- Spine Section, Department of Neurosurgery, Southern Tohoku Research Institute for Neurosciences, Koriyama, Japan
- Department of Pathology, Southern Tohoku Research Institute for Neurosciences, Koriyama, Japan
Correspondence Address:
Rohit Bansil
Spine Section, Department of Neurosurgery, Southern Tohoku Research Institute for Neurosciences, Koriyama, Japan
DOI:10.4103/2152-7806.191081
Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Bansil R, Hirano Y, Sakuma H, Watanabe K. Transition of a herniated lumbar disc to lumbar discal cyst: A case report. Surg Neurol Int 22-Sep-2016;7:
How to cite this URL: Bansil R, Hirano Y, Sakuma H, Watanabe K. Transition of a herniated lumbar disc to lumbar discal cyst: A case report. Surg Neurol Int 22-Sep-2016;7:. Available from: http://surgicalneurologyint.com/surgicalint_articles/transition-herniated-lumbar-disc-lumbar-discal-cyst-case-report/
Abstract
Background:Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst.
Case Description:A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 level. It was managed conservatively for 6 months, after which symptoms recurred and progressed. The follow-up MR study revealed a discal cyst at the L4-5 without residual herniated disc. Of interest, the cyst communicated with the L4-5 intervertebral disc, which was herniated under the posterior longitudinal ligament and the disc space. During surgery, the cyst was completely removed, and his symptoms/signs resolved.
Conclusion:A discal cyst develops as pathological sequelae of a degenerated herniated disc. Although rare, these lesions must be considered among the differential diagnoses in young patients with radicular back pain. MR study clearly documents these lesions, and surgical excision of the cyst is the treatment of choice.
Keywords: Degeneration, discal cyst, intervertebral disc, lumbar, pathogenesis
INTRODUCTION
Discal cyst, a type of extradural intraspinal cyst, rarely cause low back pain and radiculopathy, and are difficult to differentiate based on symptoms/signs from routine lumbar disc herniation.[
These cysts mostly originate from the degenerated/herniated lumbar disc.[
CASE REPORT
A 42-year-old male presented with sudden onset of severe back pain after heavy lifting. He exhibited a partial left foot drop (Medical Research Council Grade 4/5). The original MR study documented a left-sided left L4-5 intervertebral disc compressing the left L5 nerve root [
Six months later, the patient's symptoms worsened; symptoms included dysesthesia in the left L5 distribution and extensor hallucis longus (EHL) weakness (MRC Grade 4/5). The second lumbar MR showed a well-defined round mass at the left L4-5 disc level, which was hypointense on T1 and hyperintense on T2-weighted images, which was consistent with a cyst [
DISCUSSION
The term discal cyst was first proposed by Chiba et al. in 2001 who described them as intraspinal cysts with a distinct connection to the corresponding intervertebral discs.[
The clinical symptoms are difficult to distinguish from those of disc herniation, manifesting as a unilateral single nerve root lesion.[
The cyst wall histologically consists of dense fibrous connective tissue, without any epithelial lining or disc material.[
Pathogenesis of discal cyst formation is controversial, with many theories proposed to explain the cyst development and pathology. Tokunaga et al. confirmed the presence of cartilaginous tissue in the cyst wall and proposed that the discal cyst develops from the absorption of an intervertebral disc herniation.[
The epidural hematoma theory suggests that a herniated disc results in the formation of epidural hematoma due to bleeding from the epidural venous plexus. The cyst, thus, develops during the hematoma resorption process.[
An MR study is essential to establish a diagnosis. The cyst appears hypointense on T1 and hyperintense on T2-weighted images, and shows a rim of enhancement in a contrast study.[
Spontaneous cyst regression was observed by some authors.[
CONCLUSION
Discal cysts are a rare cause of lumbar radiculopathy and are seen commonly in the young population. Discal cysts arise from the degeneration of a herniated intervertebral disc. An MR study plays a crucial role in diagnosing the condition as well as in differentiating a discal cyst from other types of intraspinal cysts. The recommended treatment is microsurgical cyst excision, which ensures excellent results.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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