The patient showed no recurrence of complaint at 1-year follow up evaluation. After the surgery, the radicular symptom was improved significantly. Needle puncture of the gas-containing cyst with subtotal excision of the wall was performed. During the surgery, compression of the left S1 nerve root by a gas-containing cyst was observed. Kmmell's disease (KD), or avascular necrosis of a vertebral body, presents as vertebral osteonecrosis with compression deformity, IVC, exaggerated kyphosis and intravertebral instability weeks to months. The patient underwent laminectomy and the left L5-S1 discectomy. Among which the incidence of nonunion is approximately 13.5 and the incidence of intravertebral vacuum cleft (IVC) sign is about 713 1. Hounsfield unit of the lesion was measured as -851. Axial CT revealed vacuum disc phenomenon at L5-S1 level, and intracannular posterolateral gas collection at the same level. MR imaging showed a well-encapsulated low signal intensity lesion was compatible with a gas formation or calcification. Her straight leg-raising test was negative and there was no motor dysfunction. There was no history of any invasive procedure such as surgery, lumbar puncture, or epidural injection. cleft sign, intravertebral vacuum phenomenon) in vertebral compression fractures (VCFs) is considered indicative of osteonecrosis, also referred to as Kümmell disease 13. Symptoms were aggravated by standing and walking, and were improved by sitting position. The presence of an intravertebral gas cleft (i.e. Keywords: Vacuum phenomenon, Epidural gas-containing cyst, Nerve root compressionĪ 72-year-old woman presented with last 1-month history of pain in the left lower extremity, which radiated to the buttock, lateral aspect of the upper thigh, and the posterior calf. On imaging studies, a vacuum disc can be recognized as a lucency within either the intervertebral disc or a synovial joint as a direct product of the liberation of a gas consisting of 95 nitrogen and lesser amounts of oxygen and carbon dioxide into the disc as well as joint space. The possibility of gas containing cyst should be considered in case of the nerve root compression in which epidural gas is present. The speculative mechanism of the nerve root compression is discussed. The nerve root in both patients was compressed by gas containing cyst that was surrounded by thin walled capsule separable from the gaseous degenerated disc space. Radiographic studies demonstrated intervertebral vacuum phenomenon and accumulation of gas in the lumbar epidural space compressing the dural sac and the nerve root. (B) Corresponding anatomic section depicts a normal disc at the L1-L2 level, whereas the disc at the L2-元 appears grossly abnormal. The authors describe two patients with symptomatic epidural gas-containing cyst that seem to be originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. (A) Sagittal T2-weighted MR image shows the intervertebral disc at the L1-L2 interspace of high signal intensity relative to that of the disc at the L2-元 level. However, some rare type of vacuum phenomenon in the spinal canal may bring about posterior gas displacement within the epidural space. Vacuum disc phenomenon is a collection of gas in the intervertebral disc space but rarely causes nerve compression.
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