Early symptomatic intervertebral disc pseudocysts after discectomy detected on MRI
You Zhengqiu, Zhang Zhongzu, Wang Qunbo
Department of Orthopedics, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing 402160, China
Abstract: BACKGROUND: Postoperative symptomatic intervertebral disc pseudocyst is a cystic lesion in the area of intervertebral disc surgery. It is usually found in patients undergoing MRI examination in the early postoperative period. At present, there is insufficient data on its clinical characteristics and pathogenesis, and its treatment method is still controversial.
OBJECTIVE: To investigate the clinical characteristics, pathogenesis and treatment strategy of symptomatic intervertebral disc pseudocyst after discectomy.
METHODS: Seven patients with symptomatic intervertebral disc pseudocysts after intervertebral discectomy in the Yongchuan Hospital Affiliated to Chongqing Medical University from January 2019 to September 2021 were enrolled in this study. There were 5 males and 2 females, at the age of 35-60 years. Clinical features and treatments were retrospectively analyzed.
RESULTS AND CONCLUSION: (1) Among seven patients, five patients underwent percutaneous endoscopic lumbar discectomy and two underwent posterior microscopic endoscopic discectomy. Their symptoms were significantly relieved after surgery. However, the symptoms recurred after the operation. The postoperative MRI showed low signal on T1WI and high signal on T2WI in the original operation area, and it communicated with the intervertebral disc, which was diagnosed as symptomatic intervertebral disc pseudocyst. The average time for MRI to find the pseudocyst was about 32 days. (2) For seven patients with symptomatic intervertebral disc pseudocysts, four patients received analgesia and detumescence, bed rest and other symptomatic treatments; one patient received percutaneous endoscopic lumbar discectomy; two patients received microscopic endoscopic discectomy. Waist and leg pains were significantly relieved. At 1 month after operation, MRI showed the original pseudocyst was significantly reduced. (3) The results indicate that symptomatic intervertebral disc pseudocyst usually occurs in the early postoperative period. MRI can be the first choice for examination. When conservative treatment fails, interventional or surgical treatment can be performed and the outcome can be good.
Key words: lumbar spine surgery, intervertebral disc cyst, postoperative intervertebral disc pseudocyst, percutaneous transforaminal endoscopy, intervertebral discoscopy, lumbar disc herniation, postoperative complication