Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, 3001, Heverlee, Belgium.
, Sint-Joris-Weert, Belgium.
Eur Spine J. 2019 Oct;28(10):2237-2248. doi: 10.1007/s00586-019-05996-1. Epub 2019 May 11.
Tarlov cysts (TCs) are dilations of nerve roots arising from pathologically increased hydrostatic pressure (HP) in the spinal canal. There is much controversy regarding whether these cysts are a rare source of pain or often produce symptoms. The aim of this review was to identify the reasons that symptomatic TCs (STCs) are easily overlooked.
The literature was searched for data regarding pathogenesis and symptomatology.
TCs may be overlooked for the following reasons: (1) STCs are considered clinically irrelevant findings; (2) it is assumed that it is clinically difficult to ascertain that TCs are the cause of pain; (3) MRI or electromyography studies only focus on the L1 to S1 nerves; (4) TCs are usually not reported by radiologists; (5) degenerative alterations of the lumbosacral spine are almost always identified as the cause of a patient's pain; (6) it is not generally known that small TCs can be symptomatic; (7) examinations and treatments usually focus on the cysts as an underlying mechanism; however, essentially, increased HP is the main underlying mechanism for producing symptoms. Consequently, STCs may relapse after surgery; (8) bladder, bowel and sphincter dysfunction are not inquired about during history taking. (9) Unexplained pain is often attributed to depression, whereas depression is more likely the consequence of debilitating neuropathic pain. (10) The recognition of STCs is subject to gender bias, confirmation bias and cognitive dissonance and unconscious bias in publishing.
There are several reasons STCs are underdiagnosed, mostly due to persistent misconceptions and biases. These slides can be retrieved under Electronic Supplementary Material.
Tarlov 囊肿（TCs）是源自椎管内病理性液压升高（HP）的神经根扩张。关于这些囊肿是否是疼痛的罕见来源，或者是否经常产生症状存在很多争议。本综述的目的是确定容易忽视有症状的 TCs（STCs）的原因。
搜索有关发病机制和症状学的文献数据。
TCs 可能被忽视的原因如下：（1）STCs 被认为是临床无关的发现；（2）假设临床上很难确定 TCs 是疼痛的原因；（3）MRI 或肌电图研究仅集中在 L1 至 S1 神经；（4）放射科医生通常不报告 TCs；（5）腰骶脊柱的退行性改变几乎总是被认为是患者疼痛的原因；（6）一般不知道小 TCs 可能有症状；（7）检查和治疗通常集中在囊肿作为潜在机制；然而，基本上，HP 增加是产生症状的主要潜在机制。因此，STCs 可能在手术后复发；（8）在病史询问中没有询问膀胱、肠道和括约肌功能障碍；（9）不明原因的疼痛通常归因于抑郁，而抑郁更可能是使人衰弱的神经病理性疼痛的后果；（10）对 STCs 的认识受到性别偏见、确认偏见和认知失调以及发表时无意识偏见的影响。
STCs 诊断不足的原因有几个，主要是由于持续存在的误解和偏见。这些幻灯片可以在电子补充材料中检索。
