Postoperative discal pseudocyst after percutaneous endoscopic transforaminal discectomy treated by drainage: Case report

This article reports 2 cases of symptomatic postoperative discal pseudocysts (PDP), a rare complication of percutaneous endoscopic transforaminal lumbar discectomy (PELD). In this report, we propose a possible mechanism of PDP and introduce an effective therapeutic strategy. To our knowledge, there have been no reports of the use of indwelling drainage techniques for the PDP treatment after PELD. PATIENT CONCERNS: Herein, we report 2 cases of PDP after PELD in our hospital. Both patients had disc herniation at the L4/5 level, and the symptoms of low back pain and radiculopathy were significantly relieved after PELD. However, the signs in both 2 cases recurred 20 days after surgery. MRI indicated PDP in both 2 patients with high intensity on T1- and T2-weighted imaging in the primary surgical area. INTERVENTIONS: Given the progressive symptoms in both cases, PELD was performed again and 3-lumen drainage catheters were placed at the surgical site for adequate drainage. OUTCOMES: The patient’s symptoms were significantly relieved after adequate drainage and disappeared 3 months after surgery. There was no clinical or MRI recurrence at the 6-month follow-up. CONCLUSION: According to operative findings, we found that PDP symptoms may not be attributable mainly to cyst compression but to the excessive accumulation of local inflammatory factors. Treatment of PELD combined with indwelling drainage is feasible and effective in treating PDP.