Perineural cyst (Tarlova) is one of the most common causes of back pain.. It is a cavity with liquid inside, localized at the exit site of the spinal root.. Most often affects the sacral spine, rarely affects the cervical and lumbar vertebrae. The treatment of pathology is carried out mainly by surgery, according to the online publication for girls and women from 14 to 35 years old Pannochka. net Most often, perineural cysts develop in the sacral regionPerineural cyst of the spine - what is it? Perineural (arachnoid, Tarlov) cyst is a benign neoplasm in the lumen of the spinal canal that compresses the spinal nerves and spinal cord. More often, the formations are multiple, appear on both sides.. It is a cavity that is filled with CSF (cerebrospinal fluid). The disease can develop at any age, but people aged 35-50 are more likely to get sick..

Neoplasm can form in any part of the spinal column.

Department of the spine.

Frequency of occurrence.

Description.

Cervical.

Very rarely.

The cervical vertebrae are marked with the letter C.. Cysts at the level of C1-C7 (from the first to the seventh cervical vertebrae) are extremely rare. This usually occurs after an isolated spinal injury in the cervical region..

thoracic.

Very rarely.

The thoracic vertebrae are designated Th. Perineural cysts at the level of Th1-Th12 are practically not found.

Lumbar.

Rarely.

The lumbar spine is affected more frequently than the cervical and thoracic. The vertebrae in this section are denoted by the letter L..

sacral (sacral).

In 95% of cases.

Most often, Tarlov cysts form in the sacrum.. The vertebrae in this section of the spine are denoted by the letter S.. The sacral spine consists of 5 vertebrae (S1, S2, S3, S4, S5).

Tarlov cyst at the level of the S2 vertebra occurs in half of the cases of the disease. Approximately with the same frequency, formations at the level of S1 are detected, the remaining sacral vertebrae are affected less frequently..

Causes of occurrenceThere is no single reason that would lead to the formation of this pathology. Genetics play a role in the development of the disease. Various factors can influence:.

Spinal injury.

Inflammatory processes in the back.

CSF hypertension (increased pressure of the cerebrospinal fluid).

The consequences of surgery.

Main symptoms Small perineural masses are asymptomatic. If the size increases, the cystic neoplasm compresses the nerve endings, which leads to discomfort.. Symptoms vary, but usually the main symptom is back pain.. What symptoms appear depends on the size of the neoplasm and its location:.

the larger the size, the more pronounced the clinical symptoms;

localization of pain depends on which part of the spine is affected;

irradiation of pain depends on which spinal nerve is compressed.

Symptom Name.

Description.

Pain.

Back pain is the main symptom of the disease. Pain occurs during prolonged sitting, walking, during physical activity. The localization of pain can be different and depends on the level at which the cyst has formed:.

C1-C7 - neck pain;

Th1-Th12 - chest pain;

L1-L5 - back pain;

S1-S5 - pain in the lower back.

Pain may radiate to the lower extremities, groin, lower abdomen. At the same time, pain in the back is often accompanied by weakness in the lower extremities, which is associated with damage to the corresponding nerves..

Pelvic organ dysfunction.

The perineural cyst of the sacrum may be accompanied by a violation of the innervation of the pelvic organs, which is associated with compression of the corresponding nerves. How it manifests itself:.

sexual dysfunction;

Urinary and fecal incontinence;

Frequent urination or painful urination;

constipation or diarrhea.

paresthesia.

When squeezing the nerves, numbness, a feeling of crawling may occur.

In general, the symptoms resemble a lesion of the spine of any nature.. But the disease also has its own clinical features:.

symptoms usually progress gradually, less often there is an undulating course;

symptoms often mimic that of a herniated disc with nerve entrapment;

rupture of the cyst causes a sharp drop in intracranial pressure, which is accompanied by dizziness and loss of consciousness;

with prolonged existence, cysts can cause destruction of the bone structures of the sacrum, which leads to pathological fractures.

Methods of diagnosis It is impossible to make a diagnosis only on clinical manifestations. Symptoms may indicate damage to a particular section of the spine, but it is impossible to determine the nature of the disease without using additional diagnostic methods.. For diagnosis, magnetic resonance imaging (MRI) or computed tomography (CT) is prescribed. With the help of MRI and CT, it is possible to visualize a cystic formation, determine its location and size, as well as conduct a differential diagnosis with tumors and abscesses.

How to treat pathology Not all cystic formations of the spine must be removed. Treatment tactics depend on two factors - the size of the formation and the presence of symptoms.. In the asymptomatic course of the disease, radical treatment is not used, observation with an annual MRI scan is sufficient.. If clinical symptoms are present, conservative or surgical treatment is prescribed..

If necessary, the Tarlov cyst is surgically removedConservative treatmentConservative treatment includes the use of medications and physiotherapy. Completely get rid of the disease with the help of medicines will not work. Conservative therapy is aimed at reducing the severity of symptoms and preventing complications. What medicines are used:.

non-steroidal anti-inflammatory drugs - Dicloberl, Movalis;

analgesics for pain relief - Ketanov, Analgin;

drugs to improve metabolic processes - Pentoxifylline, Nicotinic acid, B vitamins.

Indications for surgical treatment If conservative treatment does not help, move on to more radical methods. There are other indications for the operation:.

The size of the cystic formation is more than 1.5 cm.

Severe pain syndrome.

Neurological deficit (sexual dysfunction, pelvic disorders).

The need for an operation is determined by the doctor after a complete examination and obtaining information about the size and location of the formation..

How the operation is carried out The volume of surgical treatment is determined individually. The size of the formation, the age of the patient, the presence of concomitant diseases are taken into account.. The most commonly used methods are aspiration and laminectomy..

Name of surgery.

Advantages and disadvantages.

How is the operation.

Content aspiration.

The main advantage of the operation is low trauma and ease of execution..

The main disadvantage is the frequent development of relapses.. On average, the effect of the operation lasts for two months.. With the introduction of fibrin glue, aseptic meningitis often develops..

The operation is under CT control.. With the help of a special needle, the contents of the cyst are aspirated, which leads to a decrease in its size.. To improve the effect, fibrin glue can be injected into the cavity..

Laminectomy.

This is a more radical operation, the main advantage is a low likelihood of recurrence. The disadvantage is high trauma, as a complication, a neurological deficit, infection can develop..

A small piece of vertebral bone above the nerve root is removed. Then the cystic formation is removed with subsequent closure (suturing of the wall, plastic defect).

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