J Korean Soc Spine Surg.  2014 Dec;21(4):189-193. 10.4184/jkss.2014.21.4.189.

Epidural Gas-containing Pseudocyst in Lumbar Spine: A Case Report

• Kim WS
• Lee YS
• Kim TH
• Park SR

• KMID: 2097871
• DOI: http://doi.org/10.4184/jkss.2014.21.4.189

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
We report two cases regarding epidural air pseudocyst at the lumbar spine. SUMMARY OF LITERATURE REVIEW: Epidural air pseudocyst at the lumbar spine that provokes radiating pain and neurologic symptoms can be misdiagnosed as an epidural tumor or HIVD. Consequently, proper diagnosis and treatment of the epidural air pseudocyst at the lumbar spine is necessary.
MATERIALS AND METHODS
We report on two patients with radiculopathy and neurologic symptoms resulting from epidural air pseudocysts. In one patient, the epidural air pseudocyst was found within the epidural ligament flavum area on an MRI, and fluoroscopic-guided FNA (fine needle aspiration) was performed. In the other, the epidural air pseudocyst was found behind the posterior longitudinal ligament and was accompanied by spinal stenosis. In this patient, we conducted open cystectomy and posterior decompression surgery. Results: After treatment, all patients have showed symptom improvement and they are currently living without discomfort.
RESULTS
After treatment, all patients have showed symptom improvement and they are currently living without discomfort.
CONCLUSIONS
Due to frequent misdiagnosis, the careful diagnosis of lumbar epidural air pseudocyst is necessary. Physicians should select a proper treatment plan concerning the patient's condition and the location of the lesion.

Keyword

Epidural pseudocyst; Surgical treatment; Fine needle aspiration; Open cystectomy

MeSH Terms

Biopsy, Fine-Needle
Cystectomy
Decompression
Diagnosis
Diagnostic Errors
Epidural Neoplasms
Humans
Ligaments
Longitudinal Ligaments
Magnetic Resonance Imaging
Needles
Neurologic Manifestations
Radiculopathy
Spinal Stenosis
Spine*

Figure

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  Fig. 1. Multiple level degenerative disease (narrowing of the intervertabral) space and central vacuum phenomenon at lateral radiograph of the lumbar spine.

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  Fig. 2. T2-weighted MRI sagittal (A) and T1-weighted MRI sagittal (B) of the lumbar spine. A round space occupying the spinal shows a very low signal, indicating the presence of gas (arrow).

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  Fig. 3. T2-weighted MRI axial image at L3-4 (A), L4-5 (B) and L5-S1 (C) of the lumbar spine. Air bubble (arrow) from intervertebral vacuum at L3-4. Right lateral recess and right foraminal stenosis at L4-5. Both lateral recess and left neural foraminal stenosis at L5-S1.

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  Fig. 4. L3-4 Computed tomography demonstrate an air bubble(arrow) within the anterior part of the epidural space (A). Sagittal Computed tomography image demonstrate an air bubble(arrow) within the posteroinferior area of the L3 body (B).

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  Fig. 5. L3-4 Immediate post operative computed tomography demonstrate an air bubble within the anterior parth of the epidural space (A). Sagittal Computed tomography image demonstrate an air bubble within the posteroinferior area of the L3 body (B). both image demonstrate decreased air bubble.

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  Fig. 6. Lateral radiograph of the lumbar spine between L3-4 degenerative disease (narrowing of the intervertabral) space and central vacuum phenomenon (A). T2-weighted MRI sagittal (B) and axial (C) of the lumbar spine. A round space occupying the spinal shows a very low signal, indicating the presence of gas (S/p vertabroplasty in T12).

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