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

Kevin I. Pak, MD
Physiatry Department, Hospital for Special Surgery

David C. Hoffman, BA
Physiatry Department, Hospital for Special Surgery


Richard J. Herzog, MD, FACR

Director, Spinal Imaging, Chief, Division of Teleradiology, Hospital for Special Surgery
Attending Radiologist, Hospital for Special Surgery
Professor of Radiology, Weill Cornell Medical College

Gregory E. Lutz, MD

Physiatrist-in-Chief Emeritus, Hospital for Special Surgery
Associate Attending Physiatrist, Hospital for Special Surgery
Associate Professor of Clinical Rehabilitation Medicine, New York-Presbyterian Hospital

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 L5S1 level, containing a focus of gas that was compressing the left L5 nerve root and communicating with the vacuum disc at L5S1. 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.

This article appears in HSS Journal: Volume 7, Number 1.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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