Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2021; 9(6): 1439-1445
Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1439
Postoperative discal pseudocyst and its similarities to discal cyst: A case report
Chang-Feng Fu, Zhi-Sen Tian, Li-Yu Yao, Ji-Hang Yao, Yuan-Zhe Jin, Ying Liu, Yuan-Yi Wang
Chang-Feng Fu, Yuan-Zhe Jin, Ying Liu, Yuan-Yi Wang, Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Zhi-Sen Tian, Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
Li-Yu Yao, Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Ji-Hang Yao, Department of Traumatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Yuan-Yi Wang, Department of Spine Surgery, Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun 130021, Jilin Province, China
Author contributions: Fu CF and Wang YY performed the percutaneous endoscopic lumbar discectomy surgery and applied the continuous treatment; Tian ZS and Yao LY validated the data and visualization; Yao JH and Jin YZ searched the literature; Wang YY and Tian ZS drafted the manuscript; Wang YY conceptualized the study.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
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: Yuan-Yi Wang, MD, PhD, Associate Professor, Department of Spine Surgery, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. wangyuanyi@jlu.edu.cn
Received: October 15, 2020
Peer-review started: October 15, 2020
First decision: December 21, 2020
Revised: December 23, 2020
Accepted: January 5, 2021
Article in press: January 5, 2021
Published online: February 26, 2021
Processing time: 112 Days and 0.6 Hours
Abstract
BACKGROUND

Postoperative discal pseudocyst (PDP) is a rare condition that presents after surgery for lumbar disc herniation. Due to the lack of information, the diagnosis and treatment of PDP remain controversial. Herein, we report a PDP case that occurred following percutaneous endoscopic lumbar discectomy and received conservative treatment. Additionally, we review all the published literature regarding PDP and propose our hypothesis regarding PDP pathology.

CASE SUMMARY

A 23-year-old man presented with a relapse of low back pain and numbness in his left lower extremity after undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation. Repeat magnetic resonance imaging demonstrated a cystic lesion at the surgical site with communication with the inner disc. The patient was diagnosed as having PDP. The patient received conservative treatment, which resulted in rapid improvement and spontaneous regression of the lesion, and had a favorable outcome in follow-up.

CONCLUSION

PDP and discal cyst (DC) exhibit similarities in both histological and epidemiological characteristics, which indicates the same pathological origin of PDP and DC. The iatrogenic annular injury during discectomy might accelerate the pathological progression of DC. For patients with mild to moderate symptoms, conservative treatment can lead to great improvement, even inducing spontaneous regression. However, surgical cystectomy is necessary in patients with neurological deficits and where conservative treatment is ineffective.

Keywords: Postoperative discal pseudocyst; Discal cyst; Percutaneous endoscopic lumbar discectomy; Cystectomy; Case report

Core Tip: In the present paper, we present a rare case of postoperative discal pseudocyst (PDP). At presentation, the patient showed relapse symptoms after discectomy for lumbar disc herniation. He underwent conservative treatment, and revealed excellent outcomes. We review and discuss the symptoms, previous operations, and histological findings of PDP. We found that PDP mainly occurs in physically active young Asian males and is composed of dense fibrous connective tissue without epithelial lining and bloody serous fluid as cyst wall and content, respectively, which suggested that PDP and discal cyst have the same pathogenesis.