Spinal cyst - types, features of symptoms and treatment

A spinal cyst is a cavity filled with some content (hemorrhagic, cerebrospinal fluid, etc.), located in the spine. Quite a rare pathology among all diseases of the spine and can be located in any part of it (from the cervical to the sacral).

A spinal cyst may be asymptomatic and diagnosed by chance, or it may manifest itself as chronic pain that is not relieved by taking analgesics.

According to the origin, a spinal cyst may be:

• congenital,
• acquired.

Depending on the morphological features (wall structure), a spinal cyst can be:

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

The size, location and shape of a spinal cyst vary depending on the causative factors.

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Causes of spinal cysts

The causes of spinal cysts are varied.

1. For congenital spinal cysts – disturbances in tissue development in the fetus.
2. For acquired tumors:
   • degenerative-inflammatory processes of spinal tissues,
   • spinal injuries (bruises, fractures),
   • excessive, heavy loads on the spine and their uneven distribution (features of professional activity - some types of sports, loaders, builders),
   • a sedentary lifestyle over a long period of time, which leads to degenerative changes in the tissues of the spine,
   • hemorrhages in the tissues of the spine,
   • parasitic infection of the body (for example, echinococcus).

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Symptoms of a spinal cyst

Symptoms of a spinal cyst depend on the causes, size and location. Small tumors usually do not manifest themselves and are detected accidentally during examination for other diseases. If the disease progresses, the tumor begins to increase in size and put pressure on the spinal roots. And as a result:

• Neurological disorders of varying severity occur.
• Pain appears in the area of tumor projection. Pain may radiate to the buttocks, lower limbs and other parts of the body.
• Pain in the spine is felt both at rest and during movement.
• Headache and dizziness, tinnitus are possible, which is typical for arachnoid cysts of the spinal cord.
• Sensory disturbances occur (feelings of tingling, tingling, numbness in the arms and/or legs, fingers).
• The function of the intestines and bladder may be impaired if the corresponding spinal roots are damaged.
• As the disease progresses, muscle weakness appears in the lower extremities, which may cause lameness. It becomes difficult to sit for a long time.
• Paresis of the arms or legs is possible.
• Vestibular disorders (gait changes).

Perineural cyst of the spine

According to statistics, perineural cyst of the spine occurs in 7% of cases. It is often congenital due to a developmental disorder in the embryonic period - a protrusion of the spinal membranes into the lumen of the spinal canal occurs. If this protrusion is small, then it does not manifest itself clinically. But if the protrusion is large, then compression of the spinal nerves occurs. And then the clinical symptoms of a perineural cyst appear in early childhood or in adolescence:

• Pain that occurs during movement, prolonged sitting, and localized in the area of the cyst projection in the spine. The pain may be strong or weak in intensity.
• As the tumor grows, signs of compression of the spinal nerves may appear depending on the level of damage - dysfunction of urination, bowel function (constipation), a sensation of goosebumps and tingling in the lower extremities.
• Weakness in the lower limbs is possible.

Often, a perineural cyst of the spine is formed in its lower parts. If the perineural cystic formation is acquired, it occurs as a result of:

• Spinal injuries.
• Increased cerebrospinal fluid pressure due to disruption of the normal outflow of cerebrospinal fluid.

A perineural cyst of the spine is usually filled with cerebrospinal fluid.

Cervical spine cyst

A cervical spine cyst may not show clinical signs if it is small. If it is large, the following clinical signs may be observed:

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

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Cyst in the thoracic spine

A cyst in the thoracic spine, if large, can manifest itself with a variety of symptoms, since the sympathetic nervous system of the thoracic spine is closely connected with the internal organs of the chest (heart, bronchopulmonary system, esophagus) and abdominal cavity (stomach, gallbladder, liver, intestines).

