Percutaneous Intradiscal Aspiration of a Lumbar Vacuum Disc Herniation: A Case Report

Abstract

We report a case of an 83-year-old gentleman presenting with acute low back pain and radicular left lower extremity pain after golfing. A magnetic resonance imaging (MRI) of the lumbar spine revealed a low-signal-density lesion compressing the L5 nerve. A computed tomography scan was then ordered, confirming an extra-foraminal disc protrusion at the L5–S1 level, containing a focus of gas that was compressing the left L5 nerve root and communicating with the vacuum disc at L5–S1. After a failed left L5 transforaminal epidural steroid injection, the patient was brought back for a percutaneous intradiscal aspiration of the vacuum disc gas. This resulted in immediate relief for the patient. A follow-up MRI performed 2 months after the procedure found an approximate 25% reduction in the size of the vacuum disc herniation. Six months after the procedure, the patient remains free of radicular pain. This case report suggests that a percutaneous aspiration of gas from a vacuum disc herniation may assist in the treatment of radicular pain.

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Correspondence to Gregory E. Lutz MD.

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Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licencing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of this case, that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained.

The study is a case report or individual case and therefore its level of evidence is a 3.

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Pak, K.I., Hoffman, D.C., Herzog, R.J. et al. Percutaneous Intradiscal Aspiration of a Lumbar Vacuum Disc Herniation: A Case Report. HSS Jrnl 7, 89–93 (2011). https://doi.org/10.1007/s11420-010-9168-x

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Keywords

  • vacuum disc phenomenon
  • lumbar spine
  • intervertebral disc
  • epidural gas
  • percutaneous procedure