Percutaneous Intradiscal Aspiration of a Lumbar Vacuum Disc Herniation: A Case Report

Abstract

We report a case of an 83-year-old gentleman presenting with acute low back pain and radicular left lower extremity pain after golfing. A magnetic resonance imaging (MRI) of the lumbar spine revealed a low-signal-density lesion compressing the L5 nerve. A computed tomography scan was then ordered, confirming an extra-foraminal disc protrusion at the L5-S1 level, containing a focus of gas that was compressing the left L5 nerve root and communicating with the vacuum disc at L5-S1. After a failed left L5 transforaminal epidural steroid injection, the patient was brought back for a percutaneous intradiscal aspiration of the vacuum disc gas. This resulted in immediate relief for the patient. A follow-up MRI performed 2 months after the procedure found an approximate 25% reduction in the size of the vacuum disc herniation. Six months after the procedure, the patient remains free of radicular pain. This case report suggests that a percutaneous aspiration of gas from a vacuum disc herniation may assist in the treatment of radicular pain.

Radiculopathies caused by spontaneous pneumorrachis: two case reports and review of literature

“…In our cases, we noticed an improvement without using invasive procedures. Some authors reported the efficacy of the CT guided aspiration of the gas cyst [19,20]. However, in some cases, intraspinal gas recurred with a relapse of the radicular syndrome [10,11].…”

Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note

“…In the older patients, end-stage degenerative vacuum disc disease is routinely found during lumbar transforaminal endoscopy in up to 73% of patients over age 45, where there often is a collapsed vacuum disc without any structural integrity. [44][45][46][47][48] In those patients, an "inside-out" look inside the disc is a sensible step that provides more reliable long-term outcomes with fewer revision www.e-neurospine.org S41 surgeries. In younger patients, the authors are concerned with the propagation of progressive vertical disc collapse with the "inside-out" technique for which reason they routinely start the transforaminal decompression with the "outside-in" technique and only enter the intervertebral disc space if there is lack of structural integrity to improve outcomes.…”

Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

“…Other local structures and processes, such as inter-apophyseal joints, thoracic surgery, pneumothorax, penetrating chest wounds, intestinal necrosis, pyogenic infections produced by gas-forming organisms and osteonecrosis, are another potential source of gas in the spinal canal 3 , 6 , 7 , 8 , 12) . In most cases, the gas formation in the spinal canal is associated with disc herniation 12 , 13) , but isolated so-called pseudocyst have also been reported 4 , 12 , 13) .…”

“…Intraspinal air was thought to have the relationship with vacuum phenomenon by many authors 5 , 6) . Some authors demonstrated the existence of communication between the intradiscal gas and the intraspinal gas by confirming the flow of contrast media into the pseudocyst using a CT after discography 9 , 13) . Intradiscal gas can migrate into the epidural space, through this communication, as a result of normal movements of the lumbar spine acting as a piston, and this can, albeit infrequently, lead to nerve root compression 20) .…”