Gorolay Vineet V, Fields Brandon K K, Shah Vinil N
Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
Interv Pain Med. 2023 Sep 9;2(3):100278. doi: 10.1016/j.inpm.2023.100278. eCollection 2023 Sep.
Current knowledge of intervertebral discal cysts is restricted to case reports and surgical case series, typically in young adult males presenting with back pain and radiculopathy.
We review our single-center experience to describe presentation, management, and outcomes of these rare lesions.
We performed a retrospective electronic search of our institution database using key words "discal cyst," "disc cyst" and variations. Clinical presentation, imaging findings, management and outcomes were reviewed and tabulated.
Nine patients were identified (4 female), with mean age 49.1 years. Three patients had prior surgery at the level of the cyst. Seven patients presented with back pain, five with additional radiculopathy, one patient with radiculopathy alone, and one asymptomatic. Most discal cysts occurred at L5-S1, were left-sided, paracentral in location with a T2 hypointense rim and variable enhancement. One patient underwent primary cyst resection. Amongst 6 patients who underwent primary image-guided procedures, two had sustained pain relief, three proceeded to cystectomy, microdiscectomy and/or posterior decompressive surgery, and two were lost to follow-up.
Our retrospective cohort includes a wider age group with more heterogeneous clinical features, treatment approaches and response to therapy than that described in the literature. CT or fluoroscopy-guided steroid injection provided short-term symptomatic relief with several cases managed definitively with surgery. Further research is required to better understand and manage these rare lesions.
Discal cysts and pseudocysts occur in a wider range of patients and with more heterogenous presentations than previously described. Imaging-guided intervention can provide short-term symptomatic relief, but further research is required to optimize long-term management.
目前关于椎间盘囊肿的认识仅限于病例报告和手术病例系列，通常是在出现背痛和神经根病的年轻成年男性中。
我们回顾我们单中心的经验，以描述这些罕见病变的表现、管理和结果。
我们使用关键词“椎间盘囊肿”“椎间盘囊肿”及其变体对我们机构的数据库进行了回顾性电子搜索。对临床表现、影像学表现、管理和结果进行了回顾并制成表格。
共确定9例患者（4例女性），平均年龄49.1岁。3例患者在囊肿水平之前接受过手术。7例患者出现背痛，5例伴有神经根病，1例仅患有神经根病，1例无症状。大多数椎间盘囊肿发生在L5-S1，位于左侧，中央旁，T2加权像有低信号边缘且强化程度不一。1例患者接受了囊肿切除术。在6例接受初步影像引导手术的患者中，2例疼痛持续缓解，3例接受了囊肿切除术、显微椎间盘切除术和/或后路减压手术，2例失访。
我们的回顾性队列包括比文献中描述的更广泛的年龄组，具有更异质的临床特征、治疗方法和治疗反应。CT或透视引导下的类固醇注射提供了短期症状缓解，有几例通过手术得到了明确治疗。需要进一步研究以更好地理解和管理这些罕见病变。
椎间盘囊肿和假性囊肿发生在比以前描述的更广泛的患者范围内，且表现更异质。影像引导干预可提供短期症状缓解，但需要进一步研究以优化长期管理。
