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Case Reports
. 2016 Apr;29(2):129-35.
doi: 10.3344/kjp.2016.29.2.129. Epub 2016 Apr 1.

Successful Treatment of a Symptomatic Discal Cyst by Percutaneous C-arm Guided Aspiration

Hyun Jeong Yu  1 , Chan Jin Park  1 , Kyoung Hoon Yim  1
Affiliations
Case Reports

Successful Treatment of a Symptomatic Discal Cyst by Percutaneous C-arm Guided Aspiration

Hyun Jeong Yu et al. Korean J Pain. 2016 Apr.

Abstract

Although discal cysts are a rare cause of low back pain and radiculopathy. Currently, surgical excision is usually the first-line treatment for discal cysts. However, alternative treatment methods have been suggested, as in some cases symptoms have improved with interventional therapies. A 27-year-old man presented with an acute onset of severe pain, and was found to have a discal cyst after an open discectomy. The patient underwent cyst aspiration and steroid injection through the facet joint under C-arm guidance. After the procedure, the patient's pain improved to NRS 0-1. On outpatient physical examination 1 week, and 1 and 3 months later, no abnormal neurological symptoms were present, and pain did not persist; thus, follow-up observation was terminated. When a discal cyst is diagnosed, it is more appropriate to consider interventional management instead of surgery as a first-line treatment, while planning for surgical resection if the symptoms do not improve or accompanying neurologic deficits progress.

Keywords: Aspiration; Discal cyst; Injection; Intervertebral disc; Lumbar vertebra; Radiculopathy.

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Figures

Fig. 1
Fig. 1. MRI of the lumbar spine. Sagittal (A) and axial (B) T1-weighted MRI of the lumbar spine. The images show an L4-5 HIVD. Sagittal (C) and axial (D) T2-weighted MRI of the lumbar spine. The images show an L4-5 HIVD.
Fig. 2
Fig. 2. Sagittal MRI of a discal cyst. (A) The cystic mass in the L4-5 level intraspinal space shows low signal intensity on the T1-weighted image. (B) The cystic mass in the L4-5 level intraspinal space shows high signal intensity on the T2-weighted image. (C) Discal cyst on short tau inversion recovery (STIR) imaging.
Fig. 3
Fig. 3. Axial MRI of a discal cyst. (A) Discal cyst showing low signal intensity on a T1-weighted image. (B, C) Discal cyst showing high signal intensity on T2-weighted images and communication with the adjacent L4-5 intervertebral disc. (D) Discal cyst on STIR imaging.
Fig. 4
Fig. 4. Aspirated fluid from discal cyst.
Fig. 5
Fig. 5. C-arm guided aspiration and steroid injection. The discal cyst (black arrow) shows enhancement by contrast media (A). After aspiration, the discal cyst has regressed (B). Because the cyst was ruptured during the last attempt, the contrast media shown in the epidural space (black arrow head).
See this image and copyright information in PMC

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