“…2 ). In total, 22 papers were included in meta-analysis [ 2 , 4 , 5 , 9 – 15 , 17 – 21 , 23 – 29 ]: 19 for estimation of the general incidence as well as for subgroup analysis, whereas three articles were included solely in subgroup analysis without involving them in the general pool, because they pertained specifically to small groups of patients with symptoms of PGAD, two of them presented unusually high incidence of TC, and hence were deemed to pose a risk of bias for the general pool. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…It was a subject of controversy which sacral level is usually involved. Incidence of S2 TCs was declared highest in three studies [ 2 , 9 , 15 ]. S3 was the most prevalent in two papers, whereas S1 in one [ 12 , 14 , 25 ].…”
Background
Spinal perineural Tarlov’s cysts (TCs) are considered incidental findings that occasionally might exert pressure upon nerve roots and correspond with patients’ signs and symptoms. Purpose of this meta-analysis is to deliver global incidence and characteristics (location, size, and shape) of TCs.
Methods
Following PRISMA checklist, all major databases were searched by two authors for radiologic studies reporting incidence and morphologic features (location, size, and shape) of TCs. Anatomical Quality Assessment tool was applied for risk of bias evaluation. Meta-analysis of random-effects model was employed. Subgroup analysis for regional distribution, gender, sacral levels, age, correspondence with symptoms, and persistent genital arousal disorder (PGAD) were planned ahead.
Results
22 radiologic studies of level 3 evidence involving 13,266 subjects were included. Global pooled prevalence of TCs was 4.18% (95% CI 2.47–6.30). Mean pooled sagittal diameter was 11.86 mm (95% CI 10.78–12.93). Sacral cysts strongly prevailed over the other segments. Of the sacral, S2 level was the most common (46.7% [95% CI 29.4–60.5]). Geographically, the highest incidence was found in Europe (6.07% [95% CI 1.49–13.00]), followed by North America (3.82% [95% CI 0.49–9.44]), and Asia (3.33% [95% CI 1.52–5.75]). TCs were more common in women than in men (5.84% vs 3.03%, p < 0.001, test of homogeneity, χ2). Subjects with PGAD had incidence of 37.87% (95% CI 2.45–81.75). TCs in pediatric population are rare—0.53% (95% CI 0.02–1.51). 15.59% of TCs corresponded with symptoms.
Conclusions
Spinal perineural (Tarlov) cysts are found in a minority of population. S2 level of the sacral bone is affected most frequently. There is female predominance. Correspondence with symptoms is seen in less than one-fifth of TCs. Studies with stronger evidence level are needed to corroborate the results. The purported high incidence in PGAD requires confirmation in case–control studies for the risk-ratio calculation.
“…2 ). In total, 22 papers were included in meta-analysis [ 2 , 4 , 5 , 9 – 15 , 17 – 21 , 23 – 29 ]: 19 for estimation of the general incidence as well as for subgroup analysis, whereas three articles were included solely in subgroup analysis without involving them in the general pool, because they pertained specifically to small groups of patients with symptoms of PGAD, two of them presented unusually high incidence of TC, and hence were deemed to pose a risk of bias for the general pool. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…It was a subject of controversy which sacral level is usually involved. Incidence of S2 TCs was declared highest in three studies [ 2 , 9 , 15 ]. S3 was the most prevalent in two papers, whereas S1 in one [ 12 , 14 , 25 ].…”
Background
Spinal perineural Tarlov’s cysts (TCs) are considered incidental findings that occasionally might exert pressure upon nerve roots and correspond with patients’ signs and symptoms. Purpose of this meta-analysis is to deliver global incidence and characteristics (location, size, and shape) of TCs.
Methods
Following PRISMA checklist, all major databases were searched by two authors for radiologic studies reporting incidence and morphologic features (location, size, and shape) of TCs. Anatomical Quality Assessment tool was applied for risk of bias evaluation. Meta-analysis of random-effects model was employed. Subgroup analysis for regional distribution, gender, sacral levels, age, correspondence with symptoms, and persistent genital arousal disorder (PGAD) were planned ahead.
