Discal Cyst Research Articles

Extramedullary spinal cysts in dogs.

To (1) synthesize the terminology used to classify extramedullary spinal cysts in dogs to clarify some of the commonly reported misconceptions, and (2) propose a classification scheme to limit confusion with terminology. Literature review. An online bibliographic search was performed in January 2013 for articles relating to extramedullary spinal cysts in dogs using PubMed (http://www.pubmed.gov/) and Google Scholar (http://scholar.google.com/) databases. Only peer-reviewed clinical literature describing cystic lesions pertaining to the spinal cord and associated structures was included. From 1962 to 2013, 42 articles were identified; 25 (95 dogs) reported meningeal cysts, 10 (24 dogs) described 60 extradural cysts, 3 reports (18 dogs) described discal cysts or acute compressive hydrated nucleus pulposus extrusions (HNPE). Spinal cysts were categorized by location based on cross-sectional imaging as meningeal or extradural non-meningeal. Sub-classification was then performed based on surgical findings and pathology. Meningeal cysts included arachnoid diverticulae and Tarlov (perineural) cysts. Extradural non-meningeal cysts included intraspinal cysts of the vertebral joints, ligaments and discs. Discal cysts also fit this category and have been reported extensively in humans but appear rare in dogs. Extramedullary spinal cysts should be first classified according to location with a sub-classification according to pathologic and surgical findings. Previous canine cases of discal cysts appear to represent a different disease entity and the term acute compressive HNPE is therefore preferred.

The Effectiveness of Transforaminal Epidural Injection for Discal Cyst of Lumbar Spine

Prior literature does not provide clear data on the therapeutic outcome for each of the treatment methods studied for discal cyst (DC). The purpose of the current study evaluate the clinical outcomes of transforaminal epidural injection (TFEI) for DC in the lumbar spine, and to compare those to the outcomes of TFEI in treatment of disc herniation (DH) in the lumbar spine, using a prospective cohort study design. To our knowledge, this is the first report that evaluates the outcomes of TFEI for DC. Between June 2011 and February 2013, 87 patients who underwent TFEI for either DC or DH were enrolled in the current study. Clinical data using visual analogue pain scale (VAS) and the Oswestry Disability Index (ODI), were evaluated throughly. There was no significant difference in the demographic data between both groups. In DC group, two cases with TFEI had failed as indicated by showing no improvements in spite of two-times TFEI procedures. In DH group, four cases with TFEI procedure failed. There was no statistical differences in VAS and ODI scores between the two groups during the regular follow-up times post-TFEI. However, the VAS and ODI scores in DC group were slightly elevated after six months following TFEI procedure compared to those in DH group, although this increase was not statistically significance. TFEI might be a reasonable therapeutic option for patients with DC in lumbar spine. However, the possibility of gradually worsening radiating pain and functional status six months post-TFEI should be informed to the patients.

Radiculopathy Caused by Discal Cyst

Discal cyst is an intraspinal cyst with a distinct communication with the corresponding intervertebral disc. It is a rare condition and could present with radiculopathy similar to that caused by lumbar disc herniation. We present a patient with a large discal cyst in the ventrolateral epidural space of the 5th lumbar vertebral (L5) level that communicated with the adjacent 4th lumbar and 5th lumbar intervertebral disc, causing L5 radiculopathy. We alleviated the radiating pain with selective transforaminal epidural blocks.

Intraoperative Discography for Detecting Concealed Lumbar Discal Cysts

Lumbar discal cyst is a rare cause of radiculopathy. Their exact pathogenesis and the optimal treatment modality remain unidentified. Depending on their location, discal cysts cannot always be easily identified intraoperatively. We describe 2 patients with discal cysts and introduce an intraoperative discography technique for discal cyst location. Both patients were treated with surgical excision; with intraoperative discography, the cystic lesions could easily be detected and removed.

Clinical analysis of microscopic removal of discal cyst.

