Sacral cyst?
Hello Doctor: I accidentally had pressure applied to my sacral vertebra, which resulted in a slight numbness in my labia (but there is no pain at all).
Later, I consulted an orthopedic doctor who mentioned spinal stenosis and attempted to perform a lumbar traction, but I experienced pain when my pelvis was pulled, so the procedure was stopped.
On the third day, I developed a strong feeling of heaviness and downward pressure in my lower body.
I then sought acupuncture treatment, which led to sensations of crawling and neurological symptoms (perineal pain, sciatica, inability to sit or stand, and pain in the groin area, making it difficult to do anything but lie down).
I have researched extensively but only found information from China, and I noticed that my symptoms are similar to those of a sacral cyst.
An MRI showed cysts on both sides of S2, and a neurologist indicated there is compression and recommended I see a neurosurgeon.
However, several neurosurgeons I consulted said it is not affecting me.
I have been receiving glucose and PRP treatments for six months with no improvement, so I would like to ask for your advice on how to proceed.
I feel really helpless and am in pain every day.
Could you please provide some guidance or recommend a neurosurgeon specializing in this area? I sincerely appreciate your help.
Thank you.
Ann, 30~39 year old female. Ask Date: 2024/02/18
Dr. Zhang Junwei reply Neurosurgery
Most spinal cysts do not have an impact; I can only suggest that you consult a neurosurgeon at a medical center for further evaluation.
Reply Date: 2024/02/18
More Info
Understanding sacral cysts, particularly in the context of your symptoms and MRI findings, requires a comprehensive approach that encompasses the nature of the cysts, their potential impact on surrounding structures, and the appropriate treatment options available.
What are Sacral Cysts?
Sacral cysts, often referred to as sacral or spinal cysts, can be classified into several types, including arachnoid cysts, dermoid cysts, and synovial cysts. These cysts are fluid-filled sacs that can develop in the sacral region of the spine. They may be congenital (present at birth) or acquired due to trauma, degeneration, or other pathological processes.
Symptoms
The symptoms associated with sacral cysts can vary significantly depending on their size, location, and whether they are exerting pressure on nearby nerves or structures. Common symptoms include:
- Numbness or tingling in the lower extremities, which you have described as a "微麻" sensation in the labia.
- Pain in the lower back, buttocks, or legs, which can manifest as sciatica or pelvic pain.
- Weakness in the legs or difficulty with mobility.
- Heavy or dragging sensations in the lower body, which you have experienced as a "下墜沈重感."
- Changes in bowel or bladder function, although this may not be present in all cases.
Diagnosis
The diagnosis of sacral cysts typically involves imaging studies, with MRI being the gold standard. An MRI can provide detailed images of the cysts and their relationship to surrounding structures, including the spinal cord and nerve roots. In your case, the MRI has indicated the presence of cysts at the S2 level, which may be contributing to your symptoms.
Treatment Options
The management of sacral cysts largely depends on the symptoms they produce and their impact on neurological function. Here are some potential treatment options:
1. Observation: If the cysts are small and not causing significant symptoms, a "watchful waiting" approach may be appropriate. Regular follow-up with MRI scans can help monitor any changes.
2. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the pelvis and lower back, potentially alleviating some discomfort and improving function.
3. Medications: Pain management may involve non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesics to help control pain and inflammation.
4. Injections: Corticosteroid injections may be considered to reduce inflammation and provide temporary relief from pain.
5. Surgical Intervention: If the cysts are large, symptomatic, or causing significant neurological deficits, surgical options may be warranted. This could involve cyst excision or decompression to relieve pressure on the spinal cord or nerve roots.
Next Steps
Given your ongoing symptoms and the lack of improvement despite conservative treatments such as glucose and PRP injections, it may be beneficial to seek a second opinion from a neurosurgeon who specializes in spinal disorders. They can provide a more detailed assessment of your MRI findings and discuss the potential benefits and risks of surgical intervention.
Conclusion
Living with the symptoms you described can be challenging, and it’s important to have a clear treatment plan. Make sure to communicate openly with your healthcare providers about your symptoms and concerns. They can guide you through the process of managing your condition effectively. If you feel that your current treatment team is not addressing your concerns adequately, do not hesitate to seek out specialists who can provide the care you need.
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