The Combination Strategy of the Drainage and Resection under the Microendoscope for Giant Discal Cyst: A Case Report.

Abstract

Introduction: Discal cysts have been reported as intraspinal extradural cysts connected with corresponding intervertebral discs. The resection of the discal cyst has illustrated the good result. However, we report a much larger discal cyst, which was seemed to be difficult to resect all of them under the microendoscope safety.

Case report: A 21-year-old man had experienced pain in the right lower limb for at least a month and was diagnosed with radiculopathy of the right S1 nerve root. Magnetic resonance image showed that mild disc degeneration and cyst at L5/S1, which was measured 12.0 mm on the sagittal view, accounted for 71.1% of the sagittal diameter of the spinal canal. He underwent hemi-flavectomy and the resection of the cyst under the microendoscope. During surgery, we found that there was not enough space in the epidural to remove the cyst safety without the laminectomy. The right S1 nerve root was strongly pushed to the dorsal side, adhered, and stretched by the cyst. First, we have tried to drain the liquid context of the cyst and decrease the volume to make the enough epidural space to perform the surgical procedure safety. Second, we resected the wall, which procedure made the nerve root loosen.

Conclusion: The combination of the drainage and resection under the microendoscope has ability to secure the enough working space, prevent the nerve root injury, and minimize the surgical invasion. This strategy can expand the surgical indication for the larger cystic lesion, which have been performed by the open surgery so far.