ObjectiveThe purpose of this study was to evaluate the clinical presentation and surgical outcome in patients with symptomatic discal cyst.MethodsThe authors reviewed consequent 9 patients in whom microscopic excision of the discal cyst with or without additional discectomy for discal cyst from 2005 to 2012. Diagnostic imagings including simple radiographs, computed tomography with discogram and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and related complications.ResultsIn all patients, discal cyst was located in the lumbar region and they presented with back pain and unilateral radiating pain. The preoperative magnetic resonance images (MRI) and computed tomography (CT) scan with discogram showed a connection between the cyst and the involved intervertebral disc. All patients obtained immediate relief of symptoms after microscopic excision of discal cyst. There were no recurrent lesions during follow-up period. The mean preoperative visual analogue scale (VAS) was 7.8 when compared with 2.6 in preoperative assessment. All patients obtained excellent or good outcome according to modified MacNab's criteria.ConclusionDiscal cysts are rare lesions that can lead to back pain and refractory sciatica. Microscopic excision of the cyst can achieve remarkable improvement of symptoms.

CTガイド下に穿刺後, 腰痛•片側下肢症状が消失した腰椎椎間板囊腫の1例

CTガイド下に穿刺後, 腰痛•片側下肢症状が消失した腰椎椎間板囊腫の1例

Discal Cyst in Pediatric Patients: Case Report and Review of the Literature

Discal (intraspinal extradural) cysts which communicate with intervertebral disk are uncommon cause of lumbar radiculopathy, especially in pediatric patients. Only three pediatric cases have been reported in the literature. A 15-year-old boy presented with acute onset left-sided S1 radiculopathy. Magnetic resonance imaging of the lumbar spine revealed a well-defined round extradural mass seated in the left ventrolateral epidural space of the spinal canal behind the S1 vertebral body. He did not respond to the conservative therapies. Because of persistent left S1 radiculopathy, left laminotomy was performed at L5-S1 level with coagulation of the posterior longitudinal ligament surrounding the anular tear; however, discectomy was not done. The symptoms resolved and no recurrence was found at 7-year follow-up. The clinical manifestations, imaging findings, possible pathogeneses, and treatment options of these lesions are discussed and the relevant literature is reviewed.

Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative microdiscectomy patients

OBJECTIVE: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. MATERIALS AND METHODS: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. RESULTS: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. CONCLUSION: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified.

Atypical clinical presentation and long-term survival in a patient with optic nerve medulloepithelioma: a case report

IntroductionMedulloepithelioma is a rare congenital tumor of the primitive medullary neuroepithelium. A significant proportion of patients with medulloepithelioma arising from the optic nerve die from intracranial spread or cerebral metastasis. Because it has no known distinct clinical features and because of its low frequency, this tumor presents within the first two to six years of life and is usually misdiagnosed clinically as a different type of optic nerve tumor. Here, we describe a new and atypical case of medulloepithelioma of the optic nerve in a 12-year-old boy. To the best of our knowledge, he is the oldest reported patient to present with this disease and, now as an adult, has the longest documented period of disease-free survival.Case presentationA 12-year-old Caucasian boy with headache and unilateral amaurosis was referred for a presumed optic nerve glioma to our hospital. A computed tomography scan showed optic nerve enlargement, and fundoscopy showed a whitish mass at the optic disc. Our patient had been followed at his local hospital for four years for an 'optic disc cyst' with no change or progression. He experienced mild progressive visual impairment during that period. He was admitted for resection, and a histopathological analysis revealed a medulloepithelioma of the optic nerve. Supplemental orbital radiotherapy was performed. He remained disease-free for 25 years.ConclusionsMedulloepithelioma of the optic nerve can clinically mimic more common pediatric tumors, such as optic glioma, meningioma, or retinoblastoma. Thus, medulloepithelioma should be included in the differential diagnoses of pediatric optic nerve lesions. Fundoscopy in these patients may provide relevant information for diagnosis. Anterior optic nerve medulloepitheliomas may behave differently from and have a better prognosis than medulloepitheliomas that have a more posterior location. Our case report illustrates that long-term survival can be achieved in patients with this malignant tumor.

Insights on the natural history and pathogenesis of multilevel discal cysts

Discal cysts are rare lesions and uncommon causes of low back pain and radiculopathy. Despite growing evidence regarding the clinical, pathological and radiological presentation of these lesions, we do not yet have a detailed understanding of their natural history, etiology or pathogenesis. To our knowledge this is the first report of multiple and multilevel discal cysts, and possible mechanisms of pathogenesis are proposed.

