. 2023 Oct 13;66(1):1–30. doi: 10.1007/s00234-023-03226-6

Table 1.

Incidental radiographic findings and prevalence of Tarlov cysts

Author, report year, country	Study sample	Tarlov cyst prevalence	Summary
Burdan [33] 2013 Poland	• Between January 2011 to December 2012, 842 patients (543 women, 145 men) • Underwent 1.5 T MRI in the cervical, thoracic, lumbar and sacral spine regions	• Overall Tarlov cysts 8.9% (75/842) • Sacral Tarlov cyst 7.6% (64/842)	• Cysts occurred as single cysts (29.3%) or multiple cysts (70.7%) • Tarlov cysts mainly occurred at the S2 (n = 22) and S2/S3 (n = 20) sacral levels • Cyst patterns occurred at all other spinal levels but rarely cervical cysts (n = 3) all occurred in women • Cyst incidence was higher in women than men,
Joo [34] 2009 South Korea	• Between January 2006 and June 2009, 2669 patients (1633 women, 1036 men) • Primary complaints low back pain or sciatica visited the outpatient Dpts of Anesthesiology, Orthopedic Surgery, Neurosurgery, Neurology and Rehabilitation Medicine • Underwent lumbosacral MRI	• Sacral Tarlov cysts 2.5% (67/2669)	• Cysts located below sacral S3 level (n = 21) • Lower lying terminations of dural sacs (below the S3 sacral vertebrae) were found in 1.6% of the 2669 cases • The abnormal position of the dural sac termination results in an more inferiorly extended spinal cavity and presence of Tarlov cysts in the sacrum presented an increased risk of dural puncture with caudal blocks
Kuhn [36] 2017 France	• 1000 adults (604 women, 396 men) age range 18–94 years and 100 children and adolescents (age range 2 months–17 years • Underwent 1100 consecutive sacral 1.5 T MRI	• Sacral Tarlov cysts 13.2% (132/1000)	• Cysts (n = 263) were found in 132 adults (101 women, 31 males), none were found in children or adolescents • Prevalence of cysts increased by age • Mean cyst size 12.8 ± 5.6 mm and mean cyst number was 2.0 ± 1.2 per patient, maximum number was 6 cysts • Cysts mainly affected the S2 (n = 71) and S3 (n = 3) sacral nerve roots • Unusual cyst architecture occurred: endocystic nerve fiber crossing (n = 28), septations (n = 5), bone erosions (n = 70), endopelvic extension (n = 13)
Langdown [37] 2005 Australia	• Over 5 years, 3535 patients • Investigations for lower back pain, sciatica or spinal stenosis • Underwent lumbosacral MRI	• Sacral Tarlov cysts 1.5% (54/3535)	• 54 sacral cysts (38 women, 16 men) • Symptoms included low back pain (n = 30), nerve root pain (n = 17), leg pain (n = 9), neurological loss (n = 5), spinal claudication (n = 5) with durations from months to years • Identified 3 groups based on relationship of symptoms to pathology: group 1, symptoms thought unrelated to sacral cyst (n = 38); group 2, sacral cyst possibly contributory but thought not to be primary cause (n = 9); group 3, sacral cyst directly responsible (n = 7)
Park [13] 2011 South Korea	• Between January 2007 and October 2009, 1268 patients (847 women, 421 men) • Presenting symptoms of chronic back pain and radiating pain • Underwent lumbar 1.5 T MRI for clinically suspected herniated intervertebral disc	• Overall incidental findings 8.4% (107/1,268) • Sacral Tarlov cysts 2.1% (27/1,268)	• Occurrence of pathologies – fibrolipoma (3.2%), Tarlov cysts (2.1%), vertebral hemangiomas (1.5%), synovial cyst (0.8%) and sacral meningocele (0.8%)
Paulsen [5] 1994 Unite States	• 500 consecutive patients (265 women, 234 men) age range 11 to 89 years • Underwent lumbosacral MRI for low back pain	• Sacral Tarlov cysts 4.6% (23/500)	• 22% (5/23) of sacral cysts were thought to have symptoms consistent with cyst location
Senoglu [38] 2012 Turkey	• Between January 2010 and 2012, 1000 patients (641 women, 358 men) • Patients referred to a neurosurgical outpatient clinic primarily for low back pain and/or sciatica • Underwent lumbar MRI • Evaluated for sacrococcygeal abnormalities and the risk of dural sac puncture during caudal epidural blocks	• Sacral Tarlov cysts 1.3% (12/1000)	• Majority of cysts (10/12) were at or below the S3 level • Dedicated sacral MRIs were not performed
Shoyab [39] 2021 Bangladesh	• Between January 2017 and December 2019, 384 patients (202 women, 182 men) • Underwent 3.0 T MRI at all spinal levels (cervical, thoracic, lumbar, sacral) for back pain	• Overall Tarlov cyst 6.5% (25/384) • Sacral Tarlov cysts 6.0% (23/384)	• Majority of cysts were in the sacral region, 1 was in the thoracic and 1 in the cervical spine levels • Prevalence of Tarlov cysts was similar for men (6.0%) and women (6.9%) • Cysts were single level cysts in majority of patients (72%) and occurred mainly (60%) at S1/S2 sacral root level • Mean cyst diameters were significantly greater in the craniocaudal (24 ± 10.25 mm) than the sagittal (9.5 ± 2.07 mm) or transverse (12 ± 2 mm) dimensions

Author, report year, country

Study sample

Tarlov cyst prevalence

Summary

Burdan [33] 2013

Poland

• Between January 2011 to December 2012, 842 patients (543 women, 145 men)

• Underwent 1.5 T MRI in the cervical, thoracic, lumbar and sacral spine regions

• Overall Tarlov cysts 8.9% (75/842)

• Sacral Tarlov cyst 7.6% (64/842)

• Cysts occurred as single cysts (29.3%) or multiple cysts (70.7%)

• Tarlov cysts mainly occurred at the S2 (n = 22) and S2/S3 (n = 20) sacral levels

• Cyst patterns occurred at all other spinal levels but rarely cervical cysts (n = 3) all occurred in women

• Cyst incidence was higher in women than men,

Joo [34]

2009 South Korea

• Between January 2006 and June 2009, 2669 patients (1633 women, 1036 men)

• Primary complaints low back pain or sciatica visited the outpatient Dpts of Anesthesiology, Orthopedic Surgery, Neurosurgery, Neurology and Rehabilitation Medicine

• Underwent lumbosacral