A cyst is a fluid-filled sac (not a tumor) that can be found in the spinal cord, but it is rare. It is characterized as a congenital abnormality because it forms before birth. Cysts can occur anywhere in the spinal cord and are commonly referred to as an arachnoid cyst.
Signs and Symptoms
Most spinal cord cysts are benign (not dangerous) and do not change or grow over time. In fact, most cysts in the spine do not cause any symptoms and most of the time are found incidentally on imaging studies of the spine (for example, a spine MRI) done to look for something else. In some cases, a cyst can grow and put pressure on the spine that is next to it. When this happens, a child can develop signs and symptoms that are based on the location of the cyst such as:
- Nausea and vomiting
- Pain or stiffness in the neck
- Loss of balance or trouble walking
- Weakness in the legs or arms
- Back pain
- Changes in bowel function
- Trouble urinating
Although rare, a spinal cord cyst can rupture or hemorrhage and require immediate attention and possible surgery.
There are several potential causes of cysts in the spinal cord. These include abnormal development, infection and trauma.
Diagnosis of a cyst starts with a detailed neurologic exam and physical exam and medical history. Other procedures and tests may be needed to diagnose a cyst including a magnetic resonance imaging magnetic resonance imaging (MRI) scan.
If a cyst is found and is not causing any problems, it will be imaged with an MRI again in about a year to make sure the cyst has not changed.
A customized treatment plan is put together for your child based on:
- The cyst’s location and size
- Your child’s age and general health
- Your child’s tolerance for treatment
- You and your child’s preferences
Treatment for a spine cyst may include one or a combination of the following options:
- Steroid injections. This procedure is used to inject a steroid (Kenalog, Dexamethasone – strong steroidal anti-inflammatory medications) and a local anesthetic (Lidocaine, Bupivacaine) into the cyst around your spine to help decrease inflammation and swelling typically leading to improvement in pain in your neck, arms, back and legs. This procedure is performed by a physician double board certified in Anesthesia and Pain Medicine using live x-ray in either the office or surgery center setting. This procedure typically takes just a few minutes and may be performed either with just local anesthetic or IV sedation in the surgery center depending on you and your child’s preference. An area of your child’s skin will then be cleaned/sterilized, which may feel cold. They will then feel an injection with a small needle into their skin to numb the area. Most procedures involve a needle which is advanced to the target area under fluoroscopic (x-ray) guidance. A small amount of x-ray contrast will be injected to confirm accurate placement. Once the needle has been properly placed, a combination of a local anesthetic and/or injectable steroid will be placed into the targeted area.
- Cyst fenestration, or drainage. The goal of surgery is to drain the cyst and relieve the pressure on the spinal cord but only if the cyst is causing problems. The surgery is performed by a pediatric neurosurgeon under general anesthesia. It is generally well tolerated. This procedure is performed by creating a hole in the cyst (fenestration) to drain the cyst fluid into another part of the spinal canal.
- Cyst removal. Removal of the cyst involves making an opening in the spine, removing a piece of the spine followed by its replacement at the end of the operation, and using a microscope or special high-powered glasses to remove the cyst and/or place holes in (fenestrate) its membranes. Your child will need to stay in the hospital for 2-3 days, with the length of stay determined by the extent of surgery.
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