Cyst of spine - types, features of symptoms and treatment

Cyst of the spine - a cavern filled with any contents (hemorrhagic, liquor, etc.), located in the spine. Quite a rare pathology among all diseases of the spine and can be located in any of its departments (from cervical to sacral).

The cyst of the spine can have an asymptomatic course and be diagnosed accidentally, and may manifest as chronic pain that is not stopped by taking analgesics.

By origin of the cyst of the spine it is possible: 

• congenital, 
• acquired.

Depending on the morphological features (the structure of the wall), the cyst of the spine can be: 

• the true (epithelial lining is present inside the tumor), 
• false (epithelial lining absent).

The size, location and shape of the cyst of the spine are varied, depending on the causative factors.

[1], [2]

Causes of a cyst of the spine

Causes of the cyst of the spine are manifold. 

1. For congenital cysts of the spine - the development of tissue in the fetus. 
2. For acquired tumors:
   • degenerative-inflammatory processes of the spinal tissues, 
   • spinal trauma (bruises, fractures), 
   • Excessive, heavy loads on the spine and their uneven distribution (features of professional activity - some sports, loaders, builders), 
   • sedentary lifestyle for a long time, which leads to dystrophic changes in the tissues of the spine, 
   • hemorrhage in the tissues of the spine, 
   • parasitic damage to the body (eg, echinococcus).

[3], [4], [5], [6],

Symptoms of the cyst of the spine

Symptoms of the cyst of the spine depend on the causes of its causes, on its size and location. Tumors of small size usually do not manifest themselves at all and are detected accidentally during examination for other diseases. In the case of disease progression, the neoplasm begins to increase in volume and exert pressure on the spinal roots. And as a consequence: 

• There are neurological disorders of varying severity. 
• There is pain located in the area of the tumor projection. Possible irradiation of pain in the buttocks, lower extremities and other parts of the body. 
• Pain in the spine is felt both at rest and during movements.
• Possible headache and dizziness, noise in the ears, which is typical for arachnoid cysts of the spinal cord. 
• There are violations of sensitivity (sensation of creeps, tingling, numbness in the hands and / or feet, fingers). 
• The bowel and bladder function may be impaired, with the lesion of the corresponding spinal roots. 
• With the progression of the disease, muscle weakness in the lower extremities appears, which makes lameness possible. It becomes difficult to stay in the sitting position for a long time. 
• Parezy of hands or feet. 
• Disorders of the vestibular apparatus (change in gait).

Perineural cyst of the spine

According to statistics, the perineural cyst of the spine is found in 7% of cases. Often is congenital due to disruption of development in the embryonic period - there is a protrusion of the spinal cord into the lumen of the spinal canal. If this is a small protrusion, then it does not appear clinically. And if the protrusion of a large size, then the compression of the spinal nerves occurs. And then the clinical symptomatology of the perineural cyst appears in early childhood or in young periods: 

• Pain arising during movements, prolonged sitting position and localized in the projection site of the cyst in the spine. By intensity, pain can be severe or weak. 
• As the tumor grows, there may be signs of compression of the spinal nerves depending on the level of the lesion - a malfunction of the urination, intestines (constipation), a sensation of crawling and tingling in the lower extremities.
• There may be weakness in the lower extremities.

Often the perineural cyst of the spine is formed in its lower parts. If the perineural cystic formation is acquired, it results from: 

• Injury of the spine. 
• Increased cerebrospinal pressure due to a violation of normal outflow of cerebrospinal fluid.

The perineural cyst of the spine, as a rule, is filled with cerebrospinal fluid.

Cyst of the cervical spine

The cyst of the cervical spine may not clinically appear, in the case when it is small. In the case of its large size, the following clinical signs can be noted: 

• pain in the cervical spine of varying intensity. Occurs and intensifies when moving, 
• irradiating pain in the upper limbs, 
• tension of neck muscles, 
• headache, 
• dizziness (non-systemic - sensation that the person himself is spinning or systemic - feeling that objects are spinning), 
• lability of blood pressure (then high, then low), 
• a feeling of numbness and tingling in the fingers.

[7], [8], [9], [10], [11], [12], [13], [14], [15]

Cyst in the thoracic spine

The cyst in the thoracic spine in case of its large size can manifest itself with a variety of symptoms. The sympathetic nervous system of the thoracic spine is closely related to the internal organs of the chest (heart, bronchopulmonary system, esophagus) and abdominal cavity (stomach, gallbladder, liver intestine).

