Virginia Via Research Day Book 2026

Medical Student Research Case Reports

21 ATYPICAL TRANSITION FROM L4–L5 PATHOLOGY TO L5–S1 DISCAL CYST FORMATION IN A COLLEGIATE BASEBALL PLAYER

Dominic Riccione, OMS-I; Mark Rogers, DO; Andrew Krueger, DO Corresponding author: driccione@vcom.edu

VCOM-Virginia, Blacksburg, VA

reintroducing baseball-specific drills and without any specific injury, he developed recurrent and progressively worsening right-sided radicular pain radiating into the glute, hamstring, and calf, particularly with lumbar flexion and rotation. Re-examination demonstrated positive slump testing, straight leg raise pain at low angles, positive Braggard's maneuver, restricted lumbar motion, and right sacroiliac tenderness, with neurologic strength and sensation intact. A repeat MRI, obtained four months after the initial study, showed a dramatic interval change: a large right subarticular L5–S1 discal cyst extending caudally and substantially displacing the S1 nerve root, while the previous L4–L5 findings remained unchanged. Transforaminal S1 epidural steroid injection and an attempted cyst aspiration were performed. However, aspiration could not be completed due to the cysts proximity to the traversing S1 nerve and reproduction of paresthesias. Symptoms did not improve with injection. Given persistent S1 radiculopathy and significant neural displacement, the patient underwent right L5–S1 hemilaminotomy with decompression and discal cyst excision. Postoperative follow-up demonstrated improvement in radicular severity with expected recovery.

Context: Lumbar discal cysts are rare extradural cystic lesions that communicate with the intervertebral disc, typically arising slowly from disc degeneration or annular injury and most often reported in young adult males. Their development is seldom documented in real time, and the rate of cyst formation remains unclear in the literature. This case describes a uniquely rapid progression from a mild L5–S1 disc bulge to a large, symptomatic discal cyst within four months in a collegiate baseball player. Report of Case: An 18-year-old male collegiate baseball player presented with chronic low back pain and intermittent bilateral sciatica following a twisting injury. Examination demonstrated an antalgic gait, paraspinal tenderness, discomfort-limited lumbar range of motion, and intact strength and sensation. Initial MRI revealed a mild L4–L5 disc protrusion with mild canal and foraminal stenosis and a mild L5–S1 disc bulge without stenosis. His symptoms initially aligned with the L4–L5 findings, and he was treated conservatively with NSAIDs and physical therapy while continuing baseball participation. Over the following months, his symptoms improved with rehabilitation, and he completed summer baseball without complications. In the fall, after

Diagnosis: Right L5–S1 discal cyst with associated S1 radiculopathy, confirmed by MRI and intraoperative findings. Comments: The literature reports lumbar discal cysts as rare lesions that arise at the same vertebral level as underlying disc degeneration, often presenting with radiculopathy. Reported cases involve gradual symptom onset and do not demonstrate changes in symptomatic level. Although few studies reference approximate intervals of cyst development or spontaneous regression, these descriptions lack precise imaging correlation or defined timelines. In contrast, this case provides a well-documented four-month progression from a mild L5–S1 disc bulge to a large, nerve-displacing discal cyst, accompanied by an uncommon transition in symptomatic level from initial L4–L5 findings to later L5–S1 pathology. This combination of rapid cystogenesis and atypical level change has not been documented in prior literature and highlights the importance of repeat imaging in athletes with recurring or evolving radicular symptoms.

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58 Edward Via College of Osteopathic Medicine (VCOM)