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Background <p>Intraspinal gas-filled cysts are relatively rare, and their pathogenesis remains unclear. While most patients remain asymptomatic, a subset may develop lower extremity symptoms due to nerve compression. Surgical intervention is indicated for patients who do not respond to conservative management. We report three cases of symptomatic intraspinal gas-filled cysts treated with full endoscopic spinal decompression following unsuccessful conservative therapy, with no recurrence observed during a follow-up period of one to three months. Additionally, we provide a review of the relevant literature.</p> Case Report <p>The first case involved a 70-year-old male with a left L4-5 lateral recess disc herniation accompanied by a gas-filled cyst, presenting with left lower extremity radicular pain. He underwent full endoscopic transforaminal discectomy and cystectomy under local anesthesia. The second case was a 75-year-old female with a left L4-5 paramedian disc herniation and a gas-filled cyst, presenting with left lower extremity radicular pain and muscle weakness. She underwent full endoscopic transforaminal discectomy and cystectomy under local anesthesia. The third case was a 55-year-old male with a left posterolateral L4-5 epidural gas-filled cyst, presenting with left lower extremity radicular pain and dorsiflexion weakness. He underwent percutaneous endoscopic interlaminar decompression with partial ligamentum flavum resection and cyst removal under local anesthesia.</p> Results <p>All three patients successfully underwent surgery, with operative times ranging from 30 to 75&#xa0;min (average: 55&#xa0;min). Postoperatively, pain was significantly alleviated, and Visual Analog Scale (VAS) scores markedly decreased. Muscle strength improved notably in the second and third cases. All patients were followed up for one to three months, with no recurrence observed.</p> Conclusion <p>For symptomatic gas-filled cysts, full endoscopic spinal surgery is a favorable option following failed conservative management. Compared to open surgery, it offers advantages such as minimal invasiveness, reduced bleeding, decreased soft tissue damage, faster recovery, and lower recurrence rates.</p>

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Percutaneous Endoscopic Lumbar Decompression for Symptomatic Gas-filled Cysts Within the Lumbar Spinal Canal: A Report of 3 Cases and Literature Review

  • 期刊论文

  • 发表日期：

    2025年7月22日

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  • Cheng-Zhou Liu,
  • Cong-Hui Ren,
  • Bao-Xin Jia,
  • Ting Wang

摘要

Background

Intraspinal gas-filled cysts are relatively rare, and their pathogenesis remains unclear. While most patients remain asymptomatic, a subset may develop lower extremity symptoms due to nerve compression. Surgical intervention is indicated for patients who do not respond to conservative management. We report three cases of symptomatic intraspinal gas-filled cysts treated with full endoscopic spinal decompression following unsuccessful conservative therapy, with no recurrence observed during a follow-up period of one to three months. Additionally, we provide a review of the relevant literature.

Case Report

The first case involved a 70-year-old male with a left L4-5 lateral recess disc herniation accompanied by a gas-filled cyst, presenting with left lower extremity radicular pain. He underwent full endoscopic transforaminal discectomy and cystectomy under local anesthesia. The second case was a 75-year-old female with a left L4-5 paramedian disc herniation and a gas-filled cyst, presenting with left lower extremity radicular pain and muscle weakness. She underwent full endoscopic transforaminal discectomy and cystectomy under local anesthesia. The third case was a 55-year-old male with a left posterolateral L4-5 epidural gas-filled cyst, presenting with left lower extremity radicular pain and dorsiflexion weakness. He underwent percutaneous endoscopic interlaminar decompression with partial ligamentum flavum resection and cyst removal under local anesthesia.

Results

All three patients successfully underwent surgery, with operative times ranging from 30 to 75 min (average: 55 min). Postoperatively, pain was significantly alleviated, and Visual Analog Scale (VAS) scores markedly decreased. Muscle strength improved notably in the second and third cases. All patients were followed up for one to three months, with no recurrence observed.

Conclusion

For symptomatic gas-filled cysts, full endoscopic spinal surgery is a favorable option following failed conservative management. Compared to open surgery, it offers advantages such as minimal invasiveness, reduced bleeding, decreased soft tissue damage, faster recovery, and lower recurrence rates.