Percutaneous transforaminal endoscopic treatment of gas-containing pseudocyst compressing the L5 nerve root: A case report

Figure 1  Preoperative lumbar spine X-ray image shows a narrow intervertebral space at L4/5. A: Anteroposterior view; B: Lateral view.

Figure 2 Magnetic resonance imaging reveals a circular mass around the L4/5 intervertebral foramina at the lateral recess, which displayed low signal intensity on both T1 and T2-weighted images, endplate inflammation signs was also found. A and B: The T1 (A) and T2-weighted images (B); C: Axial T2-weighted magnetic resonance imaging. The white arrow indicates a pseudocyst within the intervertebral foramen.

Figure 3 Preoperative computed tomography demonstrating an irregular circular mass of low density surrounding the L4/5 intervertebral foramina. A: Sagittal image; B: Axial image. The arrow indicates a pseudocyst with gas content outside the intervertebral foramen.

Figure 4 Intraoperative endoscopic images. A: The L5 nerve root was compressed by a pseudocyst; B: Air bubbles observed when the pseudocyst was punctured; C: Removing the pseudocyst wall using straight and flexible graspers; D: The pseudocyst was completely removed and the nerve root was decompressed. Square: Gas-containing pseudocyst; Triangle: L5 nerve root; Star: Air bubbles; Arrow: Fluid flowing out from the pseudocyst.

Figure 5 Postoperative computed tomography images show that the gas-containing pseudocyst has been removed. A: Sagittal view; B and C: Axial views.