Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1439
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
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.
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.
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.
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.