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Joint Bone Spine
Volume 78, n° 4
pages 398-401 (juillet 2011)
Doi : 10.1016/j.jbspin.2010.10.006
accepted : 15 October 2010
Lumbar epidural gas-containing pseudocysts as a cause of severe radicular pain
 

Sung Uk Kuh a, Dong Hwa Heo b, , Keun Su Kim a, Yong Jun Cho b
a Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea 
b Department of Neurosurgery, Spine Center, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 153 Kyo-dong, Chuncheon-shi, Kangwon-do, Korea 

Corresponding author. Tel.: +82 33 240 5173; fax: +82 33 242 9970.
Abstract
Objectives

Intradiscal gas can herniate to the epidural space, and herniated epidural gas may produce pseudocysts. We assessed the characteristics of and surgical treatments for lumbar epidural gas-containing pseudocysts as a cause of severe radicular pain.

Methods

We surgically treated epidural gas-containing pseudocysts in a total of 22 patients. We reviewed radiological parameters including the concomitant presence of vacuum discs, segmental instability, spinal stenosis, and location of pseudocysts. We retrospectively reviewed preoperative clinical parameters such as age, sex, clinical symptoms, neurologic deficits, and surgical methods.

Results

We observed 25 levels of gas-containing pseudocysts in 22 patients. Twelve (48.0%) pseudocysts were in the canal, eight (32.0%) were in the foramen, and five (20.0%) were of extraforaminal type. All of the patients had degenerative vacuum discs in the affected levels. The incidence of neurologic deficits in patients with spinal stenosis was significantly higher than in patients without spinal stenosis (P <0.05).

We performed pseudocyst removal, neural decompression, and fusion surgery in 12 patients with symptomatic spinal stenosis or instability, and microscopic removal of pseudocysts in 10 patients without symptomatic spinal stenosis or instability.

Conclusion

We propose that lumbar gas-containing pseudocysts can produce radicular pain and/or neurologic symptoms, and that surgical removal of pseudocysts with or without optimal stabilization operations can significantly improve symptoms. The selection of surgical methods may depend on the presence of concomitant spinal stenosis or segmental instability.

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Keywords : Air, Vacuum disc, Epidural space, Cysts, Sciatica




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