Rationale: Percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment for lumbar disc herniation and postoperative discal pseudocyst (PDP) can rarely develop after PELD. Patient concerns: A 30-year-old man experienced low back pain and pain in the right lower extremity for 1 month, which aggravated for 3 days. Diagnoses: Preoperative CT and MRI showed lumbar disc herniation at the L4/5 level. Then the patient underwent PELD under local anesthesia and his symptoms disappeared immediately after surgery. After 37 days of PELD, the patient complained of recurrent low back pain on the right side, and pain on the outer side of his lower leg. MR imaging revealed cystic mass with low signal on T1-weighted images (T1WI), and high signal on T2-weighted images (T2WI). The patient was diagnosed with a symptomatic PDP after PELD. Interventions: Initially, the patient was treated with conservative treatment, including administration of aescin and mannitol by intravenous infusion, physical therapy, sacral canal injection. Then he underwent discography at L4/5 and ozone ablation under local anesthesia. Outcomes: The patient's condition improved significantly after 1 week of surgery and was discharged. One-year and 3-month follow-up revealed no recurrence of low back pain and leg pain. Lessons: PDP is one of the rare complications of PELD, usually occurs in young patients. Patients with PDP have a low signal intensity on T1WI and high signal intensity on T2WI, which can be treated by conservative treatment, interventional therapy, and surgical treatment.

Background: Transforaminal Endoscopic Lumbar Discectomy (TELD) is widely applied for lumbar degenerative disease (LDDs) and satisfactory short-term outcomes have been achieved. However, the mid-term and long-term follow-up of this technique is still lacking. Objective: To retrospectively analyze the mid-term clinical efficacy of TELD for single-level LDD and its effect on intervertebral disc degeneration with a minimum of 6-year follow-up. Methods: 64 patients with single-level LDDs (lumbar disc herniation, lumbar spinal stenosis) who underwent TELD under local anesthesia in our department from December 2014 to December 2015 were observed. Visual analog scale (VAS), Japanese Orthopaedic Association evaluation treatment (JOA) score and Oswestry Disability Index (ODI) were calculated and compared before operation, 3 months after operation, 6 months after operation, 1 year after operation and at the last follow-up. Disc Height (DH), disc range of motion (ROM) and disc degeneration on standard lumbar lateral radiographs before operation and at the last follow-up were determined. Recurrence rate and operation-related complications during follow-up were recorded. Results: 64 cases were followed up for 6.4 ± 0.1 years. There were no complications such as infection, epidural hematoma and nerve root injury. 1 patient (1.67%) was found to have dural rupture and cauda equina hernia during the operation. There were significant differences in VAS, JOA, ODI between preoperative and postoperative 3 months, 6 months, 1 year and last follow-up (P < 0 01), VAS, JOA, ODI at 3 months after operation were different from 6 months after operation (P < 0 05), and there were significant differences compared with preoperative, 1 year after operation and last follow up (P < 0 01). VAS, JOA and ODI at 6 months after operation were significantly different from those before operation (P < 0.01), but not significantly different from those at 1 year after operation and the last follow-up (P > 0.05). There was no significant difference in DH, ROM and the Pfirrmann grade of intervertebral disc preoperative and the last follow-up. During the follow-up period, 3 patients (4.69%) were recurrent, 13 patients (20.31%) had various degrees of postoperative dysesthesia (POD), and 3 patients (4.69%) had various degrees of muscle weakness.

The clinical manifestations of crowned dens syndrome (CDS) include acute neck pain and neck stiffness accompanied by restricted cervical range of motion. CDS is frequently misdiagnosed as meningitis, epidural abscess, rheumatoid arthritis, rheumatoid polymyalgia, giant cell arteritis, cervical spondylosis or metastatic bone tumor, and the incidence of CDS appears to be underestimated. The present study reported on four cases of CDS diagnosed by CT. They included one male and three females, aged from 67 to 78 years, and their major symptoms were acute neck pain and restricted cervical range of motion. Serum C-reactive protein levels and erythrocyte sedimentation rate were significantly increased in all cases. Cervical CT scan revealed calcified deposits surrounding the odontoid process in all cases. Non-steroidal anti-inflammatory drugs (NSAIDs) markedly reduced the levels of inflammatory indicators and rapidly relieved the symptoms. CT scan is considered the gold standard for CDS diagnosis, which may demonstrate calcification around the odontoid process. The patients' symptoms may be improved by treatment with NSAIDs.

Background Percutaneous endoscopic lumbar discectomy (PELD) has become the most common treatment for lumbar disc herniation (LDH). However, the risk of recurrence after PELD is inevitable. Therefore, clarifying the factors for recurrent LDH is necessary to improve the success rate and reduce the postoperative recurrence rate. The study aimed to investigate the postoperative recurrence rate, factors and re-treatment of recurrent LDH after PELD. Methods A total of 685 LDH patients who underwent PELD in our hospital from January 2015 to December 2017 were enrolled in this retrospective study. Postoperative recurrence rate was calculated. Outcomes for re-treatment of recurrent LDH were assessed by comparing VAS and JOA scores before the first surgery, after recurrence and at the final follow-up in patients with recurrent LDH. The factors for recurrent LDH were analyzed by univariate and multivariate analysis. Results Recurrent LDH was observed in 23 (3.35%) patients, including 21 cases of ipsilateral recurrent herniation, and 2 cases of contralateral recurrent herniation. Mean recurrence time was 5.4 ± 2.6 months (range, 0.5–11 months). VAS score was decreased, while JOA score was increased at the final follow-up compared with the scores measured before the first surgery and after recurrence. Univariate analysis revealed that body mass index (BMI), the types of disc herniation and postoperative activity levels were correlated with postoperative recurrence, while no correlation was found between sex, age, smoking history, the levels and position of herniated disc and recurrent LDH. Multivariate analysis showed that high BMI, the types of disc herniation (i.e. extrusion, sequestration) and high-intensity postoperative activity levels were risk factors for recurrent LDH. Conclusions High BMI, the extrusion and sequestration types of disc herniation, and high-intensity postoperative activity levels may significantly increase the incidence of recurrent LDH. All patients with recurrent LDH had satisfactory results after re-treatment.