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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 133-138. doi: 10.19723/j.issn.1671-167X.2023.01.020

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Reinforced radiculoplasty for the treatment of symptomatic sacral Tarlov cysts: A clinical analysis of 71 cases

Chao WU1,Bin LIU1,*(),Jing-cheng XIE1,Zhen-yu WANG1,Chang-cheng MA1,Jun YANG1,Jian-jun SUN1,Xiao-dong CHEN1,Tao YU1,Guo-zhong LIN1,Yu SI1,Yun-feng HAN1,Su-hua CHEN1,Xiao-liang YIN1,Qian-quan MA1,Mu-tian ZHENG1,Lin ZENG2   

  1. 1. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
    2. Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-03-23 Online:2023-02-18 Published:2023-01-31
  • Contact: Bin LIU E-mail:liubin301@163.com
  • Supported by:
    Beijing Municipal Science & Technology Commission(Z181100001718171)

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Abstract:

Objective: To investigate the safety and efficacy of reinforced radiculoplasty in the treatment of symptomatic sacral Tarlov cysts (TCs). Methods: A retrospective analysis was performed on the clinical data and follow-up data of 71 patients with symptomatic sacral TCs who underwent reinforced radiculoplasty in the Neurosurgery Department of Peking University Third Hospital from June 2018 to March 2021. All the operations were performed under neuroelectrophysiological monitoring. Intraoperative cyst exploration, partial resection of the cyst wall, narrowing of the leak, nerve root sleeve radiculoplasty and artificial dural reinforcement were performed. The incidence of postoperative complications and new neurological dysfunction was analyzed. Visual analogue scale (VAS) was used to assess the changes of pain before and after surgery. The Japanese Orthopedics Association (JOA) low back pain score was used to evaluate the changes in nerve function before and after surgery. Results: In the study, 71 patients had 101 TCs, 19 (18.8%) TCs originated from the left S1 nerve, 26 (25.7%) originated from the left S2 nerve, 3 (3.0%) originated from the left S3 nerve, 14 (13.9%) originated from the right S1 nerve, 33 (32.7%) originated from the right S2 nerve, 6 (5.9%) originated from the right S3 nerve, all the TCs underwent reinforced radiculoplasty. Deep infection (1 case), subcutaneous effusion (1 case), fat li-quefaction (1 case) and urinary tract infection (4 cases) were recorded postoperatively. The patients were followed up for 12-43 months (median, 26 months). Two cases had new urinary retention after operation, and the catheter was removed at the end of the first and second months respectively. One case had new fecal weakness, which improved after 3 months. Compared with preoperation, VAS decreased significantly at the last follow-up [median, 6 (4-9) vs. 1 (0-5), Z=-7.272, P < 0.001], JOA score increased significantly [median, 20 (16-25) vs. 27 (18-29), Z=-7.265, P < 0.001]. There were 18 cured cases (25.4%), 41 excellent cases (57.7%), 8 effective cases (11.3%), and 4 invalid cases (5.6%). The total efficiency was 94.4% (67/71). Two (1.98%) cysts recurred. Conclusion: For patients with symptomatic sacral TCs, reinforced radiculoplasty can significantly improve the pain and nerve function, which is safe and reliable.

Key words: Tarlov cysts, Sacral canal, Plastic surgery procedures, Reinforced radiculoplasty

CLC Number: 

  • R651.2

Figure 1

Surgical procedure and schematic diagram of reinforced radiculoplasty A-E show the surgical procedure during the real operation, and a-e show the corresponding schematic diagram. A, the Tarlov cyst wall (*) is thin and translucent and the nerve root (yellow array) inside can be seen; B, the cyst wall (*) was dissected and the nerve root (yellow array) inside the cyst was explored; C, after excision of the excess wall, the residual wall was used for nerve root sleeve reconstruction (white arrow); D, the nerve root sleeve was wrapped with an artificial dural (blue arrow); E, artificial dural reinforcement (blue arrow) was performed."

Figure 2

Radiographic changes of a patient with multiple TCs before and after operation A and B separately shows the sagittal and axial MRI view of a patient with multiple TCs (white arrow) before the operation. The cysts located in the le-vel of S1-2. Bilateral S2 nerve roots (red arrow) can be found at the MRI axial view, and the TCs contain the bilateral S2 nerve roots. C and D separately shows the sagittal and axial view of the same patient 1 year after the surgery and the cysts disappeared (arrow). E shows the sagittal CT view of the patient 1 year after the surgery and the posterior wall of the sacral canal was reconstructed satisfactorily (arrow)."

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