ABSTRACT
Tarlov cysts are perineural cysts and are usually found in sacral region. The dorsal nerve root is encased in this type of the cyst. These may or may not be with any of the symptomatology. The entity is infrequently found as an incidental finding. These are cerebrospinal fluid (CSF) filled sacs which are diagnosed on cross sectional imaging modalities especially in magnetic resonance imaging (MRI). Tarlov cysts can cause different type of myelopathies as per their location and size. Methods: We present a series of seven cases where these perineural cysts were found during the routine imaging of lumbosacral spine. All these patients had undergone Magnetic Resonance Imaging (MRI) of lumbosacral spine for backache or some other pelvic complaints. In one case Computerized Tomography (CT) Myelography also helped in diagnosis and related bone remodeling.MR myelography adds to the delineation of CSF wrapping around the spinal cord. Results: Three patients were found to be symptomatic and the intensity of complaints corresponded to the size and location of the cysts. In our three cases, the etiopathogenesis also corresponded to the underlying development of these entities. Four patients were asymptomatic as the size of these cysts were small and not contributing to the complaints of the patient. Conclusion: MRI is the best modality to diagnose these perineural cysts which are responsible for different types of myelopathies .T2WI sequences in non contrast MRI studies are the best in delineating the size, shape, outline and location of these cysts. This also further elaborates their extension to the surrounding regions.MR myelography is adjuvant to more morphological features of these cysts.
ABSTRACT
Progressive myelopathies can be secondary to inborn errors of metabolism (IEM) such as mucopolysaccharidosis, mucolipidosis, and adrenomyeloneuropathy. The available scale, Japanese Orthopaedic Association (JOA) score, was validated only for degenerative vertebral diseases. Our objective is to propose and validate a new scale addressing progressive myelopathies and to present validating data for JOA in these diseases. A new scale, Severity Score System for Progressive Myelopathy (SSPROM), covering motor disability, sphincter dysfunction, spasticity, and sensory losses. Inter- and intra-rater reliabilities were measured. External validation was tested by applying JOA, the Expanded Disability Status Scale (EDSS), the Barthel index, and the Osame Motor Disability Score. Thirty-eight patients, 17 with adrenomyeloneuropathy, 3 with mucopolysaccharidosis I, 3 with mucopolysaccharidosis IV, 2 with mucopolysaccharidosis VI, 2 with mucolipidosis, and 11 with human T-cell lymphotropic virus type-1 (HTLV-1)-associated myelopathy participated in the study. The mean ± SD SSPROM and JOA scores were 74.6 ± 11.4 and 12.4 ± 2.3, respectively. Construct validity for SSPROM (JOA: r = 0.84, P < 0.0001; EDSS: r = -0.83, P < 0.0001; Barthel: r = 0.56, P < 0.002; Osame: r = -0.94, P < 0.0001) and reliability (intra-rater: r = 0.83, P < 0.0001; inter-rater: r = 0.94, P < 0.0001) were demonstrated. The metric properties of JOA were similar to those found in SSPROM. Several clinimetric requirements were met for both SSPROM and JOA scales. Since SSPROM has a wider range, it should be useful for follow-up studies on IEM myelopathies.