Tags

Type your tag names separated by a space and hit enter

Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review.
Eur Spine J. 2019 Oct; 28(10):2237-2248.ES

Abstract

PURPOSE

Tarlov cysts (TCs) are dilations of nerve roots arising from pathologically increased hydrostatic pressure (HP) in the spinal canal. There is much controversy regarding whether these cysts are a rare source of pain or often produce symptoms. The aim of this review was to identify the reasons that symptomatic TCs (STCs) are easily overlooked.

METHODS

The literature was searched for data regarding pathogenesis and symptomatology.

RESULTS

TCs may be overlooked for the following reasons: (1) STCs are considered clinically irrelevant findings; (2) it is assumed that it is clinically difficult to ascertain that TCs are the cause of pain; (3) MRI or electromyography studies only focus on the L1 to S1 nerves; (4) TCs are usually not reported by radiologists; (5) degenerative alterations of the lumbosacral spine are almost always identified as the cause of a patient's pain; (6) it is not generally known that small TCs can be symptomatic; (7) examinations and treatments usually focus on the cysts as an underlying mechanism; however, essentially, increased HP is the main underlying mechanism for producing symptoms. Consequently, STCs may relapse after surgery; (8) bladder, bowel and sphincter dysfunction are not inquired about during history taking. (9) Unexplained pain is often attributed to depression, whereas depression is more likely the consequence of debilitating neuropathic pain. (10) The recognition of STCs is subject to gender bias, confirmation bias and cognitive dissonance and unconscious bias in publishing.

CONCLUSION

There are several reasons STCs are underdiagnosed, mostly due to persistent misconceptions and biases. These slides can be retrieved under Electronic Supplementary Material.

Authors+Show Affiliations

Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, 3001, Heverlee, Belgium. miekehulens@skynet.be. , Sint-Joris-Weert, Belgium. miekehulens@skynet.be.Department of Neurosurgery, AZ Rivierenland, Kasteelstraat 23, 2880, Bornem, Belgium.Clinical Electromyography Laboratory, University Hospitals UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, 3001, Heverlee, Belgium.Ophthalmology Research Group, Department of Neurosciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium. Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.Department of Anesthesiology and Pain Therapy, Imelda Hospital, 2820 Bonheiden, Belgium.Department of Social and Primary Health Care, Public Health Nutrition, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31079249

Citation

Hulens, Mieke, et al. "Symptomatic Tarlov Cysts Are Often Overlooked: Ten Reasons Why-a Narrative Review." European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 28, no. 10, 2019, pp. 2237-2248.
Hulens M, Rasschaert R, Bruyninckx F, et al. Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review. Eur Spine J. 2019;28(10):2237-2248.
Hulens, M., Rasschaert, R., Bruyninckx, F., Dankaerts, W., Stalmans, I., De Mulder, P., & Vansant, G. (2019). Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 28(10), 2237-2248. https://doi.org/10.1007/s00586-019-05996-1
Hulens M, et al. Symptomatic Tarlov Cysts Are Often Overlooked: Ten Reasons Why-a Narrative Review. Eur Spine J. 2019;28(10):2237-2248. PubMed PMID: 31079249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review. AU - Hulens,Mieke, AU - Rasschaert,Ricky, AU - Bruyninckx,Frans, AU - Dankaerts,Wim, AU - Stalmans,Ingeborg, AU - De Mulder,Peter, AU - Vansant,Greet, Y1 - 2019/05/11/ PY - 2018/11/18/received PY - 2019/05/05/accepted PY - 2019/04/05/revised PY - 2019/5/13/pubmed PY - 2019/5/13/medline PY - 2019/5/13/entrez KW - Chronic pain KW - Intracranial hypertension KW - Meningeal cysts KW - Tarlov cysts KW - Unexplained pain SP - 2237 EP - 2248 JF - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JO - Eur Spine J VL - 28 IS - 10 N2 - PURPOSE: Tarlov cysts (TCs) are dilations of nerve roots arising from pathologically increased hydrostatic pressure (HP) in the spinal canal. There is much controversy regarding whether these cysts are a rare source of pain or often produce symptoms. The aim of this review was to identify the reasons that symptomatic TCs (STCs) are easily overlooked. METHODS: The literature was searched for data regarding pathogenesis and symptomatology. RESULTS: TCs may be overlooked for the following reasons: (1) STCs are considered clinically irrelevant findings; (2) it is assumed that it is clinically difficult to ascertain that TCs are the cause of pain; (3) MRI or electromyography studies only focus on the L1 to S1 nerves; (4) TCs are usually not reported by radiologists; (5) degenerative alterations of the lumbosacral spine are almost always identified as the cause of a patient's pain; (6) it is not generally known that small TCs can be symptomatic; (7) examinations and treatments usually focus on the cysts as an underlying mechanism; however, essentially, increased HP is the main underlying mechanism for producing symptoms. Consequently, STCs may relapse after surgery; (8) bladder, bowel and sphincter dysfunction are not inquired about during history taking. (9) Unexplained pain is often attributed to depression, whereas depression is more likely the consequence of debilitating neuropathic pain. (10) The recognition of STCs is subject to gender bias, confirmation bias and cognitive dissonance and unconscious bias in publishing. CONCLUSION: There are several reasons STCs are underdiagnosed, mostly due to persistent misconceptions and biases. These slides can be retrieved under Electronic Supplementary Material. SN - 1432-0932 UR - https://www.unboundmedicine.com/medline/citation/31079249/Symptomatic_Tarlov_cysts_are_often_overlooked:_ten_reasons_why_a_narrative_review_ L2 - https://doi.org/10.1007/s00586-019-05996-1 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.