This 60-year-old female patient visited our department with 6-year history of increasing lumbosacral pain and right leg radiculopathy. On neurologic examination, she complained right L5 and S1 radiculopathy. The patient rated her pain 9 of 10 on the VAS. She did not have bladder dysfunction. Preoperative MR imaging demonstrated 15×17×22 mm sized sacral cyst with S1 nerve root (). Myelogram and CT showed the contrast-filled bridge between the thecal sac and the cystic mass, and sacral cyst causing compression of adjacent nerve roots (). After careful dissection of the cyst wall, we observed the superior surface of the cyst. The main cyst originated from inferomedial side of right L5 nerve root. We performed surgery the same way but we used miniplate instead of silk for recapping (). The symptoms improved progressively after surgery. MR imaging 4 months later demonstrated complete resolution of the cyst (). At one year follow up, she had only mild back pain (3 of 10 on the VAS).
This 21-year-old man complained of worsening radiating pain and hypesthesia on left leg for 1 year. His motor weakness was grade 4 on left leg, especially when extending the left ankle. Because of worsening symptoms he eventually visited our department. He had mild claudication, positive on left straight leg raising test at 45 degree. We confirmed a mild left S1 radiculopathy on electromyography. He had no neurologic deficit associated with cauda equina syndrome. Preoperative MR imaging showed a 20×13×14 mm sized sacral cyst (). We performed myelogram and CT and found the contrast-filled stalk between the thecal sac and the cyst. The cyst compressed a contiguous structure including nerve roots ().\nWe performed surgery the same as patient 1 () and symptoms disappeared after one week. Follow up MR imaging after 2 months demonstrated complete resolution of the lesion. We checked with MR imaging after 1 year and ascertained that there was no further cystic formation and complication ().