Surgical excision of Tarlov cyst

Joe -

I am a 49 year old male. For several months, I have had left leg parasthesia and an electrical jolt sensation going into my left leg and 2 outer left toes. I have also had poorly defined low back discomfort in the sacral area. Pain rating only 2-3 on a scale of 1 to 10. Parasthesia rating was 8-9 on a 1-10 scale.

I am not a doctor goer and waited quite some time in consulting with a physician about it. However when the symptoms started interfering with my job performance, I am a mainframe programmer who sits 90% of the day at a terminal - prolonged sitting, I went to my internist and described the symptoms. He ordered a lumbar MRI which revealed a S1, S2 Tarlov cyst impinging on the S2 nerve root. Physical exam was normal, no bowel or bladder symptoms, although I was having difficulties with spontaneous erections and having "performance" issues.

He referred me to a neurosurgeon for consultation.

Because of size and location, the neurosurgeon first suggested epidural blocks however suggested that these blocks were only palliative and would not address the real issue. When I declined intradurals, he suggested surgical excision.

On October 6th, 2004, I underwent surgical excision of the Tarlov cyst and 3 days later I am back sitting at a computer, comfortable, though sore from the surgical site. He explained the procedure could last anywhere from 3 to 8 hours and reserved the OR for 5 hours. My procedure was completed in just under 2 hours. There was no CSF leakage at the time of surgery or post operatively. I was inpatient 2 days. I was on Kefzol intraoperatively and for 24 hours post op. I am on Decadron for 5 days post op for swelling prevention and treatment.

The parasthesias are gone - I noticed them gone when I awoke in the recovery room. Awesome. Immediate Post operative pain rating was a 5-6 on a scale of 1 to 10, controlled by PCA dosing of 2 mg Morphine every 10 minutes. Loradol took care of post op discomfort after the morning of surgery and the IV was discontinued. I have not had pain medication for 36 hours and am fine.

The surgical procedure consisted of a mini-laminectory at S1-S2 and excision of the Tarlov cyst. He drained the cyst intraoperatively and removed as much cyst structure as possible (80%), then did a subcutaneous fat placement which is designed to remove the possibility of cyst recurrence. The incision was closed in the standard fashion, a dry dressing was applied and activity is as tolerated. No heavy lifting. Standard post-laminectory protocol.

Complications - I have a minor anesthetic bronchitis as the procedure is done in the prone position (face down). I am a smoker and this, I am sure is contributory. I was ambulatory, with assistance the first couple of times, the night of the procedure. I also have some generalized numbness in the buttocks, perineum, scrotal and penile areas - but these should abate with time. The doctor attributes this for both unknown reasons as his work was not in the areas affected and possibly from surgical swelling in the general area.


Updated 2004-10-10

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