Uncovering "another mystery of abdominal pain" -- sacral canal cyst

This is the 3982nd article of Da Yi Xiao Hu

Aunt Hua, 50, had been suffering from abdominal pain for more than two months. She had always mistakenly thought it was a gynecological disease and had been treated in many hospitals, but the pain was not relieved. Unable to bear the pain, she went to a tertiary hospital again. Magnetic resonance imaging (MRI) showed: sacral canal cyst. This disease may not be well known, but it is a common disease in women [1]. With the widespread clinical application of MRI, sacral canal cysts have been discovered more and more.

MRI

MRI is currently the preferred method for diagnosing and differentiating sacral canal cysts and is the “gold standard” for the diagnosis of sacral canal cysts[2].

However, most people currently lack a correct understanding of sacral canal cysts, which often leads to delayed diagnosis and treatment in clinical practice.

1. What is sacral canal cyst?

Sacral canal cysts occur at the tail end of the human spine. Cyst-like lesions occur in the sacral canal, and the "cyst" is filled with cerebrospinal fluid. Due to congenital development or postnatal trauma, the internal structure of the sacral canal is weak or defective. When the local pressure increases, the human body is in an upright state, and the cerebrospinal fluid follows the principle of "water flows to the lower place" and flows from top to bottom (in>out) into the nerve root sleeve (a thin membrane wrapped around the outside of the nerve root). Over time, the nerve root sleeve will become more and more swollen, thus forming a cyst-like tumor. Therefore, it is also called "intraspinal tumor" [2].

Therefore, sacral canal cyst is not a cyst or a tumor in essence, but rather a cerebrospinal fluid leak.

2. Is the patient’s “abdominal pain” caused by the tumor compressing the nerves?

YES

Although the sacral canal cyst is just a water bag, it has nerve roots inside. When the internal nerve roots are pulled and the adjacent external nerve roots are squeezed, the patient will feel pain. The pain site is related to the location. For example, when the sciatic nerve is compressed, the pain is in the waist, buttocks, thighs, soles of the feet, etc.; if the water bag falls into the pelvic cavity, the patient will experience pain in the abdomen, perineum, and around the anus. It is the real "culprit" of the patient's "abdominal pain".

3. Assuming surgery, does the sacral canal cyst have to be completely removed?

NO

Suppose you cut open a sacral canal cyst and find that it is empty except for cerebrospinal fluid and nerve roots. Then can you cut a little bit of the cyst wall? No, you can't. In fact, the cyst wall is just a sleeve of nerve roots expanded by cerebrospinal fluid. It is not a diseased tissue at all. On the contrary, this layer of cyst wall has been doing its best to limit the growth of the sacral canal cyst, but it can't withstand the huge pressure impact and passively expands, becoming thinner and thinner. Therefore, sacral canal cysts cannot be "resected".

There are strict surgical indications for sacral canal cysts [1]:

①The maximum diameter of the cyst is greater than 1.5 cm.

②The pain affects normal life and work.

③ Bowel and bladder dysfunction.

At present, surgical treatment options in China are constantly being optimized. For example, the modified “internal opening closure of sacral canal cyst leakage and pedicled muscle flap packing” has a good effect [1].

4. Sacral canal cyst, how to avoid the disease or recurrence?

01

Keep exercising to strengthen your waist muscles

① Flying Swallow Pose

The patient lies prone, uses the shoulders and back to lift the head and shoulders off the bed. At the same time, lift both lower limbs off the bed. Use the abdomen to touch the bed to form support. Hold for 3-5 seconds and then put it down.

②Five-point posture

The patient lies flat on the bed, bends his knees and hips, places his feet on the bed, pushes his elbows backward, pushes the top of his head backward, lifts his hips as high as possible, holds for 3-5 seconds, and then puts them down.

③Three-point position

On the basis of five-point support, lift your elbows, support your body with your feet and head, lift your hips as high as possible and hold for 3-5 seconds before lowering them.

02

Adhere to body position management to reduce sacral cerebrospinal fluid pressure

If patients with sacral canal cysts sit or stand for more than 2 hours, they need to maintain the "head low and hips high" position for 5-10 minutes to reduce the cerebrospinal fluid pressure inside the sacral canal.

Supine head low hip high position: Supine head low hip high position, that is, take out the head pillow, and place it under the buttocks, while raising the lower limbs, the buttocks connected to the thighs and the bed plane form a 450-900 angle.

03

Prevention of cysts is the key to reducing the risk of disease and recurrence

① Effectively prevent constipation by consuming foods rich in crude fiber.

② Pay attention to personal safety at ordinary times to prevent accidents such as falls.

③Regular physical examinations, active treatment, follow-up and treatment of related diseases.

④Avoid standing or sitting for more than 2 hours, and do not lift objects weighing more than 5 grams.

Key points: 1 "increase" 2 "decrease" can effectively prevent the occurrence and recurrence of sacral canal cysts

【References】

[1] Zheng Xuesheng, Zhu Hanshuo. Analysis of the efficacy of internal opening closure and pedicled muscle flap packing in the treatment of symptomatic sacral canal cysts. Chinese Journal of Minimally Invasive Neurosurgery[J]. 2020, 25(11): 497-498.

[2] Chinese Medical Association Neurosurgery Branch, Expert consensus on the diagnosis and treatment of sacral canal cysts[J]. Chinese Journal of Neurosurgery, 2019, 35(4): 325-329.

[3] Yan Tiebin, Yin Anchun, Rehabilitation Nursing[M]. Shanghai: People's Medical Publishing House, 2018: 277-278.

Note: The pictures are from the Internet. If there is any infringement, please let us know and they will be deleted.

Author: Siping Community Health Service Center, Yangpu District, Shanghai

Zhu Tonghua, deputy chief nurse