Tarlov (perineural) Cyst: A case report

Dr Syed Sayed Ahmed, Dr Al Imran, Dr Sourav Chowdhury

A 30 year old lady presented to the Emergency department with a history of sudden, severe low back pain and numbness in both lower limbs. She was unable to walk due to the severity of the pain. There was no history of trauma, loss of consciousness, convulsion, headache or any bowel bladder involvement. She was normotensive and nondiabetic. On neurological examination her muscle power in upper limbs was intact but was significantly reduced in the lower limbs. Her Hoffman's sign was negative and there was loss of sensation in both the lower limbs. All the reflexes and tone were normal. Previously, she was suffering from lower back pain (LBP) and radiating pain down to the lower limbs following prolonged standing. During her OPD consultations, she was diagnosed as a case of sacral (S1, S2) Tarlov (perineural) cyst with lateral recess stenosis at L4 - 5 on MRI. As she was significantly incapacitated by the pain which was not resolving by analgesics, an earlier surgical intervention was performed. She underwent a laminectomy at L5/S1/S2 and the cyst was completely removed from the sacral hollow and bilateral microforaminotomy was also performed at L4/5 level. Her pain and numbness markedly improved after the surgery. She complained of local pain for the next couple of days which was managed by analgesics. There were no neurological deficits after the surgery. During her follow up after 2 months, she was making slow and steady progress and was advised to walk after a month.