Журнал позвоночника

An Epidurogram During Fluoroscopy-Guided Caudal Epidural Reveals an Asymptomatic Tarlov Cyst in a Patient with Lumbar Radicular Pain: A Case Report

Abstract

Revuelta M, Bausili M, Melo M and Catala E

Objective: Tarlov cysts are cerebrospinal fluid dilatations of the nerve root sheath at the dorsal root ganglion level. We report the incidental finding of a Tarlov cyst during a fluoroscopy-guided caudal epidural injection in a patient with acute lumbar radicular pain due to disc herniation.

Case report: A 76-year-old male was scheduled for an epidural steroid injection (ESI) for acute L5 radicular pain caused by a paracentral disc nucleous pulposus herniation. The ESI was administered via a caudal route because the patient had back surgery at the L3-L4 for Mal de Pott tuberculoses when he was 23-years old. The epidurogram revealed a fusiform image at the sacral level and the procedure was stopped. Afterwards, an MRI showed a sacral cyst of 50 × 18 mm and a left paracentral disc herniation at L4-L5 with L5 root compression.

Conclusion: The use of fluoroscopy with epidurogram during a caudal ESI allowed us to confirm epidural needle placement and to observe the cephalic flow of contrast medium into the level and side to treat. Without fluoroscopy, we would not have found this asymptomatic Tarlov cyst.