Clinical Notes
Tarlov cyst as a rare cause of S1 radiculopathy: A case report,☆☆

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Abstract

Nadler SF, Bartoli LM, Stitik TP, Chen B. Tarlov cyst as a rare cause of S1 radiculopathy: a case report. Arch Phys Med Rehabil 2001;82:689-90. A 37-year-old female physician presented with a chief complaint of left posterior thigh pain, which began insidiously approximately 4 months before her initial examination. Initially, she had been evaluated by her physician, and magnetic resonance imaging (MRI) was ordered. The MRI scan was reported to be within normal limits, with the exception of minimal disc bulging at L4-5. She had received physical therapy with little benefit and was referred for physiatric assessment. Review of the patient's original MRI scan showed the presence of perineurial (Tarlov) cysts within the sacral canal at the level of S2, with compression of the adjacent nerve root. Subsequent electrodiagnostic testing showed axonal degeneration consistent with an S1 radiculopathy. Tarlov cysts can be a rare cause of lumbosacral radiculopathy and should be considered in the differential diagnosis of radicular leg pain. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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Case report

A 37-year-old female physician presented with a 4-month history of left posterior thigh pain. She was initially evaluated by an orthopedic surgeon, who ordered magnetic resonance imaging (MRI) of the lumbosacral spine. According to the patient, the MRI scan was reported to be within normal limits, with the exception of minimal disc bulging at L4-5. She received physical therapy for suspected disc pathology with little benefit and was subsequently referred for physiatric assessment.

Her pain was

Discussion

Tarlov's initial descriptions of perineurial cysts were primarily localized to the posterior sacral or coccygeal nerve roots, most often the second or third sacral roots.1, 2, 3, 5 On very rare occasions, these cysts were also observed in the thoracic spine.3 These cysts generally occur at the junction of the posterior root and the dorsal ganglion, and are located between the perineurium and endoneurium. They are filled with cerebrospinal fluid (CSF) and are static in size. Histologic

Conclusions

Tarlov cysts are a rare cause of low back pain or lumbosacral radiculopathy and should be considered in the differential diagnosis of radicular symptoms. MRI is the radiologic study of choice to visualize these cysts. CT-guided percutaneous drainage offers an alternative to extensive sacral laminectomies with cyst excision, although simple monitoring may be acceptable in the minimally involved individual.

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☆☆

Reprint requests to Scott F. Nadler, DO, 90 Bergen St, Newark, NJ 07103.

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