PMC10070843_01
Preoperative CT and MRI of the lesion. Sagittal, coronal, and axial CT scan (A-F) revealing a gas-containing intraspinal cystic lesion anteromedial to the left L4/5 articular joint and bulging to the lateral canal. Osteoarthritis and vacuum clefts (arrow) are observed at the bilateral L4/5 facet joints. MRI (G-I) revealed a hypointense lesion on T1-weighted image, but a hyperintense mass with a hypointense rim (arrow) on both T2-weighted and fat suppression images.
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F1
Computed tomography (CT) found an intraspinal cystic lesion adjacent to the ligamentum flavum, anteromedial to the left L4-L5 articular joint, bulging to the lateral aspect of the canal, and leading to lateral recess stenosis (Figures 1A-F). T1-weighted image, but a hyperintense mass with a hypointense rim on both T2-weighted and fat suppression images (Figures 1G-J). The intervertebral disc showed minimal degenerative change, and no vacuum phenomenon was discovered.
Intraoperative endoscopic images. (A) After facetectomy with a trephine, the cyst (asterisk) with a fistula connecting to the resected facet joint is seen. An extruded bubble (arrow) indicates gas in the cyst. The medial ligamentum flavum is shown (arrowhead). (B) After gradual piecemeal resection of the cyst (asterisk), the impinged L5 nerve root (arrow) is seen. (C) The space beneath the nerve root (arrow) is shown and the annulus fibrosus (arrowhead) is shown to be intact.
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F2
After partial facetectomy with an endoscopic trephine, a cyst with a fistula connecting to the resected facet joint appeared in the endoscope field (Figure 2A). Subsequently, the impinged L5 nerve root gradually arose (Figure 2B). Following complete cystectomy and clearance of the ligamentum flavum, the space beneath the nerve root appeared, and the annulus fibrosus was found to be intact and therefore fully preserved (Figure 2C).
Postoperative CT (A-F) and MRI (G-J) demonstrating a bony trajectory (arrow) targeting the lesion and complete decompression of the nerve root and dura sac.
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F3
Postoperative CT and MRI demonstrated a bony trajectory targeting the lesion and full decompression of the nerve root and dura sac (Figure 3).