Clinical Application of Percutaneous Transforaminal Endoscopic Surgery in Lumbar Discal Cyst

Song Chen; Shiqi Suo; Chengli Li; Yunxia Wang; Jiaqi Li; Fei Zhang; Wei Zhang

doi:10.1016/j.wneu.2020.03.048

Clinical Application of Percutaneous Transforaminal Endoscopic Surgery in Lumbar Discal Cyst

World Neurosurg. 2020 Jun:138:e665-e673. doi: 10.1016/j.wneu.2020.03.048. Epub 2020 Mar 16.

Authors

Song Chen¹, Shiqi Suo², Chengli Li³, Yunxia Wang³, Jiaqi Li³, Fei Zhang³, Wei Zhang⁴

Affiliations

¹ Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China; Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China.
² Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China.
³ Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
⁴ Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China. Electronic address: zw_surgeon@163.com.

PMID: 32194264
DOI: 10.1016/j.wneu.2020.03.048

Abstract

Background: Discal cyst is very rare and can cause intractable low back pain and radiating leg pain. Symptoms are hard to distinguish from lumbar disc herniation. The best treatment for discal cyst is controversial. Most lumbar discal cysts are treated surgically, while most studies of percutaneous transforaminal endoscopic surgery are case reports. This study investigated the clinical value of percutaneous transforaminal endoscopic surgery for lumbar discal cyst.

Methods: A retrospective study was conducted in 9 patients with a discal cyst from June 2016 to November 2018. All patients had been treated by percutaneous transforaminal endoscopic surgery via a superior vertebral pedicle notch approach. Surgical outcomes were evaluated preoperatively and postoperatively using a visual analog scale for leg pain and the Oswestry Disability Index. At the final follow-up, patients were evaluated for clinical efficacy using modified Macnab criteria.

Results: All 9 patients had remission of symptoms after removal of discal cysts. Postoperative magnetic resonance imaging showed that all patients had complete excision of discal cysts and complete decompression of the treated segment. There were no recurrent lesions during follow-up. Mean operative time was 68.67 ± 14.02 minutes. Mean hospitalization time was 4.22 ± 1.64 days. Preoperative visual analog scale and Oswestry Disability Index score improved significantly after surgery. Visual analog scale leg score improved from 7.88 ± 1.05 preoperatively to 1.78 ± 0.66 at final follow-up (P < 0.05), and ODI score improved from 53.65 ± 12.46 to 16.25 ± 8.76 (P < 0.05). According to the modified Macnab criteria, 5 patients (55.6%) were rated excellent, 3 patients (33.3%) were rated good, and 1 patient (11.1%) was rated fair at final follow-up, with an overall excellent and good rate of 88.9%. There were no serious complications during follow-up.

Conclusions: Percutaneous transforaminal endoscopic surgery could be a safe, minimally invasive surgical treatment for discal cyst, particularly suitable for patients who cannot undergo general anesthesia.

Keywords: Endoscopy; Lumbar discal cyst; Minimally invasive; Transforaminal.

MeSH terms

Adolescent
Adult
Cysts / diagnostic imaging
Cysts / surgery*
Disability Evaluation
Diskectomy, Percutaneous / methods*
Endoscopy / methods*
Female
Fluoroscopy
Follow-Up Studies
Foramen Magnum / surgery*
Humans
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / surgery*
Magnetic Resonance Imaging
Male
Neurosurgical Procedures / methods*
Pain Measurement
Retrospective Studies
Treatment Outcome
Young Adult