Perineural cyst
The content of the article:
- Perineural cyst of the spine - what is it?
- Causes of occurrence
- The main symptoms
- Diagnostic methods
-
How to treat pathology
- Conservative treatment
- Indications for surgical treatment
- How is the operation going
- Video
Perineural cyst (Tarlova) is one of the most common causes of back pain. It is a cavity with fluid inside, localized at the exit site of the spinal root. Most often it affects the sacral spine, less often it affects the cervical and lumbar vertebrae. Treatment of pathology is carried out mainly by surgery.
Most often, perineural cysts develop in the sacral region
Perineural cyst of the spine - what is it?
A perineural (arachnoid, Tarlova) cyst is a benign neoplasm in the lumen of the spinal canal that compresses the spinal nerves and spinal cord. More often formations are multiple, arise from two sides. It is a cavity that is filled with CSF (cerebrospinal fluid). The disease can develop at any age, but more often people 35-50 years old get sick.
A neoplasm can form in any part of the spinal column.
| Spine | Frequency of occurrence | Description |
| Cervical | Rarely | The cervical vertebrae are designated by the letter C. Cysts at the level C1-C7 (from the first to the seventh cervical vertebra) are extremely rare. This usually occurs after an isolated spinal injury in the cervical spine. |
| Pectoral | Rarely | The thoracic vertebrae are designated Th. Perineural cysts at the Th1-Th12 level are practically not found. |
| Lumbar | Seldom | The lumbar spine is affected more often than the cervical and thoracic. The vertebrae in this section are designated by the letter L. |
| Sacral (sacral) | In 95% of cases |
Most often, Tarlov's cysts form in the sacrum area. The vertebrae in this spine are designated by the letter S. The sacral spine consists of 5 vertebrae (S1, S2, S3, S4, S5). Tarlov's cyst at the level of S2 vertebra occurs in half of the cases. With about the same frequency, formations at the S1 level are detected, the remaining sacral vertebrae are less often affected. |
Causes of occurrence
There is no single reason that would lead to the formation of this pathology. Heredity plays a certain role in the development of the disease. Various factors can affect:
- Spine injury.
- Inflammatory processes in the back.
- CSF hypertension (increased pressure of cerebrospinal fluid).
- The consequences of surgery.
The main symptoms
Small perineural formations are asymptomatic. If the size increases, the cystic neoplasm compresses the nerve endings, which leads to discomfort. Symptoms vary, but, as a rule, back pain is the main symptom of the pathology. 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;
- the irradiation of pain depends on which spinal nerve is compressed.
| Symptom name | Description |
| Pain |
Back pain is the main symptom of the disease. Painful sensations arise 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 - pain in the thoracic region; L1-L5 - back pain; S1-S5 - pain in the lower back. The pain can radiate to the lower extremities, groin, lower abdomen. In this case, pain in the back is often accompanied by weakness in the lower extremities, which is associated with damage to the corresponding nerves. |
| Dysfunction of the pelvic organs |
A perineural sacral cyst 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 urge or painful urination; Constipation or diarrhea. |
| Paresthesia | When the nerves are compressed, numbness, a creeping sensation 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 the picture of a herniated disc with a pinched nerve;
- rupture of the cyst causes a sharp drop in intracranial pressure, which is accompanied by dizziness and loss of consciousness;
- with long-term existence, cysts can cause destruction of the bone structures of the sacrum, which leads to pathological fractures.
Diagnostic methods
It is impossible to diagnose only by clinical manifestations. Symptoms may indicate a lesion of one or another part 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, you can visualize a cystic formation, determine its localization and size, as well as carry out differential diagnostics 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 mass and the presence of symptoms. In the case of an 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, Tarlov's cyst is surgically removed
Conservative treatment
Conservative treatment includes the use of medication and physical therapy. It will not be possible to completely get rid of the disease with the help of medicines. Conservative therapy is aimed at reducing the severity of symptoms and preventing complications. What medicines are used:
- non-steroidal anti-inflammatory drugs - Dikloberl, Movalis;
- analgesics for relief of pain syndrome - Ketanov, Analgin;
- drugs to improve metabolic processes - Pentoxifylline, Nicotinic acid, B vitamins.
Indications for surgical treatment
If conservative treatment does not help, they switch 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 deficits (sexual dysfunction, pelvic disorders).
How is the operation going
The scope of surgical treatment is determined individually. The size of education, the patient's age, the presence of concomitant diseases are taken into account. The most commonly used methods are aspiration and laminectomy.
| Name of the surgery | Advantages and disadvantages | How is the operation going |
| Content aspiration |
The main advantage of the operation is low invasiveness and ease of implementation. 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 performed 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 the low likelihood of relapse. The disadvantage is high trauma, as a complication, neurological deficit and infection can develop. | A small piece of the vertebral bone is removed above the nerve root. Then the cystic formation is removed with subsequent closure (suturing the wall, plastic defect). |
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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