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

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


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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