Symptomatic postoperative discal pseudocyst following percutaneous endoscopic lumbar discectomy

Abstract

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.

Surgical treatment of recurrent postoperative discal pseudocyst: A case report and literature review

“…In this way, the effect of different examination times could be avoided. In the present study and in most of the published literature, [1,2,4–10] PDPs have been documented to involve the L4/5 or L5/S1 level. Indeed, all 15 patients reviewed by Kang and Park [2] had PDPs at 1 of these 2 levels, which appear to be the most commonly affected sites.…”

“…For recurrent PDP, posterior instrumented lumbar fusion is an effective treatment modality. Symptoms relieved Kang and Park [2] 15 M (15) Korea 22.5 L4/5 (6), L5/S1 ( 9) TFED (6), ILED (9) 53.7 Conservative (10), surgery (5) Symptoms relieved Chung et al [3] 12 M (11), F (1) Korea 29.3 L2/3 (3), L4/5 (7), L5/S1 (2) MD (9), PELD (3) 31.2 Conservative (6), surgery (5), needle aspiration (1) Symptoms disappeared Fu et al [4] 1 M China 23 L4/5 PELD 40 Conservative Symptoms disappeared Prasad et al [5] 1 M India 30 L4/5 NA 25 Surgery Symptoms relieved Jha et al [6] 2 M (1), F (1) Japan 17 L4/5 (1), L5/S1 (1) MED (2) 45 Conservative (2) Symptoms relieved Xu et al [7] 1 M China 27 L5/S1 PEID 40 Surgery Symptoms relieved Li et al [8] 1 M China 30 L4/5 PELD 37 Ozone ablation Symptoms relieved Manabe et al [9] 1 M Japan 21 L4/5 (1) PED 42 Surgery Symptoms relieved Shiboi et al [10] 2 M (1), F (1) Japan 20.…”

“…We found 10 papers, including 1 paper from the United States [1] and 9 papers from Asia. [2][3][4][5][6][7][8][9][10] The findings of these 10 papers have been summarized in Table 1. These 10 studies and the present study included a total of 39 patients, of whom 94.87% (37 patients) were Asians, and 92.31% (36 patients) were men.…”

A Review and Summary of Patients with Symptomatic Postoperative Discal Pseudocysts of the Lumbar Spine

“…For patients who do not want to be treated again, interventional therapy under the guidance of DR or CT can be used. 21 Interventional therapy involves needle aspiration and injections of either imaging contrast agents for diagnosis or drugs (steroidal, xylocaine with dexamethasone, ozone) for treatment. Diseased tissues can be removed and cultured to rule out infections.…”

“…Diseased tissues can be removed and cultured to rule out infections. 5 , 21 , 22 In the cases in the literature, four patients (9.3%) who received conservative treatment were lost during follow up indicating that interventional treatment is an effective treatment option for PDP.…”