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969 - Management of Lower Extremity Radiculopathy Secondary to a Thoracolumbar Tarlov Cyst in a Marfanoid Patient: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

BV

Brian Vu, MD

Resident Physician
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States

Co-Author(s)

KM

Kashif Malik, MD

Resident Physician
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States

Corresponding Author(s)

EV

Emmanuel Villalpando, MD

Resident Physician PGY-2
Casa Colina
Winnetka, California, United States
RM

Richard Martirosian, MD

Resident Physician PGY2
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
HG

Hunter Goldsmith, MD

PGY2
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States

Case Diagnosis: 43-year-old male with a thoracolumbar Tarlov cyst and suspected Marfan syndrome presenting with bilateral radiculopathy.

Case Description: 43-year-old male presented with back pain and numbness radiating to the bilateral lower extremities. He denied saddle anesthesia nor bowel/bladder issues. Exam showed normal limb strength. MRI Thoracic and Lumbar Spine showed a large cerebral spinal fluid collection in the right aspect of the central canal, causing mass effect at T9 through L1. CT Myelogram confirmed a 26x9mm cyst at T11. He underwent a T9-T12 laminoplasty and T11 mass resection, later identified as a Tarlov cyst. Post-operatively, symptoms had improved. On acute rehabilitation admission, he was continued on oral and IV opioids. Intake exam revealed a marfanoid appearance. Transthoracic echocardiogram and CTA Chest showed ascending aortic dilation. He later had an assisted fall with new onset right leg weakness, spasms, and pain. MRI spine showed no acute changes. Medication regimen was adjusted to include pregabalin, carisoprodol, baclofen, pramipexole, and duloxetine. The patient's pain continued to be intense, but stable.

Discussions: Tarlov cysts are often underdiagnosed, despite its strong association as a cause of radiculopathy. Connective tissue diseases likely increase the risk of developing such cysts. Prior literature documented Marfan syndrome patients who develop Tarlov cysts with symptoms corresponding to their location - such as hydronephrosis and pelvic pain.. In the spine, these cysts commonly appear sacrally and manifest as a sacral meningocele. On the contrary, our patient had a lesion more superior with radiculopathy and function impact. Surgical intervention provided initial symptom relief, though post-op exacerbation in the right leg. While pain continued to be intense, a multimodal approach and adaptive approach stabilized and prevented symptom worsening.

Conclusions: Tarlov cysts should be considered in a Marfan syndrome patient presenting with radicular symptoms, necessitating multimodal pain management with possible surgery.