (5,14,15).…”

“…However, there has been no discussion about differential diagnosis of a simple recurrence of LDH in previous reports (4)(5)(6). We therefore present a case of recurrent LDH resembling symptomatic PDP and real symptomatic PDP, and further discuss the difficulty of the differential diagnosis.…”

“…Although postoperative discal pseudocyst (PDP) is one of the complications after discectomy, Kang and Park first reported symptomatic PDP after PELD in 2011 (4). In general, PDP is diagnosed on the basis of typical MRI findings [a cystic lesion at the discectomy site, with low intensity of a T1-weighted image (T1WI) and high intensity on a T2-weighted image (T2WI)]; however, intraoperative confirmation was not fully performed in these reported cases (4)(5)(6). The reason for continuing conservative treatment is that spontaneous regression may be expected with this pathological condition (4)(5)(6).…”

Retrospective report of symptomatic postoperative discal pseudocyst after lumbar discectomy

“…To the best of the authors' knowledge, only one clinical article and one case report have been published. Kang et al [12] reported an incidence of 1% in a single center study after endoscopic lumbar discectomy (15 lesions in 1,503 cases recorded between March 2003 and October 2008). Young et al published two cases in their case report [30].…”

“…Kang et al reported that there was no difference in the treatment outcomes between a surgically managed group and a conservatively managed group [12]. There are a small number of published reports on spontaneous regression of intraspinal extradural cysts [5,7,18,19,26].…”