Coccyx Fractures and Tarlov Cysts: Symptoms and Treatment Options

Coccygeal fracture, 2 cm sacral cyst?

Hello, I fell while skiing in Korea on February 26, landing on my buttocks.
An X-ray taken in Korea indicated a fracture.
After returning home, I visited an orthopedic specialist who performed an MRI.
The MRI report stated: "Bone marrow edema-like signal is seen at the first segment of the coccyx.
Considering the recent buttock contusion, it could be a bone contusion or a non-displaced fracture.
There is no anterior cortical breakage.
A 0.62 x 0.52 cm fatty focus is noted at the left side of the L1 vertebral body, likely a focal fatty marrow or small hemangioma.
A 1.04 x 0.71 x 1.94 cm Tarlov cyst is seen on the right side at the S1/2 level." The orthopedic physician only informed me that there was a fracture in the coccyx and did not explain anything else.
After reviewing the report at home, I discovered the cyst.
I researched Tarlov cysts, which are sacral cysts that can severely affect bowel and bladder function, and that those larger than 1.5 cm may require surgical intervention.
However, mine is nearly 2 cm at 1.94 cm.
Currently, I feel an urge to defecate, but can only pass a small amount, and I have a history of internal hemorrhoids.
I am unsure if this is due to constipation, but I have noticed blood in my stool, and I feel more urgency with less ability to hold it than before.
After the injury, I occasionally felt contractions in my uterus and sometimes experience tingling in one leg.
I am concerned that the Tarlov cyst and the small hemangioma may affect my nerve pathways.
Q1: Will the Tarlov cyst and the small hemangioma resolve or shrink on their own?
Q2: Am I experiencing signs of neurological damage?
Q3: Is my current condition dangerous? Do I need immediate surgery?
Q4: If surgery is necessary, what does the procedure entail? Is it minimally invasive?
Q5: After surgery, is there a high chance of recurrence? Thank you!

Hui, 20~29 year old female. Ask Date: 2019/03/15

Dr. Lin Ruixiang reply Rehabilitation

Hello Ms.
Hui, regarding your questions, here are the answers:
Q1: No, it will not.

Q2: It does not count, but symptoms have already begun to appear.
Increased abdominal pressure during urination or defecation can indirectly increase the pressure within the spinal column, making compression symptoms more pronounced.
Additionally, the inhibitory pathways of the bladder are also compressed, leading to difficulties in holding urine.

Q3: Emergency surgery is not required.
There are three conditions that necessitate emergency surgery: unbearable pain, weakness in the limbs, and incontinence.
You do not meet any of these criteria.

Q4: Whether the surgery is minimally invasive will be determined by the surgeon.

Q5: A single cyst will not recur.

Reply Date: 2019/03/15

More Info

Coccyx fractures and Tarlov cysts are two distinct conditions that can occur in the lower spine area, and understanding their symptoms and treatment options is crucial for effective management.
Coccyx Fractures:
A coccyx fracture, commonly known as a tailbone fracture, typically results from a fall onto the buttocks, as you experienced while skiing. Symptoms of a coccyx fracture can include localized pain at the base of the spine, tenderness, and discomfort during sitting or standing. The pain may worsen with activities such as sitting for prolonged periods, rising from a seated position, or during bowel movements.
In your case, the MRI report indicates bone marrow edema, which suggests inflammation or injury to the bone, consistent with either a contusion or a non-displaced fracture. The absence of an anterior cortical breakage is a positive sign, indicating that the fracture may not be severe. Treatment for coccyx fractures typically involves conservative measures such as pain management with NSAIDs, using a cushion while sitting, and physical therapy to strengthen surrounding muscles. Most coccyx fractures heal on their own over time, usually within a few weeks to months.

Tarlov Cysts:
Tarlov cysts are fluid-filled sacs that can develop on the nerve roots of the spine, often at the sacral level. Your MRI report indicates a Tarlov cyst measuring 1.04 x 0.71 x 1.94 cm at the S1/S2 level. While many Tarlov cysts are asymptomatic, they can cause issues if they compress nearby nerves, leading to symptoms such as pain, numbness, or dysfunction in bowel and bladder control.
Regarding your specific questions:
1. Do Tarlov cysts and small hemangiomas disappear or shrink on their own?
- Tarlov cysts can sometimes remain stable or even shrink over time, but they do not typically resolve completely without intervention. Small hemangiomas, which are benign vascular tumors, may also remain stable and often do not require treatment unless symptomatic.

2. Are you experiencing neurological damage?
- The symptoms you describe, such as changes in bowel habits, urgency in urination, and numbness, could suggest some degree of nerve involvement. It is essential to monitor these symptoms closely, as they may indicate that the cyst is affecting nerve function.

3. Is your condition dangerous, and do you need surgery?
- While your symptoms warrant further evaluation, surgery is generally considered when there is significant neurological compromise or persistent symptoms that do not respond to conservative treatment. Given that your Tarlov cyst is close to the threshold for surgical intervention, it is crucial to discuss your symptoms with a neurosurgeon or orthopedic spine specialist.

4. What does the surgery entail, and can it be minimally invasive?
- Surgical options for Tarlov cysts may include cyst excision or decompression of the affected nerve root. Some procedures can be performed using minimally invasive techniques, which involve smaller incisions and potentially quicker recovery times.

5. What is the recurrence rate after surgery?
- The recurrence rate of Tarlov cysts after surgical intervention can vary. Some studies suggest that while many patients experience relief from symptoms, there is a possibility of recurrence, particularly if the cysts are not completely excised.

In conclusion, it is vital to follow up with a specialist who can evaluate your symptoms in the context of your MRI findings. They can provide a tailored treatment plan based on the severity of your symptoms and the potential impact of the Tarlov cyst on your neurological function. Early intervention can help prevent further complications and improve your quality of life.

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