Lumbar Discal Cyst Causing Lumbar Radiculopathy: A Case Series of Multidisciplinary Management

Lumbar discal cysts are a rare phenomenon that may result in clinical symptoms of back pain and lumbar radiculopathy. The natural history of these cysts and best practices are not well established in the literature.

To report an illustrative case series of the diagnosis, management, and outcomes of a rare clinical/radiological entity known as lumbar discal cyst.

Three patients were included in the case series. Patient 1 is a 36-year-old man who presented with lumbar radiculopathy, initially diagnosed as a lumbar herniated disc. The patient underwent a successful microdiscectomy; however, symptoms returned within 6 weeks. Repeat imaging showed enlargement of a previously undiagnosed discal cyst. The patient underwent a subsequent computed tomography (CT)-guided discogram followed by cyst fenestration/rupture, with good resolution of his symptoms. Patient 2 is a 32-year-old man who presented with symptoms of lumbar radiculopathy and a known diagnosis of lumbar discal cyst. This patient was treated successfully with a CT-guided interlaminar cyst fenestration/rupture; however, symptoms returned within 3 months. Repeat imaging showed a persistent/recurrent cyst in the same location. Patient 2 subsequently underwent laminotomy and cyst excision with durable resolution of his symptoms. Patient 3 is a 47-year-old man who presented with lumbar radiculopathy that was diagnosed with a discal cyst extending into the neuroforamen. He underwent CT-guided interlaminar cyst aspiration with early and durable resolution of symptoms.

Patient 1 first underwent successful microdiscectomy with return of symptoms within 6 weeks. He went on to CT-guided fenestration/rupture of the discal cyst with durable relief at 6 months. Patient 2 was first treated with CT-guided interlaminar cyst aspiration with return of symptoms within 3 months. He went on to laminotomy and cyst excision with durable relief of symptoms at 6 months. Patient 3 underwent CT-guided interlaminar cyst aspiration with resolution of symptoms, with follow-up imaging showing resolution of the discal cyst.

We present our experience with lumbar distal cysts here, treated with initial success via different means and 2 patients subsequently requiring revision due to recrudescence of symptoms, ultimately resulting in excellent clinical outcomes. Due to their rarity and paucity of high-quality data, these entities should be treated on a case-by-case basis. Where appropriate or applicable, a multidisciplinary approach between spine surgeons and interventional radiologists may afford patients reasonable options to use a tailored approach to care.

A multidisciplinary, patient-tailored approach to lumbar discal cysts can afford satisfactory outcomes while minimizing patient morbidity.