Working Diagnosis:
12cm extradural spinal arachnoid cyst
Treatment:
Patient was referred urgently for pediatric neurosurgical evaluation. After discussing the possible treatment options with the neurosurgery team, the patient and his parents decided to take a watchful waiting approach as there was a possibility that he could have spontaneous resolution as his axial skeleton continued to grow.
Outcome:
The patient continued to have gradual improvement of his symptoms without intervention and returned to full activities within three weeks. At one year of follow up patient had not had a return of his significant low back pain or any signs of neurologic compromise. At 2 years of follow up he remained asymptomatic.
Editor's Comments:
Good case overall as many spinal arachnoid cysts are found incidentally on imaging.
Important to recall an appropriate workup to progressive non-traumatic back pain given central nervous system implications and to rule out other causes. While can an occur at any age, symptomatic spinal arachnoid cysts are commonly seen in these sex/age group. Given the variable presentation, can go undiagnosed. Good outcome with a conservative management option.
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