腰椎椎間板嚢胞の1手術例

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Reported is a case of lumbar intervertebral disc cyst producing severe radicular pain. This 66-year-old man had been suffered from left sciatic pain for the last two months, and was referred to us after the magnetic resonance (MR) study at a nearby hospital revealed an unusual mass lesion in his L5/S1 spinal canal, adjacent to the left S1 nerve root. The patient had previously received a surgical treatment of spinal schwannoma at the L2-3 level, and that made it difficult to diagnose the present lesion preoperatively. Although the usefulness of discography is circumvented in the diagnosis of cystic lesions adjacent to the intervertebral disc, we did not add that procedure because the MR study had already provided the adequate information for the diagnosis. We also intended to avoid excessive preoperative invasion to the patient. Left L5/S1 discectomy was performed, and the mass was communicated with the L5/S1 intervertebral disc space, but not with the facet capsule. Slightly bloody serous fluid and the degenerated disc component were obtained from the mass, and the operative diagnosis was confirmed as a disc cyst. Biological examination was unremarkable for either tuberculosis or bacterial infection, and the histopathological study has revealed degenerative nucleus pulposus and annulus fibrosus, associated with some abnormal fibrin. The pathological results suggest that the intervertebral disc herniation and additional bleeding seems to have formed the present disc cyst. The postoperative course was satisfactory, and the patient resumed his daily activities. Pathogenesis, radiological diagnosis, and surgical treatment of the disc cyst are discussed with some review of the pertinent literature.
日本脊髄外科学会の論文

腰椎椎間板嚢胞の1手術例

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