Symptomatic Discal Pseudocyst after Percutaneous Endoscopic Lumbar Discectomy: 3 Case reports and retrospective review analysis

Objective

To investigate the clinical features and treatment of post-discectomy symptomatic Discal Pseudocyst after percutaneous endoscopic lumbar discectomy.

Methods

A retrospective analysis of the data of 3 patients with concurrent symptomatic discal pseudocyst after percutaneous endoscopic lumbar discectomy revealed that all patients were female and had unilateral radiculopathy due to single-segmental lumbar disc herniation. Symptoms were alleviated obviously after the first operation, but pains recurred and even worse than before. The mean recurrence time was 5 weeks (2–8 weeks). Post-operative MRI showed quasi-circular occupancy in the original surgical area (low signal on T1-weighted image, high signal on T2-weighted image, same as cerebrospinal fluid), and communicating with the intervertebral disc.

Results

The symptoms of two patients gradually alleviated after conservative treatment, and the follow-up MRI showed that the cyst had completely absorbed within one year. Another patient underwent percutaneous endoscopic transforaminal cyst excision under local anesthesia again. Round-like tumors were found in the operation, with dark red and viscous contents. Postoperative cyst wall pathology suggested fibrous cyst wall tissue, and postoperative symptoms were relieved immediately. Cystic space occupancy disappeared after 6 months follow-up.

Conclusion

The concurrent symptomatic discal pseudocyst after percutaneous endoscopic lumbar discectomy are rare and often occur in the early postoperative period, and can be clearly diagnosed by MRI examination. Patients who fail to respond to conservative treatment may require surgical treatment and have a good prognosis.