Sacral perineural cyst is one group of extradural meningeal cyst at the sacral region. These lesions are distinguished from other spinal cysts because perineural cyst does not communicate with subarachnoidal space. Fluid filled cysts may compress adjacent nerve roots causing low back pain and sciatica which are dramatically improved by surgical excision. Differential diagnosis from other cysts can be accomplished by failure of collection of dye into cyst by initial myelography. C-T myelography rules out other mass lesions and often reveals communication of perineural cyst that filled with contrast medium. Magnetic resonance imaging well demonstrates three dimensinnal configures of an intraspinal cystic mass in initial study. However it is important to recognize that these cysts are one of causes of radiculopathy. We report three cases of sacral perineural cysts with radiculopathy.
Diagnosis, Differential ; Low Back Pain ; Magnetic Resonance Imaging ; Myelography ; Radiculopathy ; Sacrococcygeal Region ; Sciatica ; Tarlov Cysts*

A sacral perineural cyst is composed of an arachnoid membrane of the nerve root at the sacral region. We performed a wide posterior decompression and cystectomy in a patient who suffered from back pain with pain radiating in both lower extremities, and whose MRI findings coincided with those of a sacral perineural cyst. Clinical improvement was observed during the follow-up review. We report the surgical treatment with a review of the relevant literature.
Arachnoid ; Back Pain ; Cystectomy ; Decompression ; Follow-Up Studies ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Membranes ; Sacrococcygeal Region ; Tarlov Cysts*

OBJECTIVE: To examine the relative efficacy of three active exercise programs for work-related, chronic low back pain, and to observe to what extent the programs affected the mechanical stability of the lumbar region. METHODS: The subjects were 64 employees who were randomly divided into three groups to match the three active exercise programs which were performed 3 times a week for 6 months. All subjects were assessed with the same measurements at a pre-study examination, and then were reassessed at 2 weeks, 3 months and 6 months after the study. RESULTS: The pain intensity didn't show any significant difference among the three groups. However, the Oswestry Disability Index showed significant differences among the three groups at 6 months and the lumbar and thoracic exercise groups showed significant decreases compared to the general physiotherapy group (p<0.05). Maximal stretching with both hands in the overhead direction showed a significant difference among the three groups at 3 months and 6 months, and the thoracic exercise group at 6 months showed a significant increase in overhead stretching compared to the lumbar exercise and general physiotherapy groups (p<0.05). The lumbar region angle of inclination showed significant differences among the three groups at 2 weeks, 3 months and 6 months, with the thoracic exercise group being decreased significantly more than the lumbar exercise and general physiotherapy groups at 6 months (p<0.05). CONCLUSIONS: Exercise aimed at increasing thoracic mobility has an effect on lumbar stability. Furthermore, it is far more effective for lumbar stabilization than general physiotherapy and deep muscle strengthening lumbar exercise.
Hand ; Low Back Pain* ; Lumbosacral Region

OBJECTIVETo explore the clinical effect of the sacrococcygeal space injection for the treatment of failed back surgery syndrome.

METHODSFrom July 1998 to October 2012,47 patients with failed back surgery syndrome were treated and included 39 males and 8 females with an average age of 61.5 years old ranging from 35 to 89 years old. Among them,41 patients experienced one time of operation, 6 patients with twice of operation. Forty-one patients underwent single,bilateral fenestration or central laminectomy decompression, discectomy. Six patients underwent total laminectomy discectomy and inter body fusion and pedicle screw fixation. All patients were examined by X-ray plain film, CT or MRI before treatment. The anticoagulation was discontinuation before treatment. The needle was put into the sacrococcygeal gap at prone position in the sense of frustration,suction without cerebrospinal fluid and blood,with injection of Mailuoning (Chinese characters: see text) 15 ml. The pain was assessed by VAS before and after treatment. The Oswestry low back pain disability index and survival quality interference degree were evaluated.

RESULTSAt 1 month after treatment,the pain VAS decreased from 59.24 +/- 17.35 before treatment to 19.19 +/- 11.19 after treatment (P < 0.05); The Oswestry low back pain disability index decreased from (41.35 +/- 9.87)% before treatment to (23.17 +/- 17.56)% after treatment (P < 0.05); The survival quality interference degree decreased from 6.5 +/- 2.2 before treatment to 2.6 +/- 1.4 after treatment (P < 0.05).

CONCLUSIONThe sacrococcygeal gap injection for treatment of failed back surgery syndrome has advantages of simple, safe, fewer complications, and low treatment cost.

Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; administration & dosage ; Failed Back Surgery Syndrome ; diagnostic imaging ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Sacrococcygeal Region ; diagnostic imaging

The meridian diseases, abnormal psoas and abdominal muscles and abdominal pressure are key causes of low back pain. We treat low back pain mainly with lumbar back area, neglecting abdomen. The anterior-posterior acupoint combination, regulating to treat is effective. Based on the Chinese meridian-collateral and contemporary anatomy related to low back pain, the combination method, and its mechanism are introduced, so as to develop the thought and method for low back pain. A typical case is added.
Acupuncture Points ; Humans ; Low Back Pain ; Lumbosacral Region ; Meridians

Based on the physiological and pathological characteristics of meridian sinew theory, the staging treatment of non-specific low back pain (NLBP) is explored to provide the reference of clinical practice. The twelve meridian sinews of the human body communicate with the bones and joints of the whole body, which governs the movement, body protection and defense, and meridian regulation. Physiologically, the meridian sinew maintains the functions of the lumbar region. In pathology, the meridian sinew may encounter stasis and pain, contraction and spasm or "transverse collateral" formation. According to the pathological staging of meridian sinew disorders, the progress of NLBP is divided into 3 phases and the corresponding treatments are provided. Mild stimulation and rapid analgesia is suggested to promote tissue repair at the early phase; muscle spasm is relieved to adjust muscular status at the middle phase; and the "cord-like" muscle foci is removed at the later phase of the disease.
Humans ; Low Back Pain ; Meridians ; Pain Management ; Analgesia ; Lumbosacral Region

Tuberculous spondylitis is the most common manifestation of musculoskeletal tuberculosis (TB). The progression of the disease is usually slow and insidious. The main symptom, back pain, is not specific, which frequently results in a delayed diagnosis resulting in neurologic deficits and more advanced vertebral destruction. It is more difficult to diagnose the disease if the involved area is an uncommon sites, such as the upper thoracic, cervical or sacral region. It is important to make an early diagnosis and treatment to achieve a better treatment outcome. We reported a 29 year old female with upper thoracic TB spondylitis(T2-8) and pulmonary TB complaining of back pain that persisted for 5 months and fever. TB spondylitis was not suspected to be due to upper thoracic involvement despite her pulmonary tuberculosis. Chest CT for the evaluation of pulmonary TB found T5 destruction and the paravertebral abscess that was consistent with TB spondylitis. Her spine was examined by MRI, which made an early diagnosis before the neurologic deficit had developed. She was treated with surgical intervention due to the spinal instability and anti-TB medication for 1 year with excellent results.
Abscess ; Adult ; Back Pain ; Delayed Diagnosis ; Early Diagnosis ; Female ; Fever ; Fractures, Compression* ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Sacrococcygeal Region ; Spine ; Spondylitis ; Tomography, X-Ray Computed ; Treatment Outcome ; Tuberculosis ; Tuberculosis, Pulmonary*

Introduction: Non-Hodgkin’s lymphomas (NHLs) are a varied group of malignancy originating in the lymphatic system. As a subset of lymphomas, primary spinal epidural lymphomas are diagnosed when there are no other recognizable sites of lymphomas at the time of diagnosis. It mimics other spinal diseases making the diagnosis difficult to establish as well as in obtaining tissue diagnosis. We present an atypical case of a 45-year-old female who presented initially with back pain then eventual loss of sensory and motor function of the lower extremities, further work up showed primary spinal epidural NHL. Case: This is a case of a 45-year-old female with chief complaint of back pain. Magnetic resonance imaging (MRI) of the thoracic spine showed nonspecific epidural soft tissue mass at T5 to T6 level compressing the spinal cord. Operative procedure was done with histopathology of the epidural lesion consistent of NHL. Immunohistochemical staining showed CD20 (+), thus a diagnosis of diffuse large B cell lymphoma (DLBCL) was made. Patient underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) regimen. Conclusion Signs and symptoms of primary spinal epidural NHL often overlaps its manifestations with other spinal diseases. A high index of clinical suspicion warrants inclusion of such neoplastic condition in determining the exact and definitive diagnosis of cases manifesting spinal compression.
Back Pain

A case of a patient diagnosed as the chronic spinal epidural hematoma in the lumbar region is reported. There was no history of trauma except the repeated epidural block for controlling the lower back pain at the pain clinic. The symptoms were occurred after epidural block and were exaggerated by repeated injections. Magnetic resonance imaging showed a spinal epidural mass located dorsolaterally at the level of L3-L4. After removal of the hematoma, the symptoms were completely relieved. The diagnosis of a chronic spinal epidural hematoma was confirmed with both operative and histological findings.
Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Pain Clinics

We report a rare case of lumbar intradural dermoid cysts. A 19 year-old male presented with low back pain for 3years. Physical examination revealed no abnormalities including skin lesions. On the magnetic resonance images, multiple intradural extramedullary cystic lesions were found in the lumbar region. These lesions were removed surgically. Histologically, the mass turned out to be a dermoid cyst. We think those were unusual intraspinal dermoid cysts because they were not associated with other congenital spinal malformation, and located in the intradural extramedullary region. We report this case of lumbar dermoid cysts with a review of literatures.
Dermoid Cyst* ; Humans ; Low Back Pain ; Lumbosacral Region ; Male ; Physical Examination ; Skin ; Spinal Dysraphism* ; Young Adult