Giant sacral tarlov cyst and renal insufficiency

Abstract

A 45-year-old female patient presented with intense low back pain for 2 years, irradiating for both lower limbs and perineum with significant worsening in the orthostatic position. She referred weakness of lower limbs and bladder dysfunction with urinary retention. She developed renal insufficiency with increase of urea nitrogen (73mg/dl) and creatinine (2.5mg/dl). Patient had controlled high blood pressure, without other comorbidities. Physical exam Patient needed crutches to walk. She presented with hypoesthesia in the plantar region of left foot and degree IV force for plantar flexion of both feet. Anal sphincter reflex was reduced and she had recurrent urinary retention, with intermittent urinary catheterization. No signs of myelopathy or pyramidal release were found. Electroneuromyography: chronic axonal loss of low sacral roots. Computed tomography: Significant bone destruction of posterior elements of S1 and S2 (Figure 1).