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Case Reports
. 2019 Aug 21;11(8):e5453.
doi: 10.7759/cureus.5453.

Symptomatic Lumbar Discal Cyst: A Rare Entity that Can Mimic Other Lumbar Cystic Lesions

Zaid Aljuboori  1 , Thomas Altstadt  1
Affiliations
Case Reports

Symptomatic Lumbar Discal Cyst: A Rare Entity that Can Mimic Other Lumbar Cystic Lesions

Zaid Aljuboori et al. Cureus. .

Abstract

Lumbar discal cyst (LDC) is a rare clinical entity with unclear etiology. Three theories have been proposed to describe the pathogenesis of this condition: (i) a reaction to spinal epidural hematoma; (ii) a pseudomembrane formation that follows the focal annular tear and disc degeneration; and (iii) an inflammatory reaction to the herniated disc fragment. It usually presents with radicular symptoms. Radiographically, LDC can mimic other cystic lesions of the lumbar spine. Imaging nuances such as scalloping of the vertebral body, contrast filling with discography, and MRI signal intensity on different sequences can help to establish a diagnosis of LDC. However, there are no clear guidelines on the best treatment approach. Several treatment options have been prescribed to treat LDC with good outcomes. Here we describe a case of LDC that presented with left-sided radicular symptoms for several months and had not undergone any initial conservative management. The patient was treated successfully with microscopic resection of the cyst with complete resolution of the symptoms.

Keywords: cyst; disc; lumbar; radiculopathy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. MRI T2 sequence of lumbar spine (axial view).
Shows a left-sided hyperintense cystic lesion behind the L4 vertebral body (arrow).
Figure 2
Figure 2. MRI T2 sequence of lumbar spine (sagittal view).
Shows a hyperintense cystic lesion behind the L4 vertebral body (arrow).
Figure 3
Figure 3. CT myelogram of the lumbar spine.
Shows a left-sided cystic lesion with scalloping of the posterior vertebral body (arrow) with no contrast filling.
Figure 4
Figure 4. H&E preparation of the cyst wall (10x).
Fibrosis and absence of epithelial lining of cyst wall.
Figure 5
Figure 5. H&E preparation of the cyst wall (20x).
Hemosiderin deposition present within the cyst wall.
See this image and copyright information in PMC

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