Epidural Gascontaining Pseudocyst in Lumbar Spine - A Case Report -

Woo-sung Kim; Young-Sang Lee; Tae Hyun Kim; Sub Ri Park

doi:10.4184/jkss.2014.21.4.189

Journal List > J Korean Soc Spine Surg > v.21(4) > 1076037

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Kim, Lee, Kim, and Park: Epidural Gascontaining Pseudocyst in Lumbar Spine - A Case Report -

Case Report

Journal of Korean Spine Surg 2014;21(4):189-193.

Published online: 21 December 2014

DOI: https://doi.org/10.4184/jkss.2014.21.4.189

Epidural Gascontaining Pseudocyst in Lumbar Spine - A Case Report -

Woo-sung Kim, M.D., Young-Sang Lee, M.D., Tae Hyun Kim, M.D., Sub Ri Park, M.D.

Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea

Corresponding author: Young-Sang Lee, M.D. Department of Orthopaedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, 255-2 Seohyun-dong, Bundang-gu, Seongnam 463-050, Korea TEL: +82-31-779-0175, FAX: +82-31-779-0179 E-mail: yslee2080@yahoo.com

Received 25 May 2014 Revised 17 September 2014 Accepted 8 December 201431 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Case report.

Objectives

We report two cases regarding epidural air pseudocyst at the lumbar spine.

Summary of Literature Review

Epidural air pseudocyst at the lumbar spine that provokes radiating pain and neurologic symptoms can be misdiagnosed as an epidural tumor or HIVD. Consequently, proper diagnosis and treatment of the epidural air pseudocyst at the lumbar spine is necessary.

Materials and Methods

We report on two patients with radiculopathy and neurologic symptoms resulting from epidural air pseudocysts. In one patient, the epidural air pseudocyst was found within the epidural ligament flavum area on an MRI, and fluoroscopic-guided FNA (fine needle aspiration) was performed. In the other, the epidural air pseudocyst was found behind the posterior longitudinal ligament and was accompanied by spinal stenosis. In this patient, we conducted open cystectomy and posterior decompression surgery.

Results

After treatment, all patients have showed symptom improvement and they are currently living without discomfort.

Conclusions

Due to frequent misdiagnosis, the careful diagnosis of lumbar epidural air pseudocyst is necessary. Physicians should select a proper treatment plan concerning the patient's condition and the location of the lesion.

Keywords: Epidural pseudocyst, Surgical treatment, Fine needle aspiration, Open cystectomy

REFERENCES

1. Lee DY, Lee S. L2 radicular compression caused by a foraminal extradural gas pseudocyst. J Korean Neurosurg Soc. 2010; 47:232–4.

2. Kakitsubata Y, Theodorou SJ, Theodorou DJ, et al. Symptomatic epidural gas cyst associated with discal vacuum phenomenon. Spine(Phila Pa 1976). 2009; 34:E784–9.

3. Qasho R, Santoro A, Vangelista T, et al. Nerve root compression by a gascontaining cyst associated with stenotic lateral recess. Case report and reviewof the literature. J Neurosurg Sci. 2001; 45:181–4.

4. Sei A, Mizutamari M, Fujimoto T, et al. Gas-filled intradural cysts of the lumbar spine and the possible pathogenesis. Spine J. 2009; 9:E6–8.

5. Giraud F, Fontana A, Mallet J, et al. Sciatica caused by epidural gas. Four case reports. Joint Bone Spine. 2001; 68:434–7.

6. Bosser V, Dietemann JL, Warter JM, et al. L5 radicular pain related to lumbar extradural gascontaining pseudocyst. Role of CT-guided aspiration. Neuroradiology. 1990; 31:552–3.

7. Kaymaz M, Oztanir N, Emmez H, et al. Epidural air en-trapment after spinal surgery. Clin Neurol Neurosurg. 2005; 107:421–4.

8. Kuh SU, Heo DH, Kim KS, Cho YJ. Lumar epidural gas-contining pseudocysts as a cause of severe radicular pain. Joint Bone Spine. 2011; 78:398–401.

Fig. 1.

Multiple level degenerative disease (narrowing of the intervertabral) space and central vacuum phenomenon at lateral radiograph of the lumbar spine.

Fig. 2.

T2-weighted MRI sagittal (A) and T1-weighted MRI sagittal (B) of the lumbar spine. A round space occupying the spinal shows a very low signal, indicating the presence of gas (arrow).

Fig. 3.

T2-weighted MRI axial image at L3-4 (A), L4-5 (B) and L5-S1 (C) of the lumbar spine. Air bubble (arrow) from intervertebral vacuum at L3-4. Right lateral recess and right foraminal stenosis at L4-5. Both lateral recess and left neural foraminal stenosis at L5-S1.

Fig. 4.

L3-4 Computed tomography demonstrate an air bubble(arrow) within the anterior part of the epidural space (A). Sagittal Computed tomography image demonstrate an air bubble(arrow) within the posteroinferior area of the L3 body (B).

Fig. 5.

L3-4 Immediate post operative computed tomography demonstrate an air bubble within the anterior parth of the epidural space (A). Sagittal Computed tomography image demonstrate an air bubble within the posteroinferior area of the L3 body (B). both image demonstrate decreased air bubble.

Fig. 6.

Lateral radiograph of the lumbar spine between L3-4 degenerative disease (narrowing of the intervertabral) space and central vacuum phenomenon (A). T2-weighted MRI sagittal (B) and axial (C) of the lumbar spine. A round space occupying the spinal shows a very low signal, indicating the presence of gas (S/p vertabroplasty in T12).

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