Global incidence of spinal perineural Tarlov’s cysts and their morphological characteristics: a meta-analysis of 13,266 subjects

Abstract

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.

Large- and Small-Fiber Neuropathy in Patients with Tarlov Cysts

“…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.…”

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports

“…Approximately 1% of perineural cysts are symptomatic due to compression or stretching of the adjacent nerve roots [ 12 , 15 , 16 ]. However, Tarlov cysts can slowly increase in size over time and cause significant bone scalloping [ 17 ]. Their propensity to attenuate the mechanical endurance of the sacrum is seen in cases complicated with insufficiency fractures reported in young patients [ 16 ].…”

Large presacral Tarlov cysts in pregnancy

“…[7][8][9] Although symptomatic TCs can present with neurological symptoms such as sciatica, low back pain, lower extremity paresis, dyspareunia, and bladder/rectal disturbance, 8 the majority are asymptomatic and found by chance via magnetic resonance imaging (MRI) and computed tomography (CT) examinations performed for various lumbosacral symptoms. 4,10 Natural or artificial rupture of TCs has been reported to prompt symptom changes, including rapid deterioration of related symptoms. [11][12][13] Although some researchers have reported the presence of TCs in pregnancy and delivery, 2,14,15 the impact of vaginal delivery on presacral TCs has not been reported.…”

“…TCs grow slowly, rarely extend to the endopelvic space, and seldom show natural regression 7–9 . Although symptomatic TCs can present with neurological symptoms such as sciatica, low back pain, lower extremity paresis, dyspareunia, and bladder/rectal disturbance, 8 the majority are asymptomatic and found by chance via magnetic resonance imaging (MRI) and computed tomography (CT) examinations performed for various lumbosacral symptoms 4,10 …”