Case Report
Volume 12 Issue 10 - 2021
Full-Endoscopic Confirmation of a Discal Cyst by Indigo Carmine Injection during Lumbar Spine Surgery: A Technical Note
Yuji Yamada1,2, Toru Maeda1, Hirofumi Takami1, Naoyuki Yoshida1, Masahiro Kashima1, Shogo Tomiyama1, Junzo Fujitani2 and Koichi Sairyo2*
1Department of Orthopedic Surgery, Anan Medical Center, Anan, Japan
2Department of Orthopedics, Tokushima University, Tokushima, Japan
*Corresponding Author: Koichi Sairyo, Professor and Chairman, Department of Orthopedics, Tokushima University, Tokushima, Japan.
Received: August 10, 2021; Published: September 29, 2021


A 28-year-old man presented complaining of left leg pain. Magnetic resonance imaging revealed herniated nucleus pulposus (HNP) with a discal cyst that was compressing the L5 nerve root. Conservative therapy failed; therefore, surgical treatment was selected. Minimally invasive transforaminal full-endoscopic excision of the discal cyst as well as the HNP under local anesthesia was planned. Before surgery, a mixture of indigo carmine and contrast medium was injected into the disc space, and entry of this fluid mixture into the cystic space was confirmed using a C-arm image intensifier. Foraminoplasty was performed first to allow manipulation and rupture of the cyst wall with a radio-pulse bipolar device. Rupture of the cyst wall was confirmed by release of the blue indigo carmine dye from the cyst. The HNP and the ventral cyst wall were removed under full-endoscopic guidance. The leg pain disappeared immediately after surgery, and he returned to work 20 days later. In this report, we describe the endoscopic views during surgery.

Keywords: Full-Endoscopic Surgery; Discal Cyst; Indigo Carmine; Herniated Nucleus Pulposus


  1. Aljuboori Z and Altstadt T. “Symptomatic Lumbar Discal Cyst: A Rare Entity that Can Mimic Other Lumbar Cystic Lesions”. Cureus8 (2019): e5453.
  2. Chiba K., et al. “Intraspinal cyst communicating with the intervertebral disc in the lumbar spine: discal cyst”. Spine 19 (2001): 2112-2118.
  3. Kim JS., et al. “Removal of discal cyst using percutaneous working channel endoscope via transforaminal route”. European Spine Journal 2.2 (2009): 201-205.
  4. Jha SC., et al. “Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst”. Case Reports in Orthopedics (2015): 273151.
  5. Matsumoto M., et al. “Microendoscopic resection of lumbar discal cysts”. Minimally Invasive Neurosurgery 2 (2010): 69-73.
  6. Shibata S., et al. “Bilateral discal cysts managed by partial hemilaminectomy and microscopic resection of hemilateral cyst”. Spine 25 (2011): E1655-1658.
  7. Yeung AT. “The evolution of percutaneous spinal endoscopy and discectomy: state of the art”. Mount Sinai Journal of Medicine 67 (2000): 327-332.
  8. Yeung AT and Tsou PM. “Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases”. Spine 27 (2002): 722-731.
  9. Sairyo K., et al. “State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy”. Journal of Orthopaedic Science2 (2018): 229-236.
  10. Dezawa A., et al. “Percutaneous endoscopic translaminar approach for herniated nucleus pulposus in the hidden zone of the lumbar spine”. Asian Journal of Endoscopic Surgery4 (2012): 200-203.
  11. Sairyo K., et al. “A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: Technical considerations in a fresh cadaver model and a literature review”. The Journal of Medical Investigation1-2 (2017): 1-6.
  12. Sairyo K., et al. “A novel surgical concept of transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) for central canal stenosis of the lumbar spine with local anesthesia: A case report and literature review”. The Journal of Medical Investigation-34 (2019): 224-229.
  13. Manabe H., et al. “Thermal Annuloplasty Using Percutaneous Endoscopic Discectomy for Elite Athletes with Discogenic Low Back Pain”. Neurologia Medico-Chirurgica 2 (2019): 48-53.
  14. Sairyo K., et al. “A new surgical strategy for the intractable chronic low back pain due to type 1 Modic change using transforaminal full-endoscopic disc cleaning (FEDC) surgery under the local anesthesia: A case report and literature review”. The Journal of Medical Investigation1-2 (2021): 1-5.
  15. Koga H., et al. “Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: A case report”. Spine 28 (2003): E212-216.
  16. Kang H., et al. “Midterm results of percutaneous CT-guided aspiration of symptomatic lumbar discal cysts”. American Roentgen Ray Society 190 (2008): W310-314.
  17. Kim HS., et al. “Redefining the Evolution of Spinal Discal Cyst Under Percutaneous Endoscopy: Report of Two Cases”. Asian Journal of Neurosurgery3 (2019): 890-893.
  18. Kwon YK., et al. “Intraoperative discography for detecting concealed lumbar discal cysts”. Journal of Korean Neurosurgical Society4 (2013): 255-257.
  19. Takamatsu N., et al. “Successful Full Endoscopic Surgery for L5 Radiculopathy Due to L4-5 Discal Cyst and Disc Herniation in a Professional Baseball Player”. NMC Case Report Journal, in press (2018).
  20. Takeuchi M., et al. “Return to the Original Work Activity Following the Full-endoscopic Lumbar Surgery under the Local Anesthesia”. Neurologia Medico-Chirurgica2 (2021): 144-151.
  21. Sugiura K., et al. “Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report”. Journal of Neurological Surgery Part A: Central European Neurosurgery3 (2021): 289-293.
  22. Fujii Y., et al. “Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors”. Journal of Spine Surgery1 (2020): S294-S299.
Citation: Yuji Yamada., et al. “Full-Endoscopic Confirmation of a Discal Cyst by Indigo Carmine Injection during Lumbar Spine Surgery: A Technical Note”. EC Orthopaedics 12.10 (2021): 55-59.

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