Percutaneous Spinal Endoscopic Treatment of Symptomatic Sacral Tarlov Cysts

Abstract

To examine the surgical procedure for and the clinical efficacy of using spinal endoscopy for sacral Tarlov cyst treatment. A retrospective analysis of patients with sacral Tarlov cysts who underwent spinal endoscopy treatment from August 2018 to January 2020 at the Department of Neurosurgery, Xuanwu Hospital, China, was carried out. Spinal endoscopy treatment was performed in 15 patients with sacral Tarlov cysts (6 males, 9 females). Mean patient age was 41.3 years (range, 19-67 years). Mean follow-up period was 15.6 months (range, 12-26 months). Clinical presentations of patients included sacrococcygeal and lower limb pain (n= 14), paresthesia (n= 7), lower limb motor disorder (n= 1), bowel dysfunction (n= 4), and urinary dysfunction (n= 3). Surgeries were successfully completed in all patients. Pain was significantly alleviated after surgery in 12 (85.7%) patients. Visual analog scale scores before surgery, at 1 day and 3 months after surgery, and at last follow-up were 5.9 ± 1.2, 2.9 ± 1.5, 2.3 ± 1.3, and 2.6 ± 1.0. The postoperative visual analog scale scores were significantly decreased compared with the preoperative score (all P < 0.01). Among the patients with paresthesia, 4 (57.1%) experienced improved symptoms. Muscle strength recovered from grade 4 to grade 5 after surgery in 1 patient with lower limb motor disorder. Two (50%) of 4 patients with bowel dysfunction and 2 (66.7%) of 3 patients with urinary dysfunction experienced functional improvement. Postoperative magnetic resonance imaging showed that cyst filling was satisfactory, and cyst recurrence was not observed. Spinal endoscopy shows preliminary clinical efficacy for treatment of sacral Tarlov cysts and is safe and effective.