Incidence of Spinal Perineurial (Tarlov) Cysts among East-European Patients

Abstract

The spinal perineurial cyst (Tarlov) is a dilatation between the perineurium and endoneurium of spinal nerve roots, located at level of the spinal ganglion and filled with cerebrospinal fluid but without communication with the perineurial subarachnoid space. The aim of the study was to evaluate it incidence among East-European patients. The retrospective data collected during various magnetic resonance spinal examinations and stored on the picture archiving and communication system was analyzed for an incidence of perineurial cysts. From among 842 patients that underwent examination, 75 cases perineurial cysts were revealed. In 22 cases single anomalies were found. In remaining 53 cases, multiple uni- or less frequently bilateral changes were noted. The most common position was the sacral canal, particularly the level of S2 and S3. Occasionally, cysts were also visible on the cervical, thoracic and lumbar level. Incidence of sacral perineurial cysts was significantly higher in females than in males. Similar data was found for single and multiple changes despite of their localization. Insignificant changes were seen for patient age and cyst size. Perineurial spinal cysts were the most frequently observed on the sacral level and such changes were more common in females.

Electromyography and A Review of the Literature Provide Insights into the Role of Sacral Perineural Cysts in Unexplained Chronic Pelvic, Perineal and Leg Pain Syndromes

“…It has been reported that 61.2%-87% of patients who harbor TCs are women [5,6,30,48,50]. We found that this number was 74.8% in case reports and 90% in our EMG study.…”

“…Therefore, small TCs may have been overlooked. MRI studies of the lumbosacral spine that accounted for small cyst sizes have reported a prevalence of 9.1%-10.6 % [15,50].…”

Electromyographic Abnormalities Associated with Symptomatic Sacral Tarlov Cysts

“…The reported prevalence partly depends on cyst size from which lesions were labeled TC. Patients often have multiple cysts, and more women than men harbor symptomatic TC . One‐fifth of the TC were found to be symptomatic .…”

“…Many case reports, as well as experience with large series, have been reported in the literature. Despite a considerable number of scientific publications, this clinical entity remains controversial, and TC are almost always thought to be unrelated to the patient's symptoms . Yet the pathological entity “symptomatic Tarlov cysts (STC),” is well defined and includes progressive debilitating sacral, ischial, and pelvic pain, neurological symptoms, bladder, sexual, and bowel disorders .…”

“…Tarlov or perineural cysts patients, more women than men, can be left undiagnosed and misunderstood for many years. As a consequence, they often develop depression and may ultimately be referred for psychological or psychiatric evaluation.…”