Transition of a herniated lumbar disc to lumbar discal cyst: A case report

Abstract

Background:Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst.Case Description:A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 level. It was managed conservatively for 6 months, after which symptoms recurred and progressed. The follow-up MR study revealed a discal cyst at the L4-5 without residual herniated disc. Of interest, the cyst communicated with the L4-5 intervertebral disc, which was herniated under the posterior longitudinal ligament and the disc space. During surgery, the cyst was completely removed, and his symptoms/signs resolved.Conclusion:A discal cyst develops as pathological sequelae of a degenerated herniated disc. Although rare, these lesions must be considered among the differential diagnoses in young patients with radicular back pain. MR study clearly documents these lesions, and surgical excision of the cyst is the treatment of choice.

Minimally Invasive en bloc Excision of Rare Hemorrhagic Discal Cysts Using Unilateral Biportal Endoscopic Technique: A Report of Two Cases

“…There was no guideline suggesting the optimal treatment for HDC in the past. Most of the evidences were in the form of case reports or small series [3,11,12]. Several studies with conservative treatment showed low satisfaction rate with a low rate of…”

“…(MRI). In the reported cases, the surgical excision of the cyst seemed to be a better option than the conservative treatment [3]. While the traditional open surgery was effective, the major drawbacks were massive soft tissue dissection and excessive destruction of the bony structures.…”

Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review

“…Ganglion cysts can develop from any connective tissue of the spine. They have been associated with interspinous ligament [ 3 - 6 ], ligamentum flavum [ 7 - 14 ], PLL [ 15 - 20 ], and disc [ 21 - 27 ].…”

“…Bansil et al [ 21 ] reported on a patient suffering from a herniated lumbar disc, with subsequent transformation into a discal cyst within six months. Kim et al [ 26 ] reported on two cases defining the evolution of spinal discal cysts under percutaneous endoscopy.…”

“…They have been associated with interspinous ligament [3][4][5][6], ligamentum flavum [7][8][9][10][11][12][13][14], PLL [15][16][17][18][19][20], and disc [21][22][23][24][25][26][27].…”