This 61-year-old man presented with 2-year history of increasing lumbosacral pain and hypesthesia. On neurologic exam, he showed right L5 and S1 radiculopathy. His symptoms were aggravated by standing, walking, climbing, coughing and lifting, and relieved by sitting. The patient rated his pain 7 of 10 on the visual analogue score (VAS). He had bladder dysfunction and abnormal sensation for urination, and reported insertion of a Foley catheter 2 months ago. Preoperative MR imaging demonstrated 30×17×11 mm sized sacral cyst with another small cyst from L5 to S2 level (). 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 (). An L5 laminectomy and S1-3 en bloc laminectomy were performed. After careful dissection of the cyst wall, we observed the superior surface of the cyst compressing S1 nerve root ventromedially and S2 nerve root dorsally (). It was connected with a small cyst that was adhesive to right S2 and S3 nerve roots. The main cyst originated from inferomedial side of right L5 nerve root. The cyst was opened and its content appeared the same as the CSF content. We ligated the neck of the cyst and its wall was cut down away from the adjoining root sleeve. The sacral lamina was recapped at the back again with using heavy silk sutures (). His lumbosacral pain and radiculopathy improved progressively after surgery. Postoperative two weeks, he removed the Foley catheter. Follow up MR imaging after 6 months demonstrated complete resolution of the cyst (). At one year follow up, he had mild back pain (2 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 ().