Spinal Cysts

1. Synovial cysts are fluid-filled sacs that commonly develop in the lower back, specifically in the lumbar spine around the facet joints. They form from the lining of a spinal joint and are filled with synovial fluid, which is the lubricating fluid normally found in joints. These cysts can cause lower back pain and other symptoms if they impinge on nearby nerves.
2. Arachnoid cysts are fluid-filled sacs that develop in one of the layers covering the brain and spinal cord called the arachnoid layer. These cysts are filled with the same fluid that surrounds the brain and spinal cord, known as cerebrospinal fluid (CSF). They can form in different parts of the spine and can sometimes cause symptoms depending on their size and location.
3. Dermoid and epidermoid cysts are rare types of cysts that are present from birth. They form from skin cells and other tissues that get trapped during a baby’s development in the womb. These cysts can grow slowly over time and may cause symptoms if they press on nearby structures.
4. Tarlov cysts are fluid-filled sacs that form around the dura, or nerve coverings, most commonly at the base of the spine in an area called the sacral region. These cysts develop from outpouchings of the dura, which is the protective covering around the nerve roots. They are mostly found incidentally and do not cause symptoms, but can rarely cause pain or other symptoms if they put pressure on the nerves. Most commonly, Tarlov cysts should be observed without treatment. Resection surgery is controversial and can lead to complications such as infection or persistent spinal fluid leak.
5. Perineural cysts form from the coverings of the nerve roots, typically as they exit the spine. These cysts may require drainage or resection of they cause neurologic symptoms, but in most cases, they can be monitored without treatment.

The symptoms of spinal cysts can vary depending on the type of cyst, their size, location, and the pressure they exert on surrounding nerves and tissues. Common symptoms include:

• Pain: Localized pain at the cyst site, which can radiate to other areas such as the legs or arms.
• Numbness or Tingling: Often in the extremities, corresponding to the nerve roots affected.
• Weakness: Muscle weakness or atrophy in severe cases where nerves are significantly compressed.
• Difficulty Walking: Unsteadiness or changes in gait due to nerve compression or pain.
• Bladder or Bowel Dysfunction: In rare and severe cases, cysts can affect bladder or bowel control if they compress the spinal cord or nerves in the lower back.

The cause can vary depending on the type of cyst. They can be caused by:

• Degenerative change, aging and wear and tear on the spine can lead to the formation of synovial cysts.
• Some cysts, like Tarlov and arachnoid cysts, can be congenital, present from birth due to developmental anomalies.
• Previous spinal injuries or surgeries can lead to the formation of cysts.
• Chronic inflammatory conditions affecting the spine may contribute to cyst formation.

Diagnosing spinal cysts involves a combination of clinical evaluation and imaging studies. Dr. Colman will review your medical history, assess your symptoms, and perform a physical examination to check for neurological deficits, problems that occur when there is damage to the nervous system including the brain, spinal cord and nerves.  He will also order imaging tests including an MRI to visualize the cyst and assess the size, location and impact on the surrounding tissues; a CT scan for detailed images of the bones to diagnose certain types of cysts; and myelography, an imaging test that involves injecting contrast dye to enhance X-ray and CT images of the spinal cord and nerve roots.

Treatment for spinal cysts depends on the type, size, location, and severity of symptoms:

1. Observation: Small, asymptomatic cysts may only require regular monitoring.
2. Symptom management: Pain relievers, anti-inflammatory drugs, and muscle relaxants can help manage symptoms.
3. Physical Therapy: Exercises and therapies to strengthen the muscles around the spine and improve flexibility.
4. Injections: Corticosteroid injections can reduce inflammation and pain.
5. Aspiration: Draining the cyst using a needle under imaging guidance, though this may be temporary as cysts can refill.
6. Surgery: Indicated for larger cysts causing significant symptoms. Surgical options include cyst removal, decompression of affected nerves, and sometimes spinal fusion if instability is present.

Each patient’s treatment plan is individualized, considering the specific characteristics of the cyst and the patient’s overall health and preferences. Contact Dr. Matthew Colman at Northwestern Medicine in Chicago, Illinois. He specializes in degenerative spine conditions, spine trauma, spinal deformities, and spine oncology. His patients find him to be a kind, caring, and thorough surgeon, who has a wonderful bedside manner, and is knowledgeable and trustworthy. They note that he takes time to listen to his patients, explains conditions well, and answers their questions.