Sacral Cysts: When to Consider Surgery and Treatment Options

Sacral cyst?

Hello Doctor, I previously visited the hospital due to lower back pain and occasional leg numbness.
X-rays showed some degeneration in the sacral vertebrae, and an MRI revealed a cyst in the sacral canal measuring approximately 3x4 cm, which may be compressing the sacral vertebrae and the right-side nerve.
However, the symptoms are not very pronounced, and the doctor suggested monitoring it for now, as the standard surgical indication is over 1.5 cm.
Should I consider surgery for a cyst of this size? How often should I return for follow-up examinations? The doctor mentioned that if surgery is performed, it would involve draining the fluid inside, which has a higher recurrence rate.
There are other surgical options that involve completely removing the cyst and filling the space it occupied, which has a lower recurrence rate.
However, there is limited information available in Taiwan.
Are there any hospitals that specialize in this type of surgery? Additionally, should I avoid spinal manipulation that exerts pressure on the lower back due to the presence of the cyst?

Y, 30~39 year old female. Ask Date: 2023/02/06

Dr. Wang Zhaomin reply Rehabilitation

If a cyst is excessively large or continues to increase in size, surgical removal should be considered.
Regular follow-up is typically required every six months to a year.
For information regarding surgery, please consult a neurosurgeon.
Medical centers and hospitals of various levels across Taiwan should have the capability to manage related conditions.
Improper chiropractic practices may lead to tissue damage, and if there are lesions present, they should be avoided even more.

Reply Date: 2023/02/06

More Info

When it comes to sacral cysts, particularly those identified as sacral or spinal cysts, the decision to consider surgery largely depends on the size of the cyst, the symptoms it presents, and its potential impact on surrounding structures, such as nerves. In your case, you mentioned that the cyst measures approximately 3x4 cm and may be compressing the sacrum and the right-side nerve. While the general guideline suggests that surgical intervention is typically considered for cysts larger than 1.5 cm, the specific circumstances surrounding each case can vary significantly.

Understanding Sacral Cysts
Sacral cysts, often referred to as sacral or spinal cysts, can be classified into various types, including epidermoid cysts, dermoid cysts, and arachnoid cysts. These cysts can develop in the sacral region and may or may not cause symptoms. The symptoms can range from mild discomfort to significant pain, neurological deficits, or even bowel and bladder dysfunction, depending on the cyst's size and location.

When to Consider Surgery
1. Size and Symptoms: In your case, the cyst is relatively large (3x4 cm) and may be causing compression on the sacrum and adjacent nerves. If the cyst is symptomatic—causing pain, neurological symptoms like numbness or weakness, or affecting your quality of life—surgery may be warranted.
2. Progression: Regular follow-up is essential. If the cyst is stable and not causing significant symptoms, a conservative approach may be appropriate. However, if symptoms worsen or if there are signs of neurological compromise, surgical intervention should be reconsidered.

3. Surgical Options: The surgical options you mentioned are valid. Aspiration of the cyst can provide temporary relief, but the recurrence rate is high. More definitive surgical options involve excising the cyst completely, which can reduce the likelihood of recurrence. This approach is typically more effective but may involve a more extended recovery period.

Follow-Up and Monitoring
Regarding follow-up, it is generally recommended to have imaging studies, such as MRI, every 6 to 12 months, depending on the initial findings and the recommendation of your healthcare provider. This monitoring helps assess any changes in the size of the cyst or the emergence of new symptoms.

Avoiding Certain Activities
As for your question about avoiding spinal manipulation or chiropractic adjustments, it is advisable to be cautious. If the cyst is causing compression on the nerves or spinal structures, activities that involve significant pressure or manipulation of the lumbar region could potentially exacerbate symptoms or lead to further complications. It’s best to discuss any physical therapy or chiropractic treatments with your healthcare provider to ensure they are safe and appropriate for your condition.

Finding the Right Surgical Expertise
In Taiwan, several hospitals and medical centers specialize in spinal surgery and the management of spinal cysts. It would be beneficial to seek out a neurosurgeon or orthopedic surgeon with experience in treating sacral cysts. Hospitals affiliated with universities or specialized spinal centers often have the necessary expertise and resources to handle such cases effectively.

Conclusion
In summary, while your cyst is sizable and may warrant consideration for surgical intervention, the decision should be made based on a comprehensive evaluation of your symptoms, the cyst's behavior over time, and the potential risks and benefits of surgery. Regular follow-up with imaging and a cautious approach to physical activities will be crucial in managing your condition effectively. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

Similar Q&A

Understanding S2 Bilateral Cysts: Symptoms, Diagnosis, and Treatment Options

Hello Dr. Lai: The MRI examination revealed cysts on both sides of S2, and I am experiencing symptoms such as perineal pain, which worsens when sitting (around the labia and urethral opening), lower back pain, pain in the buttocks on both sides of the groin, and discomfort in the...

Dr. Lai Zhaokang reply Neurosurgery
Hello: 1. Cysts of the sacrum, predominantly affect females (85%). Most cases do not require surgery. Symptoms include pain in the corresponding lumbar, sacral, gluteal, and perineal regions, weakness, numbness, restlessness, and relief when lying flat or on the side. There may...

Managing Recurring Bartholin Gland Cysts: When to Consider Surgical Options

Last June, I underwent a Bartholin gland cystectomy, and my post-operative condition was good until a recurrence in April of this year. After the swelling occurred, my doctor used a syringe to aspirate the pus and prescribed medication. However, since the first recurrence, I have...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, you may need to undergo surgery again. Wishing you good health.

Understanding Bone Cysts in Children: Treatment Options Explained

Hello Dr. Lee, my daughter (3.3 years old) has been limping for the past two weeks. After X-rays and a CT scan, the doctor diagnosed her with a cyst in the femur, which occupies nearly half of the bone. The doctor suggested either observation, a needle aspiration with medication ...

Dr. Li Wenlin reply Orthopedics
Hello: In response to your question, based on your description, your daughter likely has a benign cyst in her femur, which could be a simple bone cyst or an aneurysmal bone cyst. Generally, if the area is not too large and does not invade more than half the thickness of the surro...

Understanding Subcutaneous Cysts: When to Consider Surgery?

Hello, I have a problem with a subcutaneous cyst and have seen doctors many times. However, each time the doctor prescribes medication to reduce the cyst, but it reoccurs after a few days. Since the cyst is located on my buttocks, it causes significant discomfort in my daily life...

Dr. Wu Yuxin reply Dermatology
Surgery. In the case of thick subcutaneous fat in the buttocks, it can indeed be difficult to locate after it is removed. Surgical clinics can also perform this procedure.