Discal Cyst: a Rare Cause of Neurologic Compression in the Young Adult
DOI:
https://doi.org/10.7322/jhgd.119298Palabras clave:
intervertebral disc, minimally invasive surgical procedures, sciatica, back pain, intervertebral disc displacement, radiculopathy.Resumen
Introduction: discal cysts are rare pathology. Its clinical presentation can be mistaken for disc herniation, with back pain, radiculopathy and neurological defi cit. It is more common in male patients in their fourth life decade. Because they are rare, there is no consensus about the treatment. A great variety of procedures, from medication for the pain to endoscopic or microdiscectomy excision, have been described. Objetive: Describe a case of discal cyst on the l4-l5 level with compression of l5 right nerve root treated successfully with a minimal invasive procedure. Study design: Case report. Methods: Review medical records, pertinent images, interview with the patient and surgical team, intraoperative and histopathological fi ndings. The surgical technique used was minimally invasive. Results: Magnetic resonance imaging (MRI) demonstrated a cystic lesion imaging at the level of the L4-L5 disc. The cystic mass displaced the thecal sac dorsally compressed the L5 transversing root. The patient was submitted to a minimally invasive microendoscopic technique using a tubular retractor. He recovered completely after the procedure, presenting absence of leg pain and went back to his regular activities 3 weeks after the surgery. Histopathological examination of the cyst revealed thick fi brous connective tissue interspersed with areas of chronic infl ammation. Conclusion: Discal cysts are rare intraspinal lesions. They can trigger severe neurological symptoms, and should be differentiated from other forms of epidural cysts and tumors. There are many treatment options that can be chosen from but no consensus. We used a treatment that was less invasive than the ones described in the literature.
Referencias
Caetano VC, Ribeiro LC, Cruz DT, Asmus CIRF. Desordens músculo-esqueléticas em adolescentes trabalhadores. Rev Bras Crescimento Desenvolv Hum. 2008;18(3):264-74. DOI: http://dx.doi.org/10.7322/jhgd.19889
Kono K, Nakamura H, Inoue Y, Okamura T, Shakudo M, Yamada R. Intraspinal extradural cysts communicating with adjacent herniated disks: imaging characteristics and possible pathogenesis. Am J Neuroradiol. 1999;20(7):1373-7.
Aydin S, Abuzayed B, Yildirim H, Bozkus H, Vural H. Discal cysts of the lumbar spine: report of fi ve cases and review of the literature. Eur Spine J. 2010;19(10):1621-6. DOI: http://dx.doi.org/10.1007/s00586-010-1395-9
Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Nishizawa T. Intraspinal cyst communicating with the intervertebral disc in the lumbar spine: discal cyst. Spine (Phila Pa 1976). 2001;26(19):2112-8.
Murata K, Ikenaga M, Tanaka C, Kanoe H, Okuaaira S. Discal cysts of the lumbar spine: a case report. J Orthop Surg (Hong Kong). 2007;15(3):376-9.
Hwang JH, Park IS, Kang DH, Jung JM. Discal cyst of the lumbar spine. J Korean Neurosurg Soc. 2008;44(4):262-4. DOI: http://dx.doi.org/10.3340/jkns.2008.44.4.262
Jeong GK, Bendo JA. Lumbar intervertebral disc cyst as a cause of radiculopathy. Spine J. 2003;3(3):242-6.
Hyung-Jun K, Dae-Yong K, Tae-Ho K, Ho-Sang P, Jae-Sung K, Jae-Won J, et al. Lumbar discal cyst causing bilateral radiculopathy. Surg Neurol Int. 2011;2:21. DOI: http://dx.doi.org/10.4103/2152-7806.77026
Lee HK, Lee DH, Choi CG, Kim SJ, Suh DC, Kahng SK et al. Discal cyst of the lumbar spine: MR imaging features. Clin Imaging. 2006;30(5):326-30. DOI: http://dx.doi.org/10.1016/j.clinimag.2006.05.026
Kwon YK, Choi KC, Lee CD, Lee SH. Intraoperative discography for detecting concealed lumbar discal cysts. J Korean Neurosurg Soc. 2013;53(4):255-7. DOI: http://dx.doi.org/10.3340/jkns.2013.53.4.255
Prasad G, Kabir SM, Saifuddin A, Casey AT. Spontaneous resolution of discal cyst around L5 nerve root: case report and review of literature. Br J Neurosurg. 2011;25(6):761-3. DOI: http://dx.doi.org/10.3109/02688697.2011.555020
Koga H, Yone K, Yamamoto T, Komiya S. Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: a case report. Spine (Phila Pa 1976). 2003;28(11):E212-6. DOI: http://dx.doi.org/10.1097/01.BRS.0000067279.53431.6A
Ha SW, Ju CL, Kim SW, Lee S, Kim YH, Kim HS. Clinical outcomes of percutaneous endoscopic surgery for lumbar discal cyst. J Korean Neurosurg Soc. 2012;51(4):208-14. DOI: http://dx.doi.org/10.3340/jkns.2012.51.4.208
Lin N, Schirmer CM, Proctor MR. Presentation and progression of a disc cyst in a pediatric patient. J Neurosurg Pediatr. 2011;7(2):209-12. DOI: http://dx.doi.org/10.3171/2010.11.PEDS10227
Marushima A, Uemura K, Sato N, Maruno T, Matsumura A. Osteolytic lumbar discal cyst: case report. Neurol Med Chir (Tokyo). 2008;48(8):363-6.
