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

Abstract

Prevalence of lumbar discal cyst is very low, it can cause low back pain and radiating leg pain when present. Currently, trans-sacral epiduroscopic-assisted, 1,414-nm Nd:YAG laser decompression (SELD) is commonly used for spinal pathologies. However, the use of the laser for spinal procedures can be limited due to the risk of thermal injury. We reviewed nine consecutive patients who underwent SELD ablation for discal cyst between 2014 and 2015. Each patient underwent diagnostic imaging, including simple radiographs, computed tomography with discography, and magnetic resonance imaging (MRI). Pain relief and clinical outcome assessment of patient satisfaction was the primary outcome measure. All patients presented with back pain and unilateral radiating pain. The discal cyst was located in the lumbar region in all patients. Preoperative MRI showed a connection between the cyst and the involved intervertebral disc. All patients obtained immediate relief of symptoms after the discal cyst was treated with a SELD-assisted, 1,414-nm Nd:YAG laser. The mean visual analogue scale (VAS) for back pain was 7.89±0.78 preoperatively, 1.67±1.50 at the 1-month follow up, and 0.38±0.5 at the final follow up (p< 0.01). All patients obtained excellent or good outcomes according to the modified MacNab's criteria. There were no complications. These cases demonstrated that trans-sacral, epiduroscopic-assisted, 1,414nm Nd:YAG laser decompression was a safe, viable, and efficacious option for treating lumbar discal cyst because it lowers the risk of muscle injury and can be performed under local anesthesia.

Percutaneous Transforaminal Endoscopic Decompression in Lumbar Discal Cyst

“…An alternative approach to conservative management of discal cysts is percutaneous CT-guided aspiration (7). Also, there are reports of transsacral epiduroscopic (with Nd:YAG laser) decompression (SELD) (8). Other treatments include PTELD and PIELD (3,9,10).…”