POST ACCEPTANCE, 7 January 2011
doi: 10.1097/BRS.0b013e31820e4720
Clinical Case Series: PDF Only

Association between symptomatic giant sacral meningeal diverticulum and spinal cord tethering with thickened lipomatous filum

Feigenbaum, Frank MD; Hale, Susan NP


Study Design: A review of cases where symptomatic sacral meningeal diverticulua, a.k.a. sacral meningoceles, where treated.

Objective: To determine whether there is an association between symptomatic sacral meningeal diverticulum and spinal cord tethering with a thickened fatty filum.

Summary of Background Data: In 2008 researchers reported on the unusual case of a giant sacral meningeal diverticulum containing a tethering fatty filum. This led the author to be alert to the presence of spinal cord tethering in future cases involving symptomatic meningeal diverticula. Since the time of the initial report, 49 patients with meningeal diverticula have subsequently undergone surgical treatment and not infrequently spinal cord tethering was also found. The opportunity therefore presented itself to determine to what degree the two pathologies were associated.

Methods: We reviewed the intra-operative findings, pre-operative imaging, and basic epidemiologic data from 50 consecutively treated patients with symptomatic sacral meningeal diverticula.

Results: Of the 50 patients, 14 (28%) were found to have associated spinal cord tethering with a thickened fatty filum. All 14 had a thickened fatty filum identifiable at surgery. Of these, 14 had evidence of spinal cord tethering on pre-operative imaging studies, including 11 with the conus at the level of L2 or below, and 13 with a fatty filum seen on MRI.

Conclusion: The association between symptomatic sacral meningeal diverticula is more than incidental and is probably reflective of a common congenital etiology. Treatment of symptomatic meningeal diverticula should include a careful search for evidence of spinal cord tethering with a thickened fatty filum.

(C) 2011 Lippincott Williams & Wilkins, Inc.

Abdominal pain secondary to a sacral peri neural cyst

Penn Spine Center Research Group, Department of Rehabilitation Medicine, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA. slipman@mail.med.upenn.edu

Background Context: Perineural cysts are commonly found in the sacral region and are incidently discovered on imaging studies performed for the evaluation of low back and/or leg pain. PURPOSE: To report on a patient presenting with abdominal pain secondary to a large sacral perineural cyst. STUDY DESIGN/SETTING: Case report. METHODS/PATIENT SAMPLE: A 47-year-old woman was referred to a specialized multidisciplinary spine center with complaints of left lower quadrant abdominal pain and left leg pain. Of significant note was the presence of constipation and urinary frequency over the preceding 8 months. Physical examination was normal. Magnetic resonance imaging of the lumbosacral spine revealed large perineural cysts eroding the sacrum and extending to the pelvis. The presence of abdominal symptoms prompted a neurosurgical consultation. However, after considering the possible risks associated with the surgical procedure, the patient opted to follow the nonsurgical route. RESULT AND CONCLUSIONS: Although commonly visualized, sacral perineural cysts are rarely symptomatic. When symptomatic, it may be secondary to its size and location. Presence of abdominal pain in a patient with back and/or leg pain should prompt the evaluation of the lumbosacral spine.

PMID: 14589193 [PubMed – indexed for MEDLINE]

MRI of symptomatic sacral perineural cyst.

Araki Y, Tsukaguchi I, Ishida T, Ootani M, Yamamoto T, Tomoda K, Mitomo M.
Department of Radiology, Osaka Rosai Hospital, Sakai-shi, Japan.

Sacral perineural cyst is a relatively rare condition. To our knowledge, reports of MR findings associated with sacral perineural cyst have been limited to only six cases. We present for the first time high field MR findings in a case of sacral perineural cyst. The cyst appeared as a cystic lesion in the sacral spinal canal and had intermediate signal intensity on T1W images and high signal intensity on T2*W images compared with CSF. Slight erosion remodeling of the sacrum was also seen anteriorly. Our case was symptomatic and present with radiculopathy (sciatic pain). Surgical treatment was done to result in dramatic improvement of the sciatic pain.