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Symptomatic Tarlov cysts are often overlooked: ten reasons why—a narrative review

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Abstract

Purpose

Tarlov cysts (TCs) are dilations of nerve roots arising from pathologically increased hydrostatic pressure (HP) in the spinal canal. There is much controversy regarding whether these cysts are a rare source of pain or often produce symptoms. The aim of this review was to identify the reasons that symptomatic TCs (STCs) are easily overlooked.

Methods

The literature was searched for data regarding pathogenesis and symptomatology.

Results

TCs may be overlooked for the following reasons: (1) STCs are considered clinically irrelevant findings; (2) it is assumed that it is clinically difficult to ascertain that TCs are the cause of pain; (3) MRI or electromyography studies only focus on the L1 to S1 nerves; (4) TCs are usually not reported by radiologists; (5) degenerative alterations of the lumbosacral spine are almost always identified as the cause of a patient’s pain; (6) it is not generally known that small TCs can be symptomatic; (7) examinations and treatments usually focus on the cysts as an underlying mechanism; however, essentially, increased HP is the main underlying mechanism for producing symptoms. Consequently, STCs may relapse after surgery; (8) bladder, bowel and sphincter dysfunction are not inquired about during history taking. (9) Unexplained pain is often attributed to depression, whereas depression is more likely the consequence of debilitating neuropathic pain. (10) The recognition of STCs is subject to gender bias, confirmation bias and cognitive dissonance and unconscious bias in publishing.

Conclusion

There are several reasons STCs are underdiagnosed, mostly due to persistent misconceptions and biases.

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Authors and Affiliations

  1. Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, 3001, Heverlee, Belgium

    Mieke Hulens & Wim Dankaerts

  2. Department of Neurosurgery, AZ Rivierenland, Kasteelstraat 23, 2880, Bornem, Belgium

    Ricky Rasschaert

  3. Clinical Electromyography Laboratory, University Hospitals UZ Leuven, Herestraat 49, 3000, Leuven, Belgium

    Frans Bruyninckx

  4. Ophthalmology Research Group, Department of Neurosciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium

    Ingeborg Stalmans

  5. Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000, Leuven, Belgium

    Ingeborg Stalmans

  6. Department of Anesthesiology and Pain Therapy, Imelda Hospital, 2820 Bonheiden, Belgium

    Peter De Mulder

  7. Department of Social and Primary Health Care, Public Health Nutrition, University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Greet Vansant

  8. Sint-Joris-Weert, Belgium

    Mieke Hulens

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  1. Mieke Hulens
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Hulens, M., Rasschaert, R., Bruyninckx, F. et al. Symptomatic Tarlov cysts are often overlooked: ten reasons why—a narrative review. Eur Spine J 28, 2237–2248 (2019). https://doi.org/10.1007/s00586-019-05996-1

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