Clinical symptoms of the cyst of the thoracic spine are as follows: 

• pain in the thoracic spine, arising during movements and with prolonged sitting position, 
• tension of the muscles of the back and intercostal muscles, 
• may occur both true and simulating chest pain and / or abdominal swelling due to compression of spinal nerves appropriate (e.g., Vertebrogenous psevdokoronarnaya pain simulation of clinical symptoms of angina or hernia, located in epigastrium, etc.) 
• there may be pain in the circumference, intercostal neuropathies, pain in the sternum, 
• when the upper thoracic spine is affected, there may be a violation of swallowing (dysphagia), regurgitation, 
• possible heartburn, nausea and other dyspeptic disorders, 
• restriction of movements due to pain.

[16], [17], [18], [19], [20], [21],

Cyst of the lumbar and lumbosacral (sacral) spine

Cyst of the lumbar and lumbosacral (sacral) department of the spine with small dimensions is asymptomatic and is detected accidentally. With its large size, vertebral symptomatology and functional neurological disorders are noted, as a result of compression of the spinal roots. Clinical manifestations can be diverse: 

• pain in the lumbar and sacral (sacral) departments (acute or blunt), 
• possibly, the appearance of dull and aching pain in the lumbar region and in the deep tissues of the joints of the lower limbs, 
• possible acute and shooting pain in the lumbar region irradiating in one or both legs up to the fingers, 
• a sensitivity disorder - there may be numbness and a sensation of crawling in the groin, lower limbs and toes, 
• disorder of the functions of the pelvic organs - urination, intestines, 
• change in the tone of the muscles of the spine, lower limbs, 
• decreased mobility of the spinal column.

[22], [23], [24], [25], [26], [27], [28]

Arachnoid cyst of the spine

The arachnoid cyst of the spine (cyst of Tarlova) is a cavity, the walls of which are formed by the arachnoid (spider web) of the spinal cord. This tumor is formed mainly in the lumbosacral spine. The content of the arachnoid cyst is represented by cerebrospinal fluid. This neoplasm is a kind of perineural cyst of the spine. In most cases, it is an innate pathology with asymptomatic course, it is detected accidentally. The arachnoid cyst of the spine larger than 1.5 centimeters begins to be compressed on the spinal roots and spinal cord, this is manifested by a certain clinical symptomatology: 

• pain in the spine at the location of the tumor, arising after the load, 
• with the localization of neoplasm in the cervical region are possible - headache, dizziness, lability of blood pressure, 
• with the localization of the arachnoid cyst in the lumbosacral section - the functions of the pelvic organs are broken - upset urination, intestines, potency is broken, 
• disorders of sensitivity and motor function of the upper or lower extremities (everything depends on the level of the cyst of the spine) - numbness, chills, tingling, weakness, paresis.

[29], [30], [31], [32], [33], [34]

Periarticular cyst of the spine

Periarticular cyst of the spine is formed in the region of the intervertebral (facet) joints. Often is acquired, due to injuries or degenerative disorders. The periarticular tumor leaves the intervertebral articular cavity and loses its connection with it. Periarticular cyst of the spine is found in 0.1-1% of cases of radicular pain syndrome. The periarticular cyst is divided depending on the absence or presence of synovial epithelium on: 

• ganglionic, 
• synovial.

Synovial cyst spine part bursa intervertebral joint that is separated from the main due to injury, degenerative-inflammatory processes, excessive physical exertion or formed due to congenital abnormalities bursa. The cavity of the synovial cyst has a synovial lining and is filled with liquid contents, which is produced by the structures of the synovial lining. More often the synovial cyst is formed in those parts of the spine that account for a significant load - cervical and lumbar.

Ganglionic cyst (nodular) during its formation loses contact with the articular cavity and therefore it lacks synovial lining.

Small periarticular cysts are not manifested and cease to grow after the cessation of the causative factor. At large sizes, the clinical symptomatology is diverse: 

• local pain in the lumbar region or neck can be noted (it all depends on the level of cysts finding), 
• radicular pain syndromes, 
• a disorder of sensitivity and motor activity, 
• Compression radiculopathy with this neoplasm can be very pronounced (sharp, shooting pains).

Likvornaya cyst of the spine

Likvornaya cyst of the spine is a cavity filled with cerebrospinal fluid (CSF), which circulates in the subarachnoid (arachnoid) space of the spinal cord. Likvornaya cyst of the spine may be arachnoid or perineural - arachnoid and perineural cyst. Clinical manifestations of cerebrospinal fluid cysts depend on the level of its location in the spine - pain in the spine at the site of the projection of the tumor, irradiation of pain in the upper and / or lower limbs, impaired sensitivity and motor activity, impaired functions of internal organs.

