Intraoperative Discography for Detecting Concealed Lumbar Discal Cysts
A 47-year-old male presented with radiating left buttock pain. His symptoms had developed 3 years prior, and had been aggravated 1 week before his presentation. Conservative treatment was ineffective. He had sensory abnormalities in the L4 dermatomal area of the left leg, and the straight leg raise test was positive at 60 degrees. MRI demonstrated a cystic lesion at the level of the L3/4 intervertebral disc space, with high signal intensity on T2-weighted imaging () and low signal intensity on T1-weighted imaging. The cystic mass, located between the thecal sac and the L4 nerve root, compressed both structures.\nAfter a left L3/4 partial hemilaminectomy failed to reveal the discal cyst, intraoperative discography was performed. A dark blue, cystic lesion was visualized, compressing the thecal sac and the L4 nerve root. The cyst communicated with the L3/4 intervertebral disc by means of a central annular tear. The cyst was aspirated, then totally excised. The patient achieved complete pain relief after surgery. Histologic examination revealed that the cyst had a fibrotic wall without an epithelial-cell lining (). Postoperative MRI showed no evidence of any remaining mass lesion.