Chen Y, Yu SD, Lu WZ, Ran JW, Yu KX. Epidural gas-containing pseudocyst leading to lumbar radiculopathy: A case report. World J Clin Cases 2021; 9(24): 7279-7284 [PMID: 34540989 DOI: 10.12998/wjcc.v9.i24.7279]
Corresponding Author of This Article
Ke-Xiao Yu, PhD, Attending Doctor, Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Panxi Seventh Branch Road, Jiangbei District, Chongqing 400021, China. csyxk@126.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yu Chen, Shao-Ding Yu, Wei-Zhong Lu, Jin-Wei Ran, Ke-Xiao Yu, Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
Author contributions: Chen Y and Yu KX designed the research study; Yu SD and Ran JW collect the data; Chen Y, Lu WZ, and Yu KX analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Supported bythe Top-notch Young Talent of Chongqing Traditional Chinese Medicine, No. CQSZYY2020008; Natural Science Foundation of Chongqing, No. cstc2020jcyj-msxm2234; and Capacity Building Project of Traditional Chinese Medicine Service for Public Health Emergencies in Chongqing Hospital of Traditional Chinese Medicine, No. cqszyy2020yjzx13.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this manuscript.
Conflict-of-interest statement: The authors declare that no competing interest exists.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ke-Xiao Yu, PhD, Attending Doctor, Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Panxi Seventh Branch Road, Jiangbei District, Chongqing 400021, China. csyxk@126.com
Received: May 7, 2021 Peer-review started: May 7, 2021 First decision: June 6, 2021 Revised: June 7, 2021 Accepted: July 2, 2021 Article in press: July 2, 2021 Published online: August 26, 2021 Processing time: 108 Days and 18.8 Hours
Abstract
BACKGROUND
Lumbar radiculopathy is a common symptom in the clinic and is often caused by lumbar disc herniation or osteophytes compressing the nerve root; however, it is rare for nerve roots to be compressed by epidural gas. Few symptomatic epidural gas-containing pseudocyst cases have been reported. Furthermore, the reported cases were due to a mix of gas and obvious osteophytes; therefore, it was hard to rigorously conclude that gas was the factor responsible for radiculopathy. We provide evidence that because no epidural gas accumulated before radiculopathy occurred and the symptoms were relieved after removal of the gas, the epidural gas-containing pseudocyst was the root cause of radiculopathy in this case.
CASE SUMMARY
An 87-year-old man with a 3-wk history of right radiating pain was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations showed a vacuum phenomenon and huge lesions with low signal intensity located in the same area where the pain occurred. After carefully checking the images acquired in the last 3 mo, we found an abdominal CT examination performed 40 d prior because of abdominal pain. The CT images showed no gas-containing pseudocyst in the epidural space and notably, he had no leg pain at the time. To ensure a low-intensity intervention and complete decompression of the nerve, percutaneous endoscopic lumbar nerve decompression surgery was advised. A gas-containing pseudocyst was identified under endoscopy. The symptoms were relieved after surgery, and the postoperative images showed total disappearance of the vacuum phenomenon and lesions with low signal intensity on CT and MRI. Histological examination showed that the sampled gas-containing pseudocyst tissue was fibrous connective tissue.
CONCLUSION
This case thoroughly illustrates that an epidural gas-containing pseudocyst can result in radiculopathic pain through a comprehensive evidence chain. Percutaneous endoscopic decompression is a minimally invasive and effective treatment method.
Core Tip: The rare case reported here thoroughly illustrates that an epidural gas-containing pseudocyst can result in radiculopathic pain through a comprehensive evidence chain.
