Fig. 1

Preoperative imaging findings of the patient. The red arrows highlight the gas-containing cyst, whereas the green arrows indicate the “vacuum phenomenon” within the intervertebral disc. (A, B) Preoperative flexion and extension X-rays. (C, D) Preoperative sagittal CT images reveal intraspinal and foraminal cysts, demonstrating their close proximity to the intervertebral disc while maintaining a considerable distance from the osseous structures of the facet joint. (E) Preoperative coronal CT imaging illustrates the extension of the gas-containing cyst from the spinal canal into both intra- and extraforaminal regions. (F) Preoperative axial CT images reveal that the intraspinal and foraminal cysts are not entirely interconnected. (G) Axial T2-weighted MRI. (H) Sagittal T1-weighted MRI. (I) Sagittal T2-weighted MRI. (J) Sagittal fat-suppressed T2-weighted MRI