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Tarlov Cyst Causing Sacral Insufficiency Fracture.
Oper Neurosurg (Hagerstown). 2017 06 01; 13(3):E4-E7.ON

Abstract

BACKGROUND AND IMPORTANCE

Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation.

CLINICAL PRESENTATION

The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3.

CONCLUSION

Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation.

Authors

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Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28521343

Citation

Puffer, Ross C., et al. "Tarlov Cyst Causing Sacral Insufficiency Fracture." Operative Neurosurgery (Hagerstown, Md.), vol. 13, no. 3, 2017, pp. E4-E7.
Puffer RC, Gates MJ, Copeland W, et al. Tarlov Cyst Causing Sacral Insufficiency Fracture. Oper Neurosurg (Hagerstown). 2017;13(3):E4-E7.
Puffer, R. C., Gates, M. J., Copeland, W., Krauss, W. E., & Fogelson, J. (2017). Tarlov Cyst Causing Sacral Insufficiency Fracture. Operative Neurosurgery (Hagerstown, Md.), 13(3), E4-E7. https://doi.org/10.1093/ons/opw025
Puffer RC, et al. Tarlov Cyst Causing Sacral Insufficiency Fracture. Oper Neurosurg (Hagerstown). 2017 06 1;13(3):E4-E7. PubMed PMID: 28521343.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tarlov Cyst Causing Sacral Insufficiency Fracture. AU - Puffer,Ross C, AU - Gates,Marcus J, AU - Copeland,William,3rd AU - Krauss,William E, AU - Fogelson,Jeremy, PY - 2015/10/17/received PY - 2016/11/10/accepted PY - 2017/5/19/entrez PY - 2017/5/19/pubmed PY - 2019/7/10/medline KW - Fracture KW - Fusion KW - Insufficiency KW - Sacral KW - Tarlov cyst SP - E4 EP - E7 JF - Operative neurosurgery (Hagerstown, Md.) JO - Oper Neurosurg (Hagerstown) VL - 13 IS - 3 N2 - BACKGROUND AND IMPORTANCE: Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. CLINICAL PRESENTATION: The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3. CONCLUSION: Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation. SN - 2332-4260 UR - https://www.unboundmedicine.com/medline/citation/28521343/Tarlov_Cyst_Causing_Sacral_Insufficiency_Fracture_ L2 - https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opw025 DB - PRIME DP - Unbound Medicine ER -