The clinical symptoms of a thoracic spine cyst may be as follows:

• pain in the thoracic spine that occurs during movement and when sitting for a long time,
• tension in the back muscles and intercostal muscles,
• the occurrence of both true and imitation pains of the organs of the thoracic and/or abdominal cavity is possible, due to compression of the corresponding spinal nerve roots by the tumor (for example, vertebrogenic pseudocoronary pain, imitation of clinical symptoms of angina pectoris or a hernia located in the epigastrium, etc.),
• pain of a girdle nature may occur, intercostal neuropathies, pain in the sternum area are possible,
• if the upper thoracic spine is affected, swallowing problems (dysphagia) and regurgitation may occur,
• heartburn, nausea and other dyspeptic disorders are possible,
• limitation of movement due to pain.

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Cyst of the lumbar and lumbosacral (sacral) spine

A lumbar and lumbosacral (sacral) spine cyst, if small, is asymptomatic and is detected by chance. If large, vertebral symptoms and functional neurological disorders are observed due to compression of the spinal roots. Clinical manifestations can be varied:

• pain in the lumbar and sacral (sacral) regions (sharp or dull),
• it is possible that dull and aching pain may occur in the lumbar region and in the deep tissues of the joints of the lower extremities,
• sharp and shooting pain in the lumbar region is possible, radiating into one or both legs down to the toes,
• sensory disturbances - numbness and a crawling sensation in the groin area, lower limbs and toes may be noted,
• dysfunction of the pelvic organs - urination, intestines,
• changes in muscle tone of the spine, lower limbs,
• decreased mobility of the spinal column.

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Arachnoid cyst of the spine

Arachnoid cyst of the spine (Tarlov cyst) is a cavity, the walls of which are formed by the arachnoid (arachnoid) membrane of the spinal cord. This tumor is formed mainly in the lumbosacral spine. The contents of the arachnoid cyst are cerebrospinal fluid. This neoplasm is a type of perineural cyst of the spine. In most cases, it is a congenital pathology with an asymptomatic course, detected by chance. An arachnoid cyst of the spine larger than 1.5 centimeters begins to put pressure on the spinal roots and spinal cord, this is manifested by certain clinical symptoms:

• pain in the spine at the site of the tumor, occurring after exertion,
• if the tumor is localized in the cervical region, headache, dizziness, and lability of blood pressure are possible,
• when an arachnoid cyst is localized in the lumbosacral region, the functions of the pelvic organs are disrupted - urinary and intestinal disorders, potency is impaired,
• disorders of sensitivity and motor function of the upper or lower extremities (it all depends on the level of the spinal cyst) - numbness, goosebumps, tingling, weakness, paresis.

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Periarticular cyst of the spine

A periarticular cyst of the spine is formed in the area of the intervertebral (facet) joints. It is often acquired due to injuries or degenerative disorders. The periarticular tumor comes out of the intervertebral joint cavity and loses connection with it. A periarticular cyst of the spine occurs in 0.1-1% of cases of radicular pain syndrome. Depending on the absence or presence of synovial epithelium, a periarticular cyst is divided into:

• ganglionic,
• synovial.

A synovial cyst of the spine is a part of the synovial bag of the intervertebral joint that has separated from the main one due to trauma, degenerative-inflammatory processes, excessive physical activity, or is formed due to a congenital anomaly of the synovial bag. The cavity of the synovial cyst has a synovial lining and is filled with liquid contents that are produced by the structures of the synovial lining. Most often, a synovial cyst is formed in those parts of the spine that bear significant load - the cervical and lumbar.

A ganglion cyst (nodular) loses contact with the joint cavity during the process of its formation and therefore lacks synovial lining.

Small periarticular cysts do not manifest themselves in any way and stop growing after the causative factor ceases to act. With large sizes, the clinical symptoms are varied:

• local pain in the lumbar region or neck may be noted (it all depends on the level of the cyst),
• radicular pain syndromes,
• disorders of sensitivity and motor activity,
• compression radiculopathy with this neoplasm can be very pronounced (sharp, shooting pain).