Results
22 radiologic studies of level 3 evidence involving 13,266 subjects were included. Global pooled prevalence of TCs was 4.18% (95% CI 2.47–6.30). Mean pooled sagittal diameter was 11.86 mm (95% CI 10.78–12.93). Sacral cysts strongly prevailed over the other segments. Of the sacral, S2 level was the most common (46.7% [95% CI 29.4–60.5]). Geographically, the highest incidence was found in Europe (6.07% [95% CI 1.49–13.00]), followed by North America (3.82% [95% CI 0.49–9.44]), and Asia (3.33% [95% CI 1.52–5.75]). TCs were more common in women than in men (5.84% vs 3.03%, p < 0.001, test of homogeneity, χ2). Subjects with PGAD had incidence of 37.87% (95% CI 2.45–81.75). TCs in pediatric population are rare—0.53% (95% CI 0.02–1.51). 15.59% of TCs corresponded with symptoms.
Conclusions
Spinal perineural (Tarlov) cysts are found in a minority of population. S2 level of the sacral bone is affected most frequently. There is female predominance. Correspondence with symptoms is seen in less than one-fifth of TCs. Studies with stronger evidence level are needed to corroborate the results. The purported high incidence in PGAD requires confirmation in case–control studies for the risk-ratio calculation.
“…However, diagnosis of TCs in clinical practice remains di cult, and patients can present with rare symptoms. For instance, TCs have been reported to cause abdominal pain, dyspareunia, vaginal neuralgia and depression in some patients [6,7,10,16]. To the best of our knowledge, the present study was the rst report of a case of TC with spermatorrhea as the primary symptom.…”
Background: Tarlov cysts are a commonly misdiagnosed condition, which can present with many rare symptoms. We report a case of a tarlov cyst with spermatorrhea, and review the pertinent literature.Case presentation: A 42-year-old male patient had a history of spermatorrhea for >10 years, but was incorrectly diagnosed as the patient and the doctors consistently mistook the symptoms for a genitourinary disease. Magnetic resonance imaging showed that two cysts in the sacral canal. The diagnosis was tarlov cyst. We performed surgery to remove the cyst and the symptoms of spermatorrhea disappeared after operation.Conclusions: This case demonstrates that orthopedics and urologists should improve their understanding of tarlov cysts in order to avoid misdiagnosis and mistreatment.
“… 26 , 31 Naderi 31 asserted that fluctuations in pain severity and lack of correlation between radiological findings and symptomatology are the main characteristics of TCs. Lim et al 32 found a discordant relationship between TCs and pudendal neuralgia. In a meta-analysis of 22 radiological studies, Klepinowski et al 33 found a correspondence with symptoms in only 16% of TCs.…”
Purpose
Tarlov cysts (TCs) are dilated nerve root sheaths originating from increased cerebrospinal pressure. Patients with TCs often complain of neuropathic pain and paresthesia. The aim of this study was to retrospectively review intraepidermal nerve fiber density (IENFD) and electrodiagnostic (EDX) data from TC patients.
Patients and Methods
Lower leg skin biopsy results and EDX data from the L2–S4 myotomes of patients with lumbar or sacral TCs ≥8 mm were retrieved from a database of a physical medicine clinic. Patients with compressive pathology, diabetes mellitus and chemotherapy were excluded.
Results
IENFD data from 17 patients and EDX data from 24 patients with TCs ≥8 mm were available. The mean age was 47 ± 10y, and 83% were women. In 82% of patients, the IENFD was below the 5th percentile by age and sex. EDX showed increased Hoffmann reflex latencies in 25%, increased anal reflex latencies in 95%, and a patchy distribution of neurogenic motor unit potentials in 100%. More than 50% of needle EMG abnormalities appeared in myotomes unrelated to the location of the TCs.
Conclusion
Small- and/or large-fiber neuropathy was documented in a significant proportion of patients with TCs. The novel findings may add to the understanding of the mechanisms involved in symptomatic TCs. We propose that pathologically elevated cerebrospinal fluid pressure not only dilates some of the nerve root sheaths to form TCs but also potentially damages axons in nondilated nerve root sheaths and neurons in the dorsal root ganglia.
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