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 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).