Minimally Invasive en bloc Excision of Rare Hemorrhagic Discal Cysts Using Unilateral Biportal Endoscopic Technique: A Report of Two Cases

Abstract

Hemorrhagic discal cyst (HDC) in the lumbosacral spine is a rare cause for low back pain and radiculopathy. Although there is no treatment guideline in the literatures, it is believed that the surgical excision showed better treatment results than the conservative treatment. In this report, we have two excellent treatment results from two patients with HDC using the minimally invasive unilateral biportal endoscopic (UBE) technique. Two patients with the rare HDC in their lumbosacral spines came to our clinic due to low back pain and severe sciatica after failure of conservative treatment. Both patients’ MRI revealed a cystic mass mimic a ruptured lumbar disc herniation with compression of the nerve root. The cysts were excised using UBE technique. The features of UBE technique are two small surgical wounds, minimal muscle dissection, continuous normal saline irrigation, excellent hemostasis, and a crystal clear and magnified endoscopic surgical field. These features enable meticulous dissection, en bloc excision of the cyst, and reduce the risks of dural tears or nerve root injuries. Both patients had very good symptoms relief and quick recovery after the surgery with no complications. We believe that the UBE technique is a safe, effective, and excellent surgical treatment option for patients with HDC in the lumbosacral spine.