Symptomatic Postoperative Discal Pseudocyst After Percutaneous Endoscopic Interlaminar Discectomy: Case Report and Literature Review

Abstract

Background: A postoperative discal pseudocyst (PDP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to recurrence or even worse symptoms. To our knowledge, to date, there is no research focusing specifically on PDP following percutaneous endoscopic interlaminar discectomy (PEID).

Case presentation: We present the case of a 27-year-old man with L₅ S₁ intervertebral disc herniation who was treated with PEID after failed conservative treatment. His leg pain was relieved immediately but reoccurred on the 40th day. MRI showed a PDP. Because loxoprofen and bedrest were ineffective and the patient was anxious, we performed a cystectomy. The patient's symptoms were significantly relieved, and a 6-month follow up showed no recurrence both clinically and on MRI.

Conclusion: A PDP is more likely to form using the interlaminar approach than the transforaminal approach. For patients with mental stress, severe pain, and neurological symptoms, surgery is suggested to remove the cyst. Discectomy cannot be performed when disc degeneration is mild.

Keywords: Percutaneous endoscopic interlaminar discectomy; Postoperative discal pseudocyst; Surgical treatment.

Fig. 1

Preoperative MRI showed that the left part of the intervertebral disc of L₅S₁ protruded and compressed the nerve root of S₁ (A–C). MRI on the 40th day after the first operation suggested a postoperative discal pseudocyst (PDP) (D–F). At the 6‐month follow‐up after the second operation, the MRI showed that the PDP had disappeared (G–I).

Fig. 2

The pathology of the postoperative discal cyst showed fibrous tissue hyperplasia and local glassy changes (hematoxylin and eosin stain, A × 40, B × 200).