Korean J Pain.  2016 Apr;29(2):129-135. 10.3344/kjp.2016.29.2.129.

Successful Treatment of a Symptomatic Discal Cyst by Percutaneous C-arm Guided Aspiration

• Yu HJ
• Park CJ
• Yim KH

• KMID: 2365356
• DOI: http://doi.org/10.3344/kjp.2016.29.2.129

Abstract

Although discal cysts are a rare cause of low back pain and radiculopathy. Currently, surgical excision is usually the first-line treatment for discal cysts. However, alternative treatment methods have been suggested, as in some cases symptoms have improved with interventional therapies. A 27-year-old man presented with an acute onset of severe pain, and was found to have a discal cyst after an open discectomy. The patient underwent cyst aspiration and steroid injection through the facet joint under C-arm guidance. After the procedure, the patient's pain improved to NRS 0-1. On outpatient physical examination 1 week, and 1 and 3 months later, no abnormal neurological symptoms were present, and pain did not persist; thus, follow-up observation was terminated. When a discal cyst is diagnosed, it is more appropriate to consider interventional management instead of surgery as a first-line treatment, while planning for surgical resection if the symptoms do not improve or accompanying neurologic deficits progress.

Keyword

Aspiration; Discal cyst; Injection; Intervertebral disc; Lumbar vertebra; Radiculopathy

MeSH Terms

Adult
Diskectomy
Follow-Up Studies
Humans
Intervertebral Disc
Low Back Pain
Neurologic Manifestations
Outpatients
Physical Examination
Radiculopathy
Zygapophyseal Joint

Figure

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  Fig. 1 MRI of the lumbar spine. Sagittal (A) and axial (B) T1-weighted MRI of the lumbar spine. The images show an L4-5 HIVD. Sagittal (C) and axial (D) T2-weighted MRI of the lumbar spine. The images show an L4-5 HIVD.

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  Fig. 2 Sagittal MRI of a discal cyst. (A) The cystic mass in the L4-5 level intraspinal space shows low signal intensity on the T1-weighted image. (B) The cystic mass in the L4-5 level intraspinal space shows high signal intensity on the T2-weighted image. (C) Discal cyst on short tau inversion recovery (STIR) imaging.

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  Fig. 3 Axial MRI of a discal cyst. (A) Discal cyst showing low signal intensity on a T1-weighted image. (B, C) Discal cyst showing high signal intensity on T2-weighted images and communication with the adjacent L4-5 intervertebral disc. (D) Discal cyst on STIR imaging.

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  Fig. 4 Aspirated fluid from discal cyst.

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  Fig. 5 C-arm guided aspiration and steroid injection. The discal cyst (black arrow) shows enhancement by contrast media (A). After aspiration, the discal cyst has regressed (B). Because the cyst was ruptured during the last attempt, the contrast media shown in the epidural space (black arrow head).

Reference

1. Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Nishizawa T. Intraspinal cyst communicating with the intervertebral disc in the lumbar spine: discal cyst. Spine (Phila Pa 1976). 2001; 26:2112–2118. PMID: 11698889.

2. Coscia MF, Broshears JR. Lumbar spine intracanalicular discal cysts: two case reports. J Spinal Disord Tech. 2002; 15:431–435. PMID: 12394670.

3. Ishii K, Matsumoto M, Watanabe K, Nakamura M, Chiba K, Toyama Y. Endoscopic resection of cystic lesions in the lumbar spinal canal: a report of two cases. Minim Invasive Neurosurg. 2005; 48:240–243. PMID: 16172971.

4. Nabeta M, Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Masuda T. Discal cysts of the lumbar spine. Report of five cases. J Neurosurg Spine. 2007; 6:85–89. PMID: 17233299.

5. Murata K, Ikenaga M, Tanaka C, Kanoe H, Okuaaira S. Discal cysts of the lumbar spine: a case report. J Orthop Surg (Hong Kong). 2007; 15:376–379. PMID: 18162691.

