Nerve root sheath plasty under microscope in patients with Tarlov cysts: an efficacy analysis

Zhaocong ZHENG; Liangfeng WEI; Liang XUE; Yehuang CHEN; Haiyun LIU

ABSTRACT

Objective:

To explore the curative efficacy of nerve root sheath plasty under microscope in treatment of patients with Tarlov cysts.

Methods:

A total of 41 patients with symptomatic Tarlov cysts, admitted to our hospital from March 2016 to December 2019, were collected; these patients received surgical treatment by nerve root sheath plasty under microscope and neuroelectrophysiological monitoring. The microsurgical efficacy was evaluated by changes of pain visual analogue scale (VAS) scores and lumbar Oswestry dysfunction index (ODI) before and one week, 3 months, and 6 (or 12) months after surgery.

Results:

The VAS scores and lumbar ODI of 41 patients one week, 3 months, and 6 (or 12) months after surgery were significantly reduced as compared with those before surgery, and presented a gradually decreased trend, with statistically significant differences between each time point ( P<0.05). The median of improvement rate of lumbar ODI was 72.7% (58.9%, 79.7%) curative effect was excellent in 19 patients (improvement rate of lumbar ODI>75%), good in 14 patients (51%≤improvement rate of lumbar ODI≤75%), passable in 3 patients (26%≤improvement rate of lumbar ODI≤50%), and poor in 5 patients (improvement rate of lumbar ODI≤25%), enjoying rate of excellent and good curative effect as 80.5% (33/41). Postoperative cerebrospinal fluid leakage occurred in two patients without infection. Cyst recurrence occurred in one patient on the 3 rd d of surgery due to loosening of the suture of the access hole, and no recurrence occurred after the second surgery.

Conclusion:

The compression of Tarlov cysts on nerve root can be safely and effectively relieved by nerve root sheath plasty under microscope and neuroelectrophysiological monitoring; the symptom relief rate is high and it is not easy to recur.