Clinical Outcomes of Percutaneous Endoscopic Surgery for Lumbar Discal Cyst

ObjectiveDiscal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up.MethodsAll 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria].ResultsAll 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25±0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25±2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia.ConclusionThe radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.

Discal cyst of the lumbar spine: a case report.

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.

A case report of bilateral lumbar discal cysts

A case report of bilateral lumbar discal cysts

Bilateral Discal Cysts Managed by Partial Hemilaminectomy and Microscopic Resection of Hemilateral Cyst

A case report. The objective of this article was to report a case of bilateral lumbar discal cysts and discuss the clinical, radiological, and surgical findings. Discal cysts are rare lesions and to our knowledge there has been no report on multiple discal cysts at one disc level. The patient's history, clinical examination, imaging findings, and treatment were reported. We reported on the case of a 33-year-old woman with left lower back and lower extremity pain. Neurological imagings demonstrated bilateral cysts at the L4-L5 disc level. She underwent left partial hemilaminectomy at the L4-L5 level and microscopic resection of the left cyst. The cyst contained bloody serous fluid. A connection between the cyst wall and the L4-L5 intervertebral disc and a small laceration in the annulus fibrosus were identified. Histologic examination revealed a cyst lined by fibrous connective tissue without synovium. Her symptoms improved remarkably immediately after surgery. Follow-up imaging 3 months after the operation showed that the bilateral cysts had completely disappeared. This is the first reported case of bilateral discal cysts at one disc level. Magnetic resonance images demonstrated rounded cysts on both sides of the posterior longitudinal ligament, which suggests that the discal cysts in our case were unlikely to have developed from an epidural hematoma. Partial hemilaminectomy and microscopic resection of the left cyst lead to complete regression of the bilateral cysts. This suggests that there was a communication between the two cysts via the intervertebral disc and that the content of the right cyst passed from the cyst to the disc.

Presentation and progression of a disc cyst in a pediatric patient

Disc cysts are rare intraspinal extradural lesions that communicate with the intervertebral disc and can mimic the symptoms of acute lumbar disc herniation. Initially reported in the Japanese-language literature as a new entity (discal cyst), there are few documented cases in North America, and only 1 prior case in the pediatric population. The authors present the case of a 16-year-old girl with an intervertebral disc cyst causing lumbar radiculopathy that progressed despite conservative treatment. All medical records, imaging studies, intraoperative findings, and pertinent literature were reviewed. Serial preoperative MR imaging revealed enlargement of the intraspinal cyst at the L4-5 level, resulting in compression of the right L-5 nerve root. Enlargement of the cyst occurred over a 4-month period despite conservative treatment with physical therapy and corticosteroid injections. Microsurgical discectomy and excision of the cyst resulted in complete resolution of the preoperative radiculopathy. An intervertebral disc cyst is a rare entity in the adult population and exceedingly rare in the pediatric population but should remain in the differential diagnosis of any intraspinal extradural mass. The authors hypothesize that there exists a spectrum of this entity that may not be responsive to conservative therapy. Cyst excision alone or in conjunction with microsurgical discectomy is safe and effective in treating radiculopathy caused by disc cysts.

Lumbar Discal Cyst With Spontaneous Regression and Subsequent Occurrence of Lumbar Disc Herniation -Case Report-

A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. Five months after medical treatment, the patient's symptoms improved, and the discal cyst showed complete regression on magnetic resonance imaging. Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.

Clinical outcomes of treatment for lumbar discal cyst; report of six cases

Clinical outcomes of treatment for lumbar discal cyst; report of six cases

Discal cysts of the lumbar spine: report of five cases and review of the literature

Discal cysts are rare causes of low back pain and radiculopathy. Only few reports in the literature describe these pathologies. In this article, the authors report five cases (3 males and 2 females) of lumbar discal cysts treated surgically by microdiscectomy. These patients were admitted with a history of back pain and/or sciatalgia. Magnetic resonance imaging of the lumbar spine of all patients revealed lumbar discal cysts, causing compression to the spinal dura and roots. All patients were treated by partial hemilaminectomy and microscopic cyst resection. Postoperatively, the complaints showed improvement, and the patients were discharged with no complications. The cases of lumbar discal cysts are described in the literature as individual case reports, therefore; the authors performed a wide systemic review of all these cases published in PubMed and MedLine, including the patients in the present report. The data of all patients were analyzed to obtain statistically based estimated information about the incidence, the epidemiology, the natural history and the optimum management of these lesions.

