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Journal of Neurosurgical Sciences 2002 June;46(2):93-5

Copyright © 2002 EDIZIONI MINERVA MEDICA

lingua: Inglese

Radicular compression by lumbar intraspinal epidural gas pseudocyst in association with lateral disc herniation. Role of the posterior longitudinal ligament

Salpietro F. M., Alafaci C., Collufio D., Passalacqua M., Puglisi E., Tripodo E., Di Pietro G., Tomasello F.

Department of Neurosurgery, University of Messina, Messina


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Among unusu­al abnor­mal­ities of the lum­bar ­spine report­ed ­since the intro­duc­tion of Computed Tomography (CT), the pres­ence of gas lucen­cy in the spi­nal ­canal, ­known as vac­u­um phe­nom­e­non, is ­often dem­on­strat­ed. On the con­trary, epi­du­ral gas pseu­do­cyst com­press­ing a ­nerve ­root in ­patients ­with a lat­er­al ­disc her­ni­a­tion has rare­ly ­been report­ed. We ­report a ­case of a 44-­year-old man who expe­ri­enced vio­lent low ­back ­pain and mono­lat­er­al sciat­i­ca, exac­er­bat­ed by orthos­tat­ic posi­tion, one ­week ­before admis­sion. A lum­bos­a­cral ­spine CT ­showed the pres­ence of vac­u­um phe­nom­e­non asso­ciat­ed ­with a degen­er­at­ed ­disc mate­ri­al and a cap­su­lat­ed epi­du­ral gas col­lec­tion ­with evi­dence of ­root com­pres­sion. A micro­sur­gi­cal inter­lam­i­nar ­approach was car­ried out and, ­before the pos­te­ri­or lon­gi­tu­di­nal lig­a­ment was ­entered, a spher­i­cal “bub­ble” com­press­ing the ­nerve ­roots was ­observed. The cap­su­lat­ed pseu­do­cyst was dis­sect­ed out, ­peeled off and ­excised en ­bloc. A ­large ­part of the pos­te­ri­or lon­gi­tu­di­nal lig­a­ment and the lat­er­al ­disc her­ni­a­tion ­were ­removed. Postoperatively the ­patient was com­plete­ly ­free of symp­toms. The mech­a­nism of exac­er­ba­tion of ­pain was prob­ably due to the ­increased radic­u­lar com­pres­sion in the ­upright pos­ture and, ­besides the pres­ence of a lat­er­al ­disc her­ni­a­tion, ­could be relat­ed to a pneu­mat­ic squeez­ing of gas ­from the inter­ver­te­bral ­space ­into the ­well cap­su­lat­ed sac by the solic­i­tat­ed L4-L5 ­motion seg­ment. Histological ­study of the ­wall of the pseu­do­cyst ­showed the pres­ence of ­fibrous tis­sue iden­ti­cal to the lig­a­ment. We con­clude ­that, in ­case of a lum­bar ­disc her­ni­a­tion, it is rec­om­mend­ed to per­form a com­plete micro­dis­cec­to­my and an accu­rate remov­al of the ­involved por­tion of pos­te­ri­or lon­gi­tu­di­nal lig­a­ment in ­order to pre­vent pseu­do­cys­tic for­ma­tions.

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