Department of Orthopaedics, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China.
Pain Medicine Centre, Peking University Third Hospital, Beijing, China.
BMC Musculoskelet Disord. 2022 Sep 3;23(1):835. doi: 10.1186/s12891-022-05791-y.
A symptomatic postoperative pseudocyst (PP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to worse symptoms. Some minority patients who developed PP experienced rapidly aggravating symptoms and could not be treated by any kind of conservative treatment. However, no clinical studies have evaluated the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after full-endoscopic lumbar discectomy (FELD). This study aimed to demonstrate the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after FELD.
We retrospectively analyzed the data of patients who received FELD revision surgeries due to symptomatic PP formation between January 2016 and December 2021. Common characteristics, time intervals of symptom recurrence and revision surgery, strategies for conservative treatment and revision surgery, operative time, imaging characteristics, numeric rating scale (NRS) score, Oswestry disability index (ODI) and overall outcome rating based on modified MacNab criteria were analyzed.
Fourteen patients (males = 10, females = 4), with a mean age of 24.4 years, were enrolled. The mean time intervals of symptom recurrence and revision surgery were 43.5 and 18.9 days respectively. While the patients were conservatively managed with analgesics and physical therapy, pain persisted or progressively worsened. In comparison to the initial herniated disc, the PP was larger in 11 cases, and up- or down-migrated in four cases. The PP location included the lateral recess (n = 12), foraminal (n = 1), and centrolateral (n = 1) zones. One of the two cases treated by percutaneous aspiration (PA) was eventually treated by FELD as pain was not relieved. Follow-ups revealed an improved mean NRS score from 7.1 to 1.4, mean ODI from 68.6 to 7.9% and promising overall surgical outcomes.
The progressively severe pain experienced due to PP might be a result of its enlargement or migration to the lateral recess and foraminal zones. As complete removal of capsule is the goal, we recommend FELD instead of PA.
术后症状性假性囊肿（PP）是一种在椎间盘手术区域形成的囊性病变，导致症状加重。少数出现 PP 的患者症状迅速加重，任何保守治疗都无法缓解。然而，目前尚无临床研究评估全内镜下腰椎间盘切除术（FELD）后需要翻修手术的症状性 PP 的临床特征和手术策略。本研究旨在展示 FELD 后因症状性 PP 形成而需要翻修手术的患者的临床特征和手术策略。
我们回顾性分析了 2016 年 1 月至 2021 年 12 月期间因症状性 PP 形成而接受 FELD 翻修手术的患者的数据。分析了一般特征、症状复发和翻修手术的时间间隔、保守治疗和翻修手术的策略、手术时间、影像学特征、数字评分量表（NRS）评分、Oswestry 残疾指数（ODI）以及根据改良 MacNab 标准的总体疗效评分。
共纳入 14 例患者（男 10 例，女 4 例），平均年龄 24.4 岁。症状复发和翻修手术的平均时间间隔分别为 43.5 和 18.9 天。当患者接受镇痛药物和物理治疗的保守治疗时，疼痛持续存在或逐渐加重。与初始突出物相比，11 例患者的假性囊肿增大，4 例患者假性囊肿向上或向下迁移。假性囊肿的位置包括侧隐窝（n=12）、椎间孔（n=1）和中央旁区（n=1）。2 例接受经皮抽吸（PA）治疗的患者中，1 例因疼痛未缓解而最终接受 FELD 治疗。随访发现，NRS 评分从 7.1 改善至 1.4，ODI 从 68.6%改善至 7.9%，总体手术效果良好。
PP 引起的疼痛逐渐加重可能是由于其增大或迁移至侧隐窝和椎间孔区所致。由于囊壁的完全切除是目标，我们建议采用 FELD 而不是 PA。
