CASE REPORT article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1646605
Endoscopic Cystectomy vs. Lumbar Interbody Fusion for Liquid-and Gas-filled Discal Cysts: A Case Series and Literature Review
Provisionally accepted- 1Chengdu University of Traditional Chinese Medicine, Chengdu, China
- 2Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Lumbar discal cysts are uncommon lesions that mimic disc herniation but require distinct therapeutic strategies due to their unique pathophysiology. Current literature lacks consensus on optimal surgical approaches. This study reviewed the surgical management and pathological mechanisms of primary lumbar discal cysts, emphasizing the distinction between liquid and gas-filled subtypes which require tailored therapeutic strategies due to differing pathophysiology and association with spinal instability. We report successful surgical outcomes in three patients: one with a liquid cyst treated via endoscopic resection, and two with gas-filled cysts managed via endoscopic cystectomy or lumbar interbody fusion, respectively. All achieved significant symptomatic relief and complete cyst resolution on imaging. A concurrent PubMed literature review (1990-2025) on primary gas-filled and liquid disc cysts informed the analysis. Liquid cysts predominantly occur in younger patients, associated with annular fiber damage and disc herniation, causing symptoms primarily via direct compression; endoscopic cystectomy is an effective treatment. Conversely, gas-filled cysts are more common in older patients, strongly linked to disc degeneration and the vacuum phenomenon. Symptoms arise not only from cyst compression but also potentially from concurrent spinal stenosis and vertebral instability. Therefore, surgical strategy for gas-filled cysts must consider spinal stability: endoscopic cystectomy is suitable for stable spines, while interbody fusion surgery is more appropriate when instability is present. We conclude that surgical intervention is effective for disc cysts, but the optimal approach must be individualized based on cyst subtype and the presence of spinal instability, as informed by clinical presentation and imaging features.
Keywords: Discal cyst, Gas-filled, Liquid-filled, Endoscopic resection, Lumbar InterbodyFusion, case report
Received: 16 Jun 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Huang, Li, Deng, Chen and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Rigao Chen, Chengdu University of Traditional Chinese Medicine, Chengdu, China
Yi Zhou, Chengdu University of Traditional Chinese Medicine, Chengdu, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.