Postoperative discal pseudocyst and its similarities to discal cyst: A case report

Abstract

Background: Postoperative discal pseudocyst (PDP) is a rare condition that presents after surgery for lumbar disc herniation. Due to the lack of information, the diagnosis and treatment of PDP remain controversial. Herein, we report a PDP case that occurred following percutaneous endoscopic lumbar discectomy and received conservative treatment. Additionally, we review all the published literature regarding PDP and propose our hypothesis regarding PDP pathology.

Case summary: A 23-year-old man presented with a relapse of low back pain and numbness in his left lower extremity after undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation. Repeat magnetic resonance imaging demonstrated a cystic lesion at the surgical site with communication with the inner disc. The patient was diagnosed as having PDP. The patient received conservative treatment, which resulted in rapid improvement and spontaneous regression of the lesion, and had a favorable outcome in follow-up.

Conclusion: PDP and discal cyst (DC) exhibit similarities in both histological and epidemiological characteristics, which indicates the same pathological origin of PDP and DC. The iatrogenic annular injury during discectomy might accelerate the pathological progression of DC. For patients with mild to moderate symptoms, conservative treatment can lead to great improvement, even inducing spontaneous regression. However, surgical cystectomy is necessary in patients with neurological deficits and where conservative treatment is ineffective.

Keywords: Case report; Cystectomy; Discal cyst; Percutaneous endoscopic lumbar discectomy; Postoperative discal pseudocyst.

Figure 1

Magnetic resonance imaging of case 1. A: Pre-surgical magnetic resonance imaging (MRI) showing lumbar disc herniation at L4-5; B: Post-surgical MRI confirming complete removal of the herniated disc fragment; C: Re-examination MRI revealed a cystic lesion at the surgical site with a communication stalk between the cyst and inner disc (arrow); D: Follow-up MRI after 6 mo demonstrating complete spontaneous regression of the lesion.