Disclosures: Richa Lamba, MD: Nothing to disclose

Case Description: Pain was described as sharp, constant, 5/10 at best, 8/10 at worst, and mostly located in the left buttock with radiation to the left lateral thigh and lateral calf. He also reported tingling of the sole of the left foot. Walking exacerbated the pain, while ibuprofen and over-the-counter topical preparations helped. He reported missing work on multiple occasions due to his symptoms. A T2-weighted MRI of the lumbar spine showed left paracentral acute disc extrusion with overall severe canal stenosis extending along the posterior aspect of the L5 vertebral body. The report also noted that the extradural defect at L4-L5 could alternatively reflect an intradiscal cyst. Subsequently, patient underwent a left L4-L5 hemilaminotomy with excision of the cyst.

Setting: Ambulatory clinic

Patient: 29-year-old male presenting with low back pain and left sided radicular symptoms for 1 month after a lifting injury.

Assessment/Results: At initial presentation, his gait was antalgic. Lumbar flexion was limited to 50% with end range pain. Dural tension signs were positive bilaterally. Sensation deficits were noted in the left L5 and S1 dermatomes. Strength testing was normal except for the left extensor hallucis longus muscle which was 4/5. At follow up visit on post-operative day 21, patient reported resolution of all symptoms including pain and numbness/tingling. Strength and sensation testing did not elicit any residual deficits.

Discussion: Discal cysts are ventrolateral extradural lesions attached to a lumbar disc, with occasional extension into the lateral recess. Most cases have been reported in Asian males in the third or fourth decade of life. MRI findings have been most commonly used to diagnose discal cysts as in this case. Pathogenesis, natural course, and management are largely unknown due to the limited number of cases reported in literature.

Conclusion: This case supports surgical intervention via unilateral hemilaminotomy for the successful removal of a discal cyst.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/presentation-diagnosis-and-treatment-of-a-lumbar-discal-cyst-in-a-29-year-old-caucasian-male-a-case-report/