Jha SC, Tonogai I, Higashino K, Sakai T, Takata Y, Goda Y, et al. Postoperative discal cyst: An unusual complication after microendoscopic discectomy in teenagers. Asian J Endosc Surg. 2016;9(1):89-92. DOI: http://dx.doi.org/10.1111/ases.12227
Kobayashi S, Meir A, Kokubo Y, Uchida K, Takeno K, Miyazaki T, et al. Ultrastructural analysis on lumbar discherniation using surgical specimens: Role of neovascularization and macrophages in hernias. Spine (Phila Pa 1976). 2009;34(7):655-62. http://dx.doi.org/10.1097/BRS.0b013e31819c9d5b
Kobayashi S, Takeno K, Uchida K, Yayama T, Nakajima H, Miyazaki T, et al. Pathogenesis of the discal cysts communicating with an adjacent herniated disc. Histological and ultrastructual studies of two cases. Joint Bone Spine. 2010;77(2):184-6. DOI: http://dx.doi.org/10.1016/j.jbspin.2009.09.009
Santos FGPL, SouzaI RA, BrottoI MPA, SuguitaI FM, Denise Tokechi Amaral DT, Amaral LLF. Epidural cystic masses associated with interspinous bursitis, synovial and discal cysts. Radiol Bras. 2009;42(2):1373-7. DOI: http://dx.doi.org/10.1590/S0100-39842009000200013
Okada K, Saito H, Nishida J, Miyakoshi N, Takahashi S, Nagasawa H, et al. Discal cyst associated with myxoid change and apoptosis of herniated disc materials: a case report. Ups J Med Sci. 2007;112(1):39-47.
Tarlov IM. Perineural cysts of the spinal nerve roots. Arch Neural Psychiatry. 1938;40(6):1067-74. DOI:
http://dx.doi.org/10.1001/archneurpsyc.1938.02270120017001
Rohrer DC, Burchiel KJ, Gruber DP. Intraspinal extradural meningeal cyst demonstrating ball–valve mechanism of formation. Case report. J Neurosurg. 1993;78(1):122-5. DOI: http://dx.doi.org/10.3171/jns.1993.78.1.0122
Jackson DE Jr, Atlas SW, Mani JR, Norman D. Intraspinal synovial cysts: MR imaging. Radiology. 1989;170(2):527-30. DOI: http://dx.doi.org/10.1148/radiology.170.2.2911681
Ross JS, Masaryk TJ, Schrader M, Gentili A, Bohlman H, Modic MT. MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. AJNR Am J Neuroradiol. 1990;11(4):771-6.
Takeshima Y, Takahashi T, Hanakita J, Watanabe M, Kitahama Y, Kuraishi K, et al. Lumbar discal cyst with spontaneous regression and subsequent occurrence of lumbar disc herniation. Neurol Med Chir (Tokyo). 2011;51(11):809-11.
Chou D, Smith JS, Chin CT. Spontaneous regression of a discal cyst. Case report. J Neurosurg Spine. 2007;6(1):81-4. DOI: http://dx.doi.org/10.3171/spi.2007.6.1.81
Kim JS, Choi G, Jin SR, Lee SH. Removal of a discal cyst using a percutaneous endoscopic interlaminar
approach: a case report. Photomed Laser Surg. 2009;27(2):365-9.
Descargas
Publicado
Número
Sección
Licencia
CODE OF CONDUCT FOR JOURNAL PUBLISHERS
Publishers who are Committee on Publication Ethics members and who support COPE membership for journal editors should:
- Follow this code, and encourage the editors they work with to follow the COPE Code of Conduct for Journal Edi- tors (http://publicationethics.org/files/u2/New_Code.pdf)
- Ensure the editors and journals they work with are aware of what their membership of COPE provides and en- tails
- Provide reasonable practical support to editors so that they can follow the COPE Code of Conduct for Journal Editors (http://publicationethics.org/files/u2/New_Code.pdf_)
Publishers should:
- Define the relationship between publisher, editor and other parties in a contract
- Respect privacy (for example, for research participants, for authors, for peer reviewers)
- Protect intellectual property and copyright
- Foster editorial independence
Publishers should work with journal editors to:
- Set journal policies appropriately and aim to meet those policies, particularly with respect to:
– Editorial independence
– Research ethics, including confidentiality, consent, and the special requirements for human and animal research
– Authorship
– Transparency and integrity (for example, conflicts of interest, research funding, reporting standards
– Peer review and the role of the editorial team beyond that of the journal editor
– Appeals and complaints
- Communicate journal policies (for example, to authors, readers, peer reviewers)
- Review journal policies periodically, particularly with respect to new recommendations from the COPE
- Code of Conduct for Editors and the COPE Best Practice Guidelines
- Maintain the integrity of the academic record
- Assist the parties (for example, institutions, grant funders, governing bodies) responsible for the investigation of suspected research and publication misconduct and, where possible, facilitate in the resolution of these cases
- Publish corrections, clarifications, and retractions
- Publish content on a timely basis