1. 2024;27;E873-E879Percutaneous Endoscopic Resection of Lumbar Discal Cyst
   Retrospective Study
   Shuai Ding, MD, Guangquan Zhang, MD, Yanzheng Gao, MD, Zhiqiang Hou, MD, and Fuqiang Shao, MD.

BACKGROUND: Discal cysts, an uncommon condition, can replicate the characteristic signs typically linked to a herniated lumbar disc, encompassing discomfort in the lumbar region and neuralgia that extends along the nerve paths, thereby complicating the process of distinguishing the discal cyst from other conditions. Consensus on the treatment of this disease remains elusive, and the best treatment for it is still a matter of controversy. In numerous past reports, this disease has been treated through either open or microscopic surgical approaches.

OBJECTIVES: The aim of this study is to assess the therapeutic efficacy and safety of a minimally invasive endoscopic surgery technique in the treatment of lumbar discal cysts.

STUDY DESIGN: We conducted a retrospective observational analysis.

SETTING: This research was initiated with a group of patients selected from the Spinal Surgery Unit at the Henan Provincial People’s Hospital.

METHODS: From March 2017 to May 2021, a minimally invasive endoscopic procedure was executed on a cohort of 7 male patients (average age: 30.86 ± 5.24 years), each diagnosed with discal cysts, within our spinal surgery division. The efficacy of the treatment was gauged by pre- and postoperative assessments that used the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Furthermore, the ultimate clinical efficacy of the procedure was appraised in accordance with the revised Macnab criteria.

RESULTS: The patients reported a prompt and significant relief of symptoms after the surgical removal of the lumbar disc lesions, with no cases of recurrence noted during the follow-up period. A significant drop was observed in the VAS score for lower limb pain, declining from a preoperative mean of 6.86 ± 1.35 to 1.57 ± 0.53 at the final evaluation (P < 0.05). In tandem with this finding, a marked decrease in the ODI score was noted, with a reduction from 69.14 ± 10.76 before surgery to 10.29 ± 5.59 at the concluding review (P < 0.05). The postoperative VAS and ODI scores collectively pointed toward substantial improvements in patients’ conditions. When assessed according to the revised Macnab criteria, the outcomes were distributed as follows: 4 patients (57.1%) achieved excellent results, 2 (28.6%) had very good results, and one (14.3%) had a fair result, totaling 6 patients (85.7%) with satisfactory outcomes. No severe complications or recurrences were identified during the postoperative monitoring phase.

LIMITATIONS: This observational retrospective study was based on a convenience sampling that involved a limited number of patients.

CONCLUSIONS: Percutaneous endoscopic resection emerged as a micro-invasive and secure surgical approach for the management of lumbar discal cysts.

KEY WORDS: Lumbar discal cyst, percutaneous endoscopic resection, minimally invasive