Lumbar discal cyst and post-operative discal pseudocyst: a case series

Abstract

Four cases of lumbar cyst (2 discal cysts and 2 post-operative discal pseudocysts) who presented predominantly with features of sciatica without any motor, sensory or sphincteric disturbances. The patients were treated conservatively, and the management was aimed to avert any untoward surgical intervention taking into consideration patient safety and care. Two had previous lumbar decompressive discectomy. During the mean follow-up period of 13 months, there was progressive recovery of symptoms in all our 4 patients. All our patients were successfully managed by conservative approach. An intervertebral disc cyst should be considered in young patients in the differential diagnosis of any extradural intraspinal mass ventral to the thecal sac, notwithstanding its rarity. Alongside, conservative management can be offered as first line of management with appropriate patient selection that is absence of any motor/sensory/sphincteric disturbances. Facetal micro-instability could be one of the aetiologies of this pathology which necessitates further study.

Figure 1

Case 1 L5-S1 level: there is disc desiccation and slight disc height loss; there is disc protrusion (including a cystic component) with impingement to the left traversing S1 nerve root.

Figure 2

(A) Case 2—initial MRI shows a slightly unusual abnormality associated with the L5-S1 compressing the left transiting S1 nerve root and is almost certainly a fragment of extruded/sequestered disc, and (B) case 2—updated MRI shows a significant decrease in the previously seen cystic lesion at L5-S1 level now measuring 4 mm (AP diameter, previously 11 mm).

Figure 3

(A) Case 3—an early MRI demonstrates at L5/S1 level moderate diffuse disc bulge is seen with early bilateral facet joint degenerative changes; there is irritation of the L5 nerve roots bilaterally, and at L5/S1 level moderate left posterolateral disc bulge is seen irritating the S1 nerve roots bilaterally left more than right, and bilateral facet joint degenerative changes also noted at this level, and (B) case 3—a later MRI, the cystic changes noted at the L4-L5 level which clearly shows a connection with the intervertebral disc.

Figure 4

(A) Case 4—an initial MRI showing multilevel degenerative disc disease and a cyst at the lumbar L5/S1 which is causing impingement on the left S1 nerve root, and (B) case 4—comparison was made with the previous MRI; post-contrast scan shows that the L5-S1 left-sided cystic features have nearly diminished; no neoplastic lesion is detectable.