European Spine Journal

, Volume 25, Issue 11, pp 3403–3410 | Cite as

Tarlov cysts: long-term follow-up after microsurgical inverted plication and sacroplasty

  • Ralf Weigel
  • Manolis Polemikos
  • Nesrin Uksul
  • Joachim K. Krauss
Original Article



Surgical treatment of Tarlov cysts is still a matter of debate. Published literature thus far includes mainly small case series with retrospective evaluation and short-term follow-up. We present a novel microsurgical technique that combines the decompression of the nerve fibers with the prevention of recurrence. The long-term follow-up is provided.


The indication for surgery was incapacitating pain refractory to medical therapy for at least 6 months. The surgical technique consisted in microsurgical opening of the cyst, relief of CSF followed by secured inverted plication of the cyst wall, packing of remnant space with fat graft, and sacroplasty. Pain and neurological deficits were evaluated according to a modified Barrow National Institute score (BNI score, 0–5) and the Departmental Neuro Score (DNS score, 0–20).


A total of 13 patients (9 women, 4 men) were operated and followed up to 14 years (mean FU 5.3 years). Mean age at surgery was 51.8 (±14) years. Pain and neurological deficits improved significantly in 11/13 patients (BNI score pre-OP 5 vs 3.1 ± 1.2 at 1-year-FU, and 2.8 ± 1.2 at last follow-up visit; DNS score pre-OP 5.5 ± 1.5 vs 2.8 ± 2.1 at 1-year follow-up, and 2.6 ± 2.2 at last follow-up visit. Two patients needed revision surgery due to reoccurrence of the cyst. One patient suffered deterioration of preexisting neurological deficit.


The inverted plication technique combined with sacroplasty is a promising technique. It improves pain and neurological deficits on the long term in the majority of patients with symptomatic Tarlov cysts.


Tarlov cyst Perineural cyst Microsurgical treatment Pain Outcome 


Compliance with ethical standards

Conflict of interest


Funding statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ralf Weigel
    • 1
    • 2
  • Manolis Polemikos
    • 1
  • Nesrin Uksul
    • 1
  • Joachim K. Krauss
    • 1
  1. 1.Department of NeurosurgeryMedical School HannoverHannoverGermany
  2. 2.Neurosurgical DepartmentSt. Katharinen HospitalFrankfurt Am MainGermany

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