PDF(Pubmed)
Abstract：
BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) is increasingly being utilized to treat patients with lumbar disc herniation. PELD is unique in that it uses a single working port endoscope with constant irrigation of the surgical field to visualize pathology. The current report is of a case of postoperative epidural irrigation fluid accumulation presenting as peripherally enhancing epidural lesions, masking an underlying re-herniation.
METHODS: A patient with a Lumbar 5-Sacral 1 level disc herniation presenting with radiculopathy was treated using PELD. Following the operation, the patient experienced recurrent pain, prompting a repeat MRI of the lumbar spine. Multiple ring-enhancing lesions within the epidural space were observed, creating diagnostic dilemmas. The differential diagnoses included epidural abscess, pseudomeningocele from unintended durotomy, epidural hematoma, or trapped epidural fluid collection presenting as a pseudocyst with or without recurrent disc herniation. A repeat endoscopic discectomy was performed to confirm the diagnosis of pseudocyst, revealing a recurrent disc herniation.
CONCLUSIONS: Pseudocysts are not an uncommon complication of PELD, typically believed to be due to an inflammatory response to disc fragments. However, in this case, the epidural fluid collection was likely the result of trapped irrigation fluid from continuous irrigation during the procedure, which masked an underlying re-herniation on imaging.
CONCLUSIONS: With the increasing utilization of PELD, it is important to acknowledge unique complications such as fluid accumulation from irrigation within the epidural space. Fluid accumulation can lead to contrast-enhancing pseudocyst formation, which can theoretically lead to mass effect or increased intracranial and intraspinal pressure and may mask additional underlying pathology.
METHODS: A patient with a Lumbar 5-Sacral 1 level disc herniation presenting with radiculopathy was treated using PELD. Following the operation, the patient experienced recurrent pain, prompting a repeat MRI of the lumbar spine. Multiple ring-enhancing lesions within the epidural space were observed, creating diagnostic dilemmas. The differential diagnoses included epidural abscess, pseudomeningocele from unintended durotomy, epidural hematoma, or trapped epidural fluid collection presenting as a pseudocyst with or without recurrent disc herniation. A repeat endoscopic discectomy was performed to confirm the diagnosis of pseudocyst, revealing a recurrent disc herniation.
CONCLUSIONS: Pseudocysts are not an uncommon complication of PELD, typically believed to be due to an inflammatory response to disc fragments. However, in this case, the epidural fluid collection was likely the result of trapped irrigation fluid from continuous irrigation during the procedure, which masked an underlying re-herniation on imaging.
CONCLUSIONS: With the increasing utilization of PELD, it is important to acknowledge unique complications such as fluid accumulation from irrigation within the epidural space. Fluid accumulation can lead to contrast-enhancing pseudocyst formation, which can theoretically lead to mass effect or increased intracranial and intraspinal pressure and may mask additional underlying pathology.
摘要：
背景：经皮内窥镜下腰椎间盘切除术（PELD）越来越多地用于治疗腰椎间盘突出症患者。PELD的独特之处在于，它使用单工作端口内窥镜，不断冲洗手术区域以可视化病理。目前的报告是一例术后硬膜外冲洗液积聚，表现为周围增强的硬膜外病变，掩盖了潜在的重新疝。
方法：使用PELD治疗1例腰5-骶1级椎间盘突出症伴神经根病的患者。手术后,患者经历了反复的疼痛，提示腰椎的重复MRI。观察到硬膜外腔内的多个环增强性病变，制造诊断困境。鉴别诊断包括硬膜外脓肿，意外截骨切开术引起的假脑膜膨出，硬膜外血肿,或被困的硬膜外积液表现为假性囊肿，有或没有复发性椎间盘突出。再次进行内窥镜椎间盘切除术以确认假性囊肿的诊断，显示椎间盘突出复发.
结论：假性囊肿是PELD的常见并发症，通常被认为是由于对椎间盘碎片的炎症反应。然而,在这种情况下,硬膜外积液的收集可能是由于在手术过程中连续冲洗而滞留的冲洗液所致,在成像上掩盖了潜在的重新疝。
结论：随着PELD利用率的提高，重要的是要认识到独特的并发症，例如硬膜外腔内冲洗产生的液体积聚。液体积聚可导致对比增强的假性囊肿形成，从理论上讲，这可能导致肿块效应或颅内和脊柱内压升高，并可能掩盖其他潜在的病理。
方法：使用PELD治疗1例腰5-骶1级椎间盘突出症伴神经根病的患者。手术后,患者经历了反复的疼痛，提示腰椎的重复MRI。观察到硬膜外腔内的多个环增强性病变，制造诊断困境。鉴别诊断包括硬膜外脓肿，意外截骨切开术引起的假脑膜膨出，硬膜外血肿,或被困的硬膜外积液表现为假性囊肿，有或没有复发性椎间盘突出。再次进行内窥镜椎间盘切除术以确认假性囊肿的诊断，显示椎间盘突出复发.
结论：假性囊肿是PELD的常见并发症，通常被认为是由于对椎间盘碎片的炎症反应。然而,在这种情况下,硬膜外积液的收集可能是由于在手术过程中连续冲洗而滞留的冲洗液所致,在成像上掩盖了潜在的重新疝。
结论：随着PELD利用率的提高，重要的是要认识到独特的并发症，例如硬膜外腔内冲洗产生的液体积聚。液体积聚可导致对比增强的假性囊肿形成，从理论上讲，这可能导致肿块效应或颅内和脊柱内压升高，并可能掩盖其他潜在的病理。
