Radiculoplasty with reconstruction using 3D-printed artificial dura mater for the treatment of symptomatic sacral canal cysts: Two case reports

Abstract

Rationale: Currently, interventional injection of albumin glue and nerve sleeve plasty by cyst excision is the main treatment for sacral cysts. However, albumin glue can only be used in patients with partial cystic neck stenosis, and surgical treatment may result in postoperative complications such as numbness and cyst recurrence. Here, a modified radiculoplasty is presented, in which the lamina is restored with the nerve root wrapped with 3-dimensional (3D)-printed artificial dura mater.

Patient concerns: The first patient, a 28-year-old man, had been complaining of aggravated perineal pain for 8 months a visual analog scale (VAS) score of 7. Sacrococcygeal magnetic resonance imaging (MRI) revealed multiple sacral canal cysts. The second case, a 48-year-old woman, has been complaining of lumbosacral and left leg pain for 1 month (VAS score of 7). Physical examination showed hyperalgesia below the right sacrum 2 level. Sacrococcygeal MRI and computed tomography (CT) revealed multiple sacral canal cysts and a calcified lesion in the cyst.

Diagnoses and intervention: The first patient underwent radiculoplasty with reconstruction using 3D-printed artificial dura mater, with 3 cysts treated and the lamina restored. Four cysts of the second patients were treated, including 1 bone-occupying lesion. Radiculoplasty with reconstruction using 3D-printed artificial dura mater was used for the cysts and the lamina was restored OUTCOMES:: The postoperative VAS score was 0 to 2 points in the 2 patients. No postoperative infection or new neurological dysfunction was observed. Postoperative MRI showed no cysts, with lamina restoration. After 6 months, the VAS score was 0, and MRI showed no recurrence.

Lessons: Radiculoplasty with reconstruction using 3D-printed artificial dura mater and lamina restoration could be beneficial for the treatment of symptomatic sacral canal cysts.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1

A, Sagittal MRI T1-weighted image of a sacral canal cyst (arrow). B, Postoperative T1-weighted image showing sacral canal cyst disappearance (arrow). C and D, Axial MRI T2-weighted images showing 2 sacral canal cysts (arrows). E and F, Postoperative axial MRI T2-weighted images showing sacral canal cyst disappearance (arrows). G, Sagittal MRI T2-weighted image showing multiple sacral canal cysts (arrow). H, Postoperative T2-weighted image showing the disappearance of the sacral canal cysts (arrow). J, Sagittal CT reconstruction image of the sacral canal cyst (arrow). K, Postoperative sagittal CT reconstruction image showing sacral canal cyst disappearance (arrow) and lamina restoration. CT = computed tomography, MRI = magnetic resonance imaging.

Figure 2

A, Sagittal MRI T2-weighted image showing multiple sacral canal cysts (arrow). B, Sagittal T1-weighted image of sacral canal cysts (arrow). C, Axial MRI T2-weighted image showing low signal lesions in the sacral canal cyst (arrow). D, Axial MRI T2-weighted image of sacral canal cysts (arrow). E and F, Sagittal MRI T2-weighted images showing low signal lesions in the sacral canal cyst (arrow). G, Axial CT image showing high-density lesions in the sacral canal cyst (arrow). H and I, Sagittal CT reconstruction image showing high-density lesions in the sacral canal cyst (arrow). CT = computed tomography, MRI = magnetic resonance imaging.

Figure 3

A, End of the dural sac in the sacral canal after lamina removal (∗), with multiple sacral canal cysts in the tail end (arrow). B, Bone occupying lesions in the cyst (arrow). C, Nerve root which tortuously travels and adheres to the cyst wall (arrow). D, Nerve root sleeve plasty after partial removal of the cyst wall (arrow) (∗, end of the dural sac). E, Post-radiculoplasty by artificial dura mater wrapping (arrow) (∗, end of the dural sac). F, ∗Restored lamina fixed with titanium nails and plates.

Figure 4

A, Postoperative sagittal MRI T1-weighted image showing the disappearance of multiple sacral canal cysts (arrow). B, Postoperative sagittal MRI T2-weighted image showing the disappearance of the sacral canal cysts (arrow). C, Postoperative axial MRI T1-weighted image showing the disappearance of the sacral canal cysts, with low signal lesions in the removed cysts (arrow). D, Axial MRI T2-weighted image showing the disappearance of the sacral canal cysts, with low signal indicating the reconstructed nerve root (arrow). E, Sagittal CT reconstruction image showing removal of high-density lesions, with dotted-line titanium nail shadows visible along the nerve root track (arrow). F, Sagittal CT reconstruction image showing lamina restoration (arrow). G, Axial CT image showing lamina restoration, with the fixed titanium plates showing high-density (arrow) and titanium nail shadows visible in the sacral canal. H, Postoperative 6 months sagital MRI T2-weighted image showing the disappearance of the sacral canal cysts, with low signal lesions in the cysts removed (arrow). I, Postoperative 6 months sagital MRI T1-weighted image showing the disappearance of the sacral canal cysts, with low signal lesions in the cysts removed (arrow). J, Postoperative 6 months axial MRI T1-weighted image showing the disappearance of the sacral canal cysts, with low signal lesions in the cysts removed (arrow). K. Postoperative 6 months axial MRI T2-weighted image showing the disappearance of the sacral canal cysts, with the low signal indicating the reconstructed nerve root (arrow). CT = computed tomography, MRI = magnetic resonance imaging.