Cerebrospinal fluid cyst

A spinal cerebrospinal fluid cyst is a cavity filled with cerebrospinal fluid (CSF) that circulates in the subarachnoid (arachnoid) space of the spinal cord. A spinal CSF cyst can be arachnoid or perineural – arachnoid and perineural CSF cyst. Clinical manifestations of a CSF cyst depend on the level of its location in the spine – pain in the spine at the site of tumor projection, pain radiating to the upper and/or lower limbs, impaired sensitivity and motor activity, impaired function of internal organs.

Aneurysmal cyst of the spine

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

• pain in the area where the neoplasm is located, increases as the cyst grows,
• pathological fractures may occur,
• local increase in temperature and swelling (at the site of the tumor projection),
• dilated veins,
• contractures in a nearby joint are possible,
• symptoms of damage to the spinal roots, depending on the level of tumor localization.

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Diagnosis of spinal cysts

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

1. Complaints are taken into account.
2. An anamnesis (history) of the disease is collected (the causes of the disease are determined in detail).
3. General examination, examination of the spine, palpation – assessment of the severity of the process, severity and localization of pain, disorders of sensitivity and motor activity, etc.
4. Additional examination methods are prescribed:
   • X-ray of the spine in several projections,
   • magnetic resonance imaging or computed tomography of the spine,
   • ultrasound examination of the spine,
   • myelography is an X-ray contrast study of the spinal cord pathways – a contrast agent is injected into the spinal canal, an X-ray is taken and thus its patency is determined, which may be impaired due to a tumor.
   • electromyography is ordered to assess the condition of the spinal roots.
5. General clinical research methods – general urine and blood analysis, biochemical blood test.

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Treatment of spinal cysts

Treatment of spinal cysts is complex, aimed at alleviating the condition and preventing possible severe complications. Treatment of spinal cysts can be conservative and surgical. Conservative treatment is carried out for small sizes, in the absence of severe pain syndrome and disorders of the functions of internal organs.

Conservative therapy for spinal cysts includes:

1. Bed rest.
2. A balanced diet with sufficient amounts of vitamins, protein, micro- and macroelements (especially calcium and phosphorus).
3. Administration of painkillers and anti-inflammatory drugs (NSAIDs - dicloberl; analgesics - baralgin, analgin).
4. Prescribing B vitamins (improves metabolic processes in the cell) and vitamin C (strengthens blood vessels and increases immunity).
5. Introduction of agents that improve microcirculation – pentoxifylline.
6. Use of drugs that reduce degenerative-dystrophic processes in bone and cartilage tissue (Artrofon, Dona, Structum).
7. It is possible to prescribe therapeutic blockades – the introduction of painkillers (novocaine, lidocaine) into the place where the pain is most pronounced, the so-called trigger points (most often, an epidural blockade is performed with the introduction of an analgesic into the epidural space of the spine). A blockade with the combined use of novocaine and a corticosteroid drug (Cortisone, Diprospan) is possible.
8. Physiotherapeutic methods:
   • Phonophoresis (use of ultrasound) – improves and accelerates healing processes, has anti-inflammatory and analgesic effects, reduces swelling.
   • Therapeutic massage (strengthens the back muscles and helps stabilize the spine) is performed exclusively by a specialist, after the acute period.
   • Reflexotherapy (acupuncture, electroacupuncture, laser therapy).
   • Therapeutic gymnastics begins with minimal loads and under strict supervision of a doctor. It is carried out after the removal of acute pain.
   • It is recommended to wear corsets, semi-corsets, bandages, elastic belts, recliners. They are used to treat and prevent lower back pain, as they limit the range of motion, reduce pain and muscle spasm.

Treatment of perineural cyst of the spine

Treatment of a 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, its contents are sucked out and a special fibrin substance is injected into the cavity of the neoplasm in order to fuse the walls of the neoplasm and prevent the formation of new tumors.

