Intraspinal cyst communicating with the intervertebral disc in the lumbar spine - Discal cyst
Intraspinal cyst communicating with the intervertebral disc in the lumbar spine - Discal cyst
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DOI：
10.1097/00007632-200110010-00014
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发表时间：
2001-10-01
期刊：
影响因子：
3
通讯作者：
Nishizawa, T
中科院分区：
文献类型：
--
作者：
Chiba, K;Toyama, Y;Nishizawa, T
研究设计。椎管内囊肿与相应椎间盘有明显联系的回顾性病例研究。通过澄清该疾病的临床、影像学和组织学方面，提出一个新的临床实体“椎间盘囊肿”。背景资料摘要。有几种发病机制不同的椎管内囊肿，其症状与腰椎间盘突出症难以区分，如神经周围囊肿、滑膜囊肿和神经节囊肿。然而，据作者所知，尚未对与相应椎间盘有明显联系的囊肿进行详细分析。本文回顾了8例经手术治疗的与椎间盘有明显联系的椎管内囊肿的临床表现、影像学表现、手术和组织学表现。讨论了可能的发病机制和命名建议。这种疾病的特点是：(1)临床症状与典型的椎间盘突出难以区分，表现为单侧单一神经根病变；(2)与典型的椎间盘突出相比，发病年龄略小，且发生在椎间上部；(3) T1低信号、T2高信号强度，磁共振成像圆形至椭圆形肿块病灶，与含液囊肿相容；(4)受累椎间盘有轻微退变，无论是椎间盘造影术/计算机断层摄影或磁共振成像；(5)囊肿与椎间盘图上相应的椎间盘之间有连接，注射时患腿有严重的放射痛；(6)单纯摘除囊肿后症状立即缓解；(7)囊肿壁由致密纤维结缔组织组成，含血清浆液排出物；(8)组织学检查没有椎间盘物质和特定的内衬细胞层。虽然确切的原因尚不清楚，但潜在的轻微椎间盘损伤可能是囊肿形成的基础。本文报告8例与椎间盘相通的椎管内囊肿，其症状与椎间盘突出相同。由于所有囊肿均与相应的椎间盘相连，且囊肿的发展被认为与潜在的椎间盘损伤有关，因此建议将这种临床实体命名为椎间盘囊肿。
Study Design. A retrospective case study of patients with intraspinal cyst having a distinct connection with the corresponding intervertebral disc.Objectives. To propose a new clinical entity, "discal cyst," by clarifying the clinical, radiographic, and histologic aspects of the disease.Summary of Background Data. Several types of intraspinal cysts with different pathogenesis, causing symptoms indistinguishable from those of lumbar disc herniation, have been reported, such as perineural cysts, synovial cysts, and ganglion cysts. However, to the authors' knowledge, no detailed analysis has been made of cysts that have a distinct connection with the corresponding intervertebral disc.Methods. Clinical pictures, radiographic findings, and surgical and histologic findings in eight surgically treated patients with intraspinal cyst having a distinct connection with the intervertebral disc were reviewed. Possible pathogenesis and a proposal for nomenclature were also discussed.Results. This disease can be characterized by (1) clinical symptoms indistinguishable from those of typical disc herniation, manifesting as a unilateral single nerve root lesion; (2) incidence at slightly younger age and at upper intervertebral levels than with typical disc herniation; (3) T1 low signal and T2 high signal intensity, round to oval mass lesion on magnetic resonance imaging, compatible with a liquid-containing cyst; (4) minimal degeneration of the involved disc, either on discography/computed tomographic discography or magnetic resonance imaging; (5) a connection between the cyst and the corresponding intervertebral discs on discograms with severe radiating pain in the affected leg at the time of injection; (6) immediate relief of symptoms after simple removal of the cyst; (7) cyst wall consisting of dense fibrous connective tissue containing bloody to clear serous discharge; and (8) absence of disc materials and a specific lining cell layer on histologic examination. Although the exact cause is unknown, underlying minor disc injury may serve as a basis for cyst formation.Conclusion. Eight cases of intraspinal cysts communicating with the intervertebral disc presenting symptoms identical to those of disc herniation are presented. Because all cysts were connected to the corresponding disc and the development of the cyst was assumed to be related to underlying disc injury, it is proposed to name- this clinical entity discal cyst.