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Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst.

Jha SC, Higashino K, Sakai T, Takata Y, Abe M, Nagamachi A, Fukuta S, Sairyo K - Case Rep Orthop (2015)

Bottom Line: Results.Conclusion.A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.

ABSTRACT
Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.

No MeSH data available.


Related in: MedlinePlus

Preoperative magnetic resonance imaging: (a) sagittal T2-weighted image, (b) axial T2-weighted image through the L4-L5 disc, and (c) axial T2-weighted image through L5 pedicle demonstrate the extradural cystic lesion with high signal intensity, communicating with the corresponding intervertebral disc (arrows).
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fig1: Preoperative magnetic resonance imaging: (a) sagittal T2-weighted image, (b) axial T2-weighted image through the L4-L5 disc, and (c) axial T2-weighted image through L5 pedicle demonstrate the extradural cystic lesion with high signal intensity, communicating with the corresponding intervertebral disc (arrows).

Mentions: An 18-year-old high school baseball player presented with low back pain radiating to the right lower limb after a minor road traffic accident. On physical examination, the straight leg raising test was positive at 45 degrees on the right side but the rest of his neurological examination was unremarkable. No abnormalities were seen on the plain radiograph. Magnetic resonance imaging (MRI) demonstrated an intraspinal extradural space-occupying lesion just caudal to the L4-L5 intervertebral disc on the right side. It was isointense on the T1-weighted image and hyperintense on T2-weighted sequence, suggesting the lesion was a discal cyst (Figure 1). He was managed conservatively as it was his first visit and his symptoms were relatively mild. He continued to play baseball while taking nonsteroidal anti-inflammatory drugs. His symptoms had persisted at the 3-month and 6-month follow-up consultations, and a repeat MRI showed the persisting discal cyst (Figure 2). The patient and his family were willing to undertake minimally invasive surgery for the discal cyst during the baseball off-season and they were referred to our department for PED. The patient was planning to return to baseball after the off-season prior to entering college.


Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst.

Jha SC, Higashino K, Sakai T, Takata Y, Abe M, Nagamachi A, Fukuta S, Sairyo K - Case Rep Orthop (2015)

Preoperative magnetic resonance imaging: (a) sagittal T2-weighted image, (b) axial T2-weighted image through the L4-L5 disc, and (c) axial T2-weighted image through L5 pedicle demonstrate the extradural cystic lesion with high signal intensity, communicating with the corresponding intervertebral disc (arrows).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556867&req=5

fig1: Preoperative magnetic resonance imaging: (a) sagittal T2-weighted image, (b) axial T2-weighted image through the L4-L5 disc, and (c) axial T2-weighted image through L5 pedicle demonstrate the extradural cystic lesion with high signal intensity, communicating with the corresponding intervertebral disc (arrows).
Mentions: An 18-year-old high school baseball player presented with low back pain radiating to the right lower limb after a minor road traffic accident. On physical examination, the straight leg raising test was positive at 45 degrees on the right side but the rest of his neurological examination was unremarkable. No abnormalities were seen on the plain radiograph. Magnetic resonance imaging (MRI) demonstrated an intraspinal extradural space-occupying lesion just caudal to the L4-L5 intervertebral disc on the right side. It was isointense on the T1-weighted image and hyperintense on T2-weighted sequence, suggesting the lesion was a discal cyst (Figure 1). He was managed conservatively as it was his first visit and his symptoms were relatively mild. He continued to play baseball while taking nonsteroidal anti-inflammatory drugs. His symptoms had persisted at the 3-month and 6-month follow-up consultations, and a repeat MRI showed the persisting discal cyst (Figure 2). The patient and his family were willing to undertake minimally invasive surgery for the discal cyst during the baseball off-season and they were referred to our department for PED. The patient was planning to return to baseball after the off-season prior to entering college.

Bottom Line: Results.Conclusion.A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.

ABSTRACT
Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.

No MeSH data available.


Related in: MedlinePlus