A Review and Summary of Patients with Symptomatic Postoperative Discal Pseudocysts of the Lumbar Spine.

OBJECTIVE: Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management of PDPs.

METHODS: Nine patients with PDP who received surgical treatment at our institution from January 2014 to December 2021 were retrospectively reviewed. A systematic review of the literature on PDP was performed. The demographic data, clinical and imaging features, surgical options and patient prognosis were analyzed.

RESULTS: Among the nine patients treated at our center, seven were male and two were female. The mean patient age (± standard deviation) at the time of surgery was 28.3 ± 5.7 years (range 18-37 years). The first operation performed on seven patients was percutaneous endoscopic transforaminal discectomy (PETD) and two patients underwent microdiscectomy. The time to conservative treatment before surgical intervention was 20 ± 9.2 days. In three cases, the disc cysts were located in L4/5 and in six cases the lesions were located in L5/S1. Intervertebral disc cyst interventions included foraminal scope (three cases), open discectomy (three cases), conservative treatment with a quadrant channel (one case) and CT-guided puncture (one case). All patients fully recovered after surgery and the mean follow-up time was 3.5 ± 2.1 years. A literature review identified 14 relevant articles that reported 43 PDP cases of PDP.

CONCLUSION: PDP occurs in Asian males with mild intervertebral disc degeneration and occurs 1 month after discectomy. Treatment should be based on specific patient scenarios. Conservative treatment is necessary and surgery should be performed with caution.