Tarlov Cyst Causing Sacral One Nerve Compression, a Rare Presentation: Case Report and Literature Review

Aims: We describe the clinical, radiological and pathological characteristics of a symptomatic Tarlov cyst in a female adult patient who presented with severe low back pain of prolonged duration from Kigali, Rwanda.

Presentation of Case: We report a 48-year-old Rwandan female patient who presented with a history of progressive low back pain and numbness of S1 and S2 distributions for the last 15 years. A magnetic resonance imaging (MRI) was carried out to evaluate for disc degenerative disease, however, we found an incidental symptomatic Tarlov cyst in front of the first sacral vertebra. The symptomatic cyst was surgically excised and the excision site after repair covered with durafoam. The patient reported a remarkable improvement in her symptoms in the post-operative period and follow up of up to 8 months duration.

Discussion: Tarlov cyst (TC) or sacral perineurial cyst is a cystic lesion of the nerve root that is common in the sacrum. TCs are typically located at the junction of the dorsal ganglion and the posterior nerve root and usually develop between the endoneurium and perineurium of the nerve root. Perineural cysts are commonly detected as incidental findings during magnetic resonance imaging of the lumbosacral spine in the imaging of suspected disc degenerative disease.

Conclusion: Tarlov cysts very rarely occur and when they do they are commonly asymptomatic. They cause sacral radiculopathy and sacral pain syndrome, particularly in women. To our knowledge, this is the first case of asymptomatic Tarlov cyst causing unbearable pain in Rwanda.