6. Koga H, Yone K, Yamamoto T, Komiya S. Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: a case report. Spine (Phila Pa 1976). 2003; 28:E212–E216. PMID: 12782997.

7. Kim SY. Radiculopathy caused by discal cyst. Korean J Pain. 2014; 27:86–89. PMID: 24478908.

8. Chou D, Smith JS, Chin CT. Spontaneous regression of a discal cyst. Case report. J Neurosurg Spine. 2007; 6:81–84. PMID: 17233298.

9. Jeong GK, Bendo JA. Lumbar intervertebral disc cyst as a cause of radiculopathy. Spine J. 2003; 3:242–246. PMID: 14589206.

10. Aydin S, Abuzayed B, Yildirim H, Bozkus H, Vural M. Discal cysts of the lumbar spine: report of five cases and review of the literature. Eur Spine J. 2010; 19:1621–1626. PMID: 20364391.

11. Toyama Y, Kamata N, Matsumoto M, Nishizawa T, Koyanagi T, Suzuki N, et al. Pathogenesis and diagnostic title of intraspinal cyst communicating with intervertebral disk in the lumbar spine. Rinsho Seikei Geka. 1997; 32:393–400.

12. Kono K, Nakamura H, Inoue Y, Okamura T, Shakudo M, Yamada R. Intraspinal extradural cysts communicating with adjacent herniated disks: imaging characteristics and possible pathogenesis. AJNR Am J Neuroradiol. 1999; 20:1373–1377. PMID: 10473000.

13. Lucantoni C, Than KD, Wang AC, Valdivia-Valdivia JM, Maher CO, La Marca F, et al. Tarlov cysts: a controversial lesion of the sacral spine. Neurosurg Focus. 2011; 31:E14. PMID: 22133181.

14. Liu SS, Williams KD, Drayer BP, Spetzler RF, Sonntag VK. Synovial cysts of the lumbosacral spine: diagnosis by MR imaging. AJNR Am J Neuroradiol. 1989; 10:1239–1242. PMID: 2512789.

15. Rimmelin A, Clouet PL, Salatino S, Kehrli P, Maitrot D, Stephan M, et al. Imaging of thoracic and lumbar spinal extradural arachnoid cysts: report of two cases. Neuroradiology. 1997; 39:203–206. PMID: 9106295.

16. Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights Imaging. 2015; 6:579–590. PMID: 26432098.

17. Chung D, Cho DC, Sung JK, Choi E, Bae KJ, Park SY. Retrospective report of symptomatic postoperative discal pseudocyst after lumbar discectomy. Acta Neurochir (Wien). 2012; 154:715–722. PMID: 22223287.

18. Lee HK, Lee DH, Choi CG, Kim SJ, Suh DC, Kahng SK, et al. Discal cyst of the lumbar spine: MR imaging features. Clin Imaging. 2006; 30:326–330. PMID: 16919553.

19. Tokunaga M, Aizawa T, Hyodo H, Sasaki H, Tanaka Y, Sato T. Lumbar discal cyst followed by intervertebral disc herniation: MRI findings of two cases. J Orthop Sci. 2006; 11:81–84. PMID: 16437354.

20. Hwang JH, Park IS, Kang DH, Jung JM. Discal cyst of the lumbar spine. J Korean Neurosurg Soc. 2008; 44:262–264. PMID: 19096689.

21. Ha SW, Ju CI, Kim SW, Lee S, Kim YH, Kim HS. Clinical outcomes of percutaneous endoscopic surgery for lumbar discal cyst. J Korean Neurosurg Soc. 2012; 51:208–214. PMID: 22737300.

22. Demaerel P, Eerens I, Goffin J, Wilms G. Spontaneous regression of an intraspinal disc cyst. Eur Radiol. 2001; 11:2317–2318. PMID: 11702179.

23. Dasenbrock HH, Kathuria S, Witham TF, Gokaslan ZL, Bydon A. Successful treatment of a symptomatic L5/S1 discal cyst by percutaneous CT-guided aspiration. Surg Neurol Int. 2010; 1:41. PMID: 20847922.