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This report examines the rare phenomenon of spontaneous regression of a lumbar perineural cyst. Lumbar perineural cysts, typically associated with nerve root compression, are generally managed surgically. However, instances of nonsurgical resolution have been documented. A 54-year-old male presented with lower back and left leg pain, with magnetic resonance imaging (MRI) revealing a perineural cyst at the left L4–L5 level. Choosing conservative management, the patient experienced an unexpected and swift regression of the cyst, confirmed by follow-up MRI. This case illustrates the potential for conservative management in lumbar perineural cysts and underscores the importance of individualized patient care. It challenges the traditional surgical preference and advocates for flexible, patient-centered treatment approaches in spinal pathology. [ABSTRACT FROM AUTHOR]

Objective: To explore the safety and effectiveness of separation surgery in patients with neurological symptoms of spinal metastases., Methods: From January 2020 to December 2022, 14 patients with neurological symptoms of spinal metastases underwent separation surgery, including 7 males and 7 females, aged from 30 to 76 years old with an average of (61.57±12.16) years old. In comparison with eleven patients underwent conservative treatment during the same period, including 6 males and 5 femals, aged from 46 to 88 years old with an average of (66.55±12.32) years old. The changes in visual analogue scale (VAS), Frankel grades, Karnofsky scores, and quality of life score (QOL) before and after treatment were compared between two groups., Results: Fourteen patients in the separation surgery group underwent surgery successfully, with surgery time of (218.57±50.00) minutes and intraoperative blood loss of (864.29±332.97) ml, 2 patients developed delayed hematoma and recovered well finally after emergency surgery, the follow-up time was 3 to 36 months, after separation surgery, the pain was significantly relieved, and neurological function recovered well in the patients. Three months after treatment, the VAS in the separation surgery group (1.43±0.76) scores was significantly lower than that in the conservative treatment group (8.64±0.51) scores ( P <0.05);and the Frankel grades, Karnofsky scores, and QOL scores in the separation surgery group were significantly better than those in the conservative treatment group( P <0.05)., Conclusion: For patients with obvious neurological symptoms of spinal metastases, separation surgery not only can rapidly relieve nerve compression but also carry relatively low surgical risks, and improve the quality of life of patients.

Lumbar burst fractures account for 21% to 58% of all thoracolumbar fractures. L5 lumbar burst fractures are rare, comprising 1.2% of spinal burst fractures. This report discusses the optimal treatment for an adolescent with an L5 lumbar burst fracture and neurological symptoms caused by a high-fall injury, which involved surgical decompression and spinal fixation. Complete decompression and fixation of the L5 lumbar burst fracture, complicated by neurological symptoms, were achieved using arthroscopic-assisted uniportal spinal surgery (AUSS) combined with percutaneous pedicle screw fixation (PPSF). The AUSS approach, used alongside PPSF, significantly improved the vertebral canal occupation rate, increased the anterior edge height ratio of the damaged vertebra, and alleviated the lower back pain and nerve root symptoms postoperatively. AUSS combined with PPSF is a minimally invasive technique for treating lumbar burst fractures, effectively relieving compression of the vertebral canal and nerves caused by fracture fragments.