Aneurysmal cyst of the spine

Aneurysmal cyst of the spine is a cavity formed inside the bone, due to its expansion and filled with venous blood. This is a serious enough pathology that relates to tumor-like diseases and leads to pronounced bone fractures and fractures. It is observed more often in childhood, mainly in girls. The cause of an aneurysmal spine cyst is usually a trauma. The clinical symptoms of this tumor are as follows: 

• pain in the area of finding a neoplasm, increase as the cyst increases, 
• can be noted pathological fractures, 
• local increase in temperature and swelling (at the site of projection of the lesion), 
• enlarged veins, 
• possible contractures in the proximity of the located joint, 
• symptoms of lesions of the spinal roots, depending on the level of tumor localization.

[35], [36], [37], [38], [39], [40]

Diagnosis of the cyst of the spine

Diagnosis of the cyst of the spine is performed by a neurosurgeon and is based on a comprehensive examination. 

1. Complaints are taken into account. 
2. There is an anamnesis (history) of the disease (the causes of the disease are explained in detail). 
3. General examination, examination of the spine, palpation - assessment of the severity of the process, the severity and localization of pain, sensitivity disorders and motor activity, etc. 
4. Appointed additional survey methods: 
   • roentgenography of the spine in several projections, 
   • magnetic resonance or computed tomography of the spine, 
   • ultrasound examination of the spine, 
   • myelography - X-ray diffraction study of the conducting pathways of the spinal cord - inject contrast material into the spinal canal, make an X-ray and thus determine its patency, which can be disrupted due to the tumor. 
   • appointment of electromyography to assess the condition of the spinal roots. 
5. General clinical methods of investigation - general analysis of urine and blood, biochemical blood test.

[41], [42], [43],

Treatment of the cyst of the spine

Treatment of the cyst of the spine is complex, aimed at alleviating the condition and preventing possible serious complications. Treatment of the cyst of the spine can be conservative and surgical. Conservative treatment is performed at small sizes, in the absence of severe pain syndrome and disorders of internal organs.

Conservative therapy of cysts of the spine includes: 

1. Bed rest. 
2. A balanced diet with enough vitamins, protein, micro- and macro elements (especially calcium and phosphorus). 
3. The introduction of analgesics and anti-inflammatory drugs (NSAIDs - diclobberl; analgesics - baralgin, analgin). 
4. The appointment of B vitamins (improve metabolic processes in the cell) and vitamin C (strengthens blood vessels and increases immunity). 
5. The introduction of funds to improve microcirculation - pentoxifylline. 
6. Use of drugs that reduce degenerative - dystrophic processes in bone-cartilage tissue (Arthrofon, Don, Structum). 
7. Perhaps the appointment of therapeutic blockade - the introduction of painkillers (novocaine, lidocaine) in the place where the most pain is expressed, the so-called trigger points (most often an epidural blockade with the introduction of an analgesic in the epidural space of the spine). Possible blockade with the combined use of novocaine and a corticosteroid drug (Cortizone, Diprospan). 
8. physiotherapy methods: 
   • Phonophoresis (use of ultrasound) - improves and speeds up healing processes, has anti-inflammatory and analgesic effect, reduces swelling. 
   • Therapeutic massage (strengthens the back muscles and promotes stabilization of the spine) is performed exclusively by a specialist, after an acute period. 
   • Reflexotherapy (acupuncture, electroacupuncture, laser therapy). 
   • Therapeutic gymnastics begins with minimal stress and under the strict supervision of a doctor. It is carried out after the removal of acute pain. 
   • It is recommended to wear corsets, half-corsets, bandages, elastic belts, recliners. With their help, treatment and prevention of low back pain are carried out. They limit the amount of movement, reduce pain and muscle spasm.

Treatment of the perineural cyst of the spine

Treatment of the perineural cyst of the spine is determined by its size. If the size is more than 1.5 centimeters, then surgical treatment is performed. The tumor is opened, sucked up its contents and injected into the cavity of the neoplasm with a special fibrin substance with the purpose of fusing the walls of the neoplasm and preventing the formation of new tumors.

At its small sizes (less than 1,5 sm) conservative treatment is usually spent: 

• bed rest, 
• nonsteroidal anti-inflammatory (dicloberl, movalis, diclofenac),
• Analgesics - analgin, baralgin, 
• if necessary, prescribe muscle relaxants, to reduce muscle tension and spasm - midolgism, 
• vasoactive drugs, to improve blood circulation and metabolic processes - nicotinic acid, pentoxifylline, 
• vitamins of group B (improve metabolic processes in the cell and neuromuscular conduction) and C (antioxidant and improves vascular tone), 
• drugs that reduce degenerative-dystrophic processes (Arthrofon, Structum, Don),
• Physiotherapeutic methods described above in general treatment.