If the size is small (less than 1.5 cm), conservative treatment is usually carried out:

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

Treatment of periarticular cyst of the spine

Treatment of periarticular cyst of the spine can be conservative and surgical. Conservative treatment of periarticular cyst is the same as for all others – described above. But also used additionally:

• injection of corticosteroids (hydrocortisone) into the epidural space,
• injection of painkillers into trigger points,
• novocaine blockades.

Indications for surgical treatment of periarticular cysts are as follows:

• Absolute - paresis of the feet due to compression of the spinal roots of the lumbosacral region, dysfunction of the pelvic organs, including sensitivity,
• Relative – severe pain syndrome that cannot be relieved despite conservative therapy for a month, as well as progressive deterioration of motor functions.

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

Treatment of aneurysmal cyst of the spine

Treatment of an aneurysmal cyst of the spine in case of its small size is conservative, including bed rest, prescription of non-steroidal anti-inflammatory drugs (diclofenac), vasoactive drugs (pentoxifylline), vitamins of group B and C, it is recommended to wear corsets, belts or fixing bandages. But very often it is necessary to resort to its surgical removal. Often they use a puncture method, which consists in introducing hormonal agents (prednisolone, hydrocortisone) into the cavern. They also use a radical method of therapy - removal of the damaged part of the vertebra, but this operation is very difficult, it can be complicated by severe bleeding. Sometimes this operation has to be replaced by aspiration of the tumor contents and injection of calcitonin into the cavern to prevent relapse. If there are contraindications to the operation, then radiation therapy is often used.

Spinal cyst removal

Surgical removal of a spinal cyst is performed 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 result, to prevent disability and restore maximum working capacity.

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

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

Treatment of spinal cysts with folk remedies

Treatment of a spinal cyst with folk remedies should be carried out after consultation with a doctor, if the tumor is small in size and does not threaten the loss of ability to work and life.

1. Treatment of spinal cysts with burdock juice. Burdock leaves are washed and crushed, juice is obtained and infused for four to five days (do not wait until it ferments). Take two tablespoons several times a day before meals. The course of therapy is two months.
2. Using elecampane infusion. Prepare the infusion in this way - dry elecampane herb (forty grams) is mixed with yeast prepared in advance (one tablespoon of dry yeast, poured with three liters of warm water). It should be infused for two days. Use the infusion twice a day for 21 days.
3. Tincture of acacia leaves and flowers. Acacia leaves and flowers (four tablespoons each) are poured with 0.5 liters of vodka. Infuse for a week. Use the infusion several times a day half an hour before meals, one teaspoon at a time. The course of therapy is two months.
4. A mixture of various herbs is used. Sorrel and burdock roots, nettle, oregano, green walnut leaves, string and knotweed are finely crushed and mixed (the ratio of parts is equal). Then immortelle (three tablespoons), valerian herb (one tablespoon) and St. John's wort (three tablespoons) are added. Mix thoroughly, two tablespoons of the mixture are taken and poured with 0.5 liters of boiling water, and infused for ten hours. Take one tablespoon three to four times a day before meals. The course of therapy is one month.

Prevention of spinal cysts

Prevention of spinal cysts is non-specific and consists of the following.

1. Proper nutrition with sufficient micro- and macroelements (especially calcium and phosphorus), protein, and vitamins.
2. Avoid injuries and bruises (do not engage in traumatic sports, do not participate in fights).
3. Avoid heavy physical exertion and lifting weights. Distribute the load evenly throughout the body.
4. Do sports – swimming, walking, therapeutic exercises.
5. Control your weight, as excess weight increases the load on the spine.
6. Eliminate bad habits – smoking, alcohol.
7. Get regularly tested for parasites in your body.
8. Have a preventive examination of your entire body every year.

Spinal cyst prognosis

The prognosis for a spinal cyst with a small size and no clinical manifestations is favorable for both life and work. With a large spinal cyst and untimely treatment, the prognosis for work is unfavorable. Because this pathology can lead to disability, since 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 take simple measures to prevent spinal cysts.