Pathogenesis of the discal cysts communicating with an adjacent herniated disc. Histological and ultrastructual studies of two cases

Discal cyst of the lumbar spine is a very rare cause of back pain and sciatica. We report two cases of discal cysts communicating with an adjacent herniated disc. From CT and MRI findings, they were diagnosed as having a discal cyst in the epidural space, which compressed the nerve root. After an adequate surgical field was obtained with a microscope and a Casper retractor, the discal cyst could be excised and satisfactory decompression of the adjacent nerve root was obtained. From histological and electron microscopic study, the presence of residual herniated tissues was confirmed in the cyst wall. Macrophages played an important role in the absorption of herniated tissue and the formation of the discal cyst. Hemorrhage in the cyst wall will make the serous hemorrhagic fluid-filled cystic structure in the absorbed spaces of the prolapsed disc. In this study, we confirmed that the discal cyst could have developed from the absorption process of a disc herniation. (C) 2009 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.