Disclosures: Haruki Ishii, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with 6-week-history of right sided low back pain with radiculopathy down to right foot. Pain is exacerbated by prolonged sitting, standing, or laying supine, but is alleviated by laying prone. Patient denied fever, chills, bowel/bladder dysfunction, saddle anesthesia, or unexplained recent weight loss. Patient had an unremarkable physical exam. Patient was prescribed ibuprofen and cyclobenzaprine, and instructed to return to office in one week. At follow-up, patient reported no improvement and now exhibited positive straight leg raise on the right in addition to significant local tenderness at right gluteal and piriformis muscles. Lumbar spine MRI demonstrated small non-enhancing T2 hyperintense lesion at the extraforaminal portion of the right L4-5 nerve root deep to the iliopsoas muscle, favoring a perineural sleeve (Tarlov) cyst. Patient was treated with 7-day-course of prednisone and started physical therapy.

Setting: Tertiary care academic hospital.

Patient: A 62-year-old female. Assessment/

Results: Significant improvement was reported shortly after completion of prednisone. At one month follow-up, patient reported occasional local back pain without radiculopathy and no longer exhibited positive straight leg raise. Patient reported absence of symptoms at two months following prednisone treatment.

Discussion: Tarlov cysts are often incidental findings with an overall prevalence of 4.6% in which only 1% actually result in pain/neurological symptoms (likely secondary to a direct mechanical compression of the nerves). Although Dowsett et al reported surgical treatment resulted in either complete or partial resolution in most cases, the best management is still undetermined due to limited date comparing surgical and nonsurgical options. This case report supports management of symptomatic Tarlov cysts with oral steroids as seen in cases by Mitra et al.

Conclusion: Though it’s rare, Tarlov cysts should be included in differential diagnosis for low back pain with radiculopathy. Oral steroids can be an effective treatment, particularly in those who don’t respond to initial therapies.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/successful-treatment-of-symptomatic-tarlov-cysts-with-oral-steroids-a-case-report/