1464. A Systematic Comparative Outcome Analysis of Surgical versus Percutaneous techniques in the management of symptomatic sacral perineural (Tarlov) cysts: A Meta-analysis.

Authors: Mayur Sharma, MD, MBBS; Pooja SirDeshpande, MD; Beatrice Ugiliweneza; Nicholas Dietz, MD; Maxwell Boakye (Louisville, KY)

Introduction:

Symptomatic Perineural or Tarlov cysts (TCs) are a rare cause of chronic low back pain. Given the rarity of the disease, there is no literature consensus regarding the optimal management of these cysts.

Methods:

We conducted the comparative outcome analysis of symptomatic TCs treated with surgical (Group A, 32 studies, n=333) vs. Percutaneous interventions (Group B, 6 studies, n=417). The search was performed using the PubMed, Medline, Cochrane and Ovid databases up to 2018 were included in the analysis. The MeSH search terms used were “Tarlov cyst”, “sacral perineural cyst”, “sacral nerve root cyst”, “meningeal cyst of the sacral spine”, “extra meningeal cyst with spinal nerve root fibers”, “spinal extradural arachnoid pouch,” and “cyst of the sacral nerve root sheath”.We used statistical tests for two proportions using the “N-1” chi-square test with free version of MedCalc for Windows for comparison among the groups.

Results:

Overall symptomatic improvement was reported in 83.5% of patients in both groups however; exacerbation of pre-procedural symptoms was significantly higher in-group B as compared to group A (10.1% vs. 3.3%, p=0.0003). The overall complication rate in surgical and non-surgical group was 21% and 12.47% respectively. Transient Sciatica was the most common complication in both the groups (17% vs 8%,p=0.017). Incidence of cyst recurrence was much lower in-group A compared to group B (8% vs. 20% p: 0.0018). The mean follow-up for surgical group was 38 +29 months (25 studies, n= 279) while that for non-surgical group was 15 +12 months (4 studies, n: 290), p<0.0001.

Conclusion:

We noted that although the surgical interventions are associated with higher post-procedural complication rates, long-term efficacy and success in terms of cyst resolution were superior following surgery compared to percutaneous techniques in the management of symptomatic TCs. There was no difference in symptom recurrence with either of the techniques.