A rare cause of thoracic spinal cord compression by multiple large Tarlov cysts

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Introduction The spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Tarlov cyst (TC) is predominantly found at the lumbosacral level of the spine. Bifocal location of SEACs, thoracic and sacral, is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral cysts. The surgical management and postoperative outcome are discussed. Material and methods Case presentation: a 34-year-old woman was referred to the hospital for acute thoracic pain superimposed on a background of chronic long-standing back pain. She was complaining of walking difficulties. Neurological examination demonstrated a spastic paraparesis. MRI was performed, and revealed a large cystic formation from T7-11 and at the level of the sacrum. Based on the imaging findings, a diagnosis of SEAC was suspected. For spinal cord decompression, we did laminectomies at the level of interest from T7-11 exposing the SEACs. The cysts were dissected carefully from the underlying dura after removal of the CSF. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Then, a duraplasty was performed with autologous grafts from the lumbar fascia. The patient dramatically improved after surgery and was still doing well at follow-up. Conclusion It is important to keep in mind that before any clinical presentation of spinal cord compression a radiological exploration is necessary. Although the surgical treatment of CT is controversial especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.