Treatment of the periarticular cyst of the spine

Treatment of the periarticular cyst of the spine can be conservative and operative. Conservative treatment of periarticular cyst is the same as all others - described above. But in addition are used also: 

• introduction into the epidural space of corticosteroids (hydrocortisone), 
• the introduction into trigger points of anesthetics, 
• Novocaine blockades.

Indications for surgical therapy periarticular cyst are as follows: 

• Absolute - paresis of the feet due to compression of the spinal roots of the lumbosacral spine, disorders of the pelvic organs, including sensitivity, 
• Relative - not coped strong pain syndrome against conservative therapy for a month, as well as progressive deterioration of motor functions.

Surgical therapy of the periarticular cyst is most effective, in which complete excision of the tumor along with its walls is carried out. Relapses occur rarely after such an operation.

Treatment of an aneurysmal cyst of the spine

Treatment of an aneurysmal cyst of the spine in the case of its small dimensions conservative, including bed rest, the appointment of non-steroidal anti-inflammatory drugs (diclofenac), vasoactive drugs (pentoxifylline), vitamins B and C, it is recommended to wear corsets, belts or fixative bandages. But very often you have to resort to its rapid removal. Often used puncture technique, which consists in the introduction into the cavern of hormonal agents (prednisolone, hydrocortisone). The radical method of therapy is also used - removal of the damaged vertebral site, but this operation is very difficult, it can be complicated by heavy bleeding. Sometimes this operation has to be replaced by aspiration of the contents of the tumor and injected into the cavity calcitonin to prevent relapse. If there are contraindications to the operation, then often use radiation therapy.

Removal of the cyst of the spine

Surgical removal of the cyst of the spine is performed in order to eliminate compression of the spinal roots and spinal cord, improve blood circulation, restore impaired sensitivity and motor activity, as well as impaired functions of internal organs. And as a consequence, prevent disability and restore to maximum capacity for work.

As a rule, large tumors are removed. The volume and type of surgical intervention is determined by the neurosurgeon, after the diagnosis. Usually the tumor is removed by the puncture method or is excised completely with all its walls.

During the operation, microsurgical and endoscopic instruments under X-ray or tomographic control are used to reduce invasiveness and postoperative complications.

Treatment of the cyst of the spine by alternative means

Treatment of the cyst of the spine by alternative means should be done, after consulting with a doctor, if the tumor is small and does not threaten the loss of ability to work and life. 

1. Treatment of cysts of the spine with the juice of burdock. The burdock leaves are washed and crushed, get juice and insist it for four to five days (do not wait until it starts to wander). Use two tablespoons several times a day before meals. The course of therapy is two months. 
2. Use of infusion is elecampane. Prepare the infusion in this way - dry grass elecampane (forty grams) mixed with yeast pre-cooked (one tablespoon of dry yeast, filled with three liters of warm water). You need to insist for two days. Use infusion two times a day for 21 days. 
3. Tincture of leaves and acacia flowers. Sheets and flowers of acacia (four tablespoons each) are filled with 0.5 liters of vodka. Insist for a week. Use infusion several times a day for half an hour before eating one teaspoon. The course of therapy is two months. 
4. A collection of various herbs is used. The root of sorrel and burdock, nettle, oregano, green walnut leaves, turns and spores are well crushed and stirred (the ratio of parts is equal). Then add immortelle (three tablespoons), valerian herb (one tablespoon) and St. John's wort (three tablespoons). Stir thoroughly, take two tablespoons of the collection and pour 0.5 liters of boiling water, insist for ten hours. Eat one tablespoon three to four times a day before eating. The course of therapy is one month.

Prophylaxis of the cyst of the spine

Prophylaxis of the cyst of the spine is nonspecific and consists in the following.

1. Proper nutrition with a sufficient content of micro- and macroelements (especially calcium and phosphorus), protein, vitamins. 
2. Avoid injuries and bruises (do not engage in traumatic sports, do not participate in fights). 
3. Exclude heavy physical activity, lifting weights. Distribute the load evenly throughout the body. 
4. To go in for sports - swimming, walking, medical gymnastics. 
5. Control weight, because Overweight increases the burden on the spine. 
6. Eliminate bad habits - smoking, alcohol. 
7. Regularly monitor for the presence of parasites in the body. 
8. Annually go for a prophylactic examination of the whole body.

Prognosis of the cyst of the spine

The prognosis of the cyst of the spine with its small size and clinically not showing itself is favorable for both life and work. With large spine cysts and untimely treatment, the prognosis for work is unfavorable. Because this pathology can lead to disability, as it disrupts the functions of many organs and systems. In addition, tumors can recur, even after surgical treatment. Therefore, it is important to monitor your health and carry out simple measures to prevent spinal cysts.