A 43-year-old female patient, without known drug allergies or toxic habits, who for 8 months had a history of disabling sacral pain, continuously irradiating to the posterior portion of the left thigh.
No sphincter alterations or loss of sphincter control were observed.
For this reason he consulted in multiple hospitals.
A lumbar CT scan showed a hemangioma in L5, a pelvic MRI showed grade I muscular rupture of the left major glue and a structure interpreted as a Tarlov cyst.
She was treated with paracetamol, nolotil, tramadol and gabapentin without improvement.
Two facet blocks and even a left piriformis muscle block were performed, all of them without results.
In the latter, the patient had residual left lower limb hypoesthesia.
The patient was referred to our hospital for evaluation of pain when L5 hemangioma was suspected.
The patient was conscious and oriented at the time of examination.
No language alterations were observed.
The function of the cranial nerves was normal.
He had a very important pain to sacral posture 8/10 according to the VAS scale, approximately at the level of S2 and a slight decrease in strength in the left lower limb of 4/5, with distal flexure-ext deficit.
The rest of the limbs were force 5/5.
Hypoesthesia was noticed in L5 territory.
There was no evidence of Babinsky's sign.
Walking was difi cult.
A general blood test showed no remarkable alterations.
Lumbosacral MRI (Philips Medical Systems) was performed, showing vertebral hemangiomas in L2 and L5, clearly revealing a cystic lesion in the lateral sacral and spinal canal transition S2.
This structure occupied almost all the canal and partially occupied the posterior contour of vertebral bodies and posterior elements.
This formation was in close contact with both roots S3 and S4, without including them.
Its morphology was oval and its contours were clear with a maximum size of approximately 22 X 19 X 14 mm. According to the Nabors classification, it corresponded to an occult intrasacral meningocele.
Puncture was performed (Needle Ostycut 150 mm 13G Angiomed) and CT-guided sacral cyst evacuation (GE Medical Systems BrightSpeed) obtaining 2 cc of a fluid.
Cytological examination described a benign cellularity.
The subsequent evolution was marked improvement of sacral pain, which in the VAS scale was 3/10 restarting ambulation without weakness in left foot or hypoesthesia.