Microendoscopic Resection of Lumbar Discal Cysts

A lumbar discal cyst is a relatively rare cystic lesion that communicates with lumbar intervertebral discs. Surgical resection of the cyst is the reported treatment of choice. In this study, the authors report the minimally invasive surgical resection of lumbar discal cysts using a microendoscopy. Seven male patients with lumbar discal cysts underwent microendoscopic resections (mean age: 25.1+/-3.2 years and the mean follow-up period: 27.9 months). During the surgeries, the cysts were subtotally resected in a piecemeal fashion, and the fistulas forming the communications between the cysts and the corresponding intervertebral discs were coagulated using a bipolar coagulator. All the patients obtained relief from their pain after surgery, and no recurrences occurred during a mean follow-up period of 28 months. The mean operation time was 72.6+/-20.2 min, and the mean blood loss was 44.4+/-13.7 grams. No intra- or peri-operative complications were noted in any of the patients. Microendoscopic resection appears to be a minimally invasive and feasible surgical option for the treatment of lumbar discal cysts.

Discography for disc cysts is obsolete

Dear Editor,Werecentlyencounteredadisccystina32-year-oldmanwithrefractory low back pain and radiation into the left L5dermatome since almost 1 year. MRI revealed a liquid-containingcystwithextensionintotheleftlateralrecessofL5and scalloping of the adjacent vertebral body (Fig. 1). Thisradiological sign is indicative of a long-standing process as itis the result of bone remodeling. The cyst caused dorsaldisplacement and significant compression of the thecal sacand left L5 root. The cyst was removed through a left L4hemilaminectomy. A small annular fissure on the L4–L5 discwas noted after cyst removal, and subsequently, a discec-tomy was performed. After surgery, the low back pain andsciatica disappeared. Histological examination of the cystwall exhibited chondrocytes and fibrillary stroma of discmaterial with areas of myxoid degeneration.Disc cysts (also known as discal cysts) are rare cysticlesions in the ventrolateral epidural space. Theyare located atL4–L5 more often thanat other lumbar levels, and they occurmostly in young men who present with refractory low backpain and sciatica. Disc cysts were first described one decadeago and distinguished from ganglion cysts of the posteriorlongitudinal ligament (PLL) by means of their cyst–disccommunication at discography [4]. Ganglion cysts of thePLL [7] and disc cysts differ from juxtafacet cysts [10]byvirtue of a ventral location, an intimate or pedicledattachment to the annulus fibrosus or PLL, and absentconnection with a degenerative facet joint. Unlike juxtafacetcysts, disc cysts and ganglion cysts of the PLL are bothwalled-in by fibrous connective tissue without a synoviallining and frequently show myxoid degeneration. Chondro-cytes could be demonstrated in the cyst wall of our case andin only a very few other disc cysts reported in the literature[9]. Because of the clinical, radiological, surgical, andhistological similarities between disc cysts and ganglioncysts, Marshman et al. [6] suggested that their distinction onthe basis of disc space communication is unnecessary. Forthe same reason, they also proposed to use the term “disccyst” for both disc cysts and ganglion cysts of the PLL.Discography is an invasive diagnostic procedure inwhich radiopaque contrast medium is injected into thenucleus pulposus. In disc cysts, this technique can be usedto assess disc–cyst communication and to reproduceradiating pain into the affected leg [8]. As explained above,disc–cyst communication at discography was originallyemployed as a means to distinguish disc cysts fromganglion cysts of the PLL. Nevertheless, discography wasnot used in nearly all of the reported ganglion cysts of thePLL, and the same is true for some reports on disc cysts [2,3, 5]. The reason is that patients were either treatedconservatively [2, 3] or the disc–cyst communication wasevaluated surgically [5]. This can be achieved by directvisualization of a connection between the cyst and itscorresponding disc or by observation of a defect in theannulus fibrosus after cyst removal [6, 8]. The onlyremaining importance of disc–cyst communication lies inthe fact that its presence is generally regarded as anindication for discectomy in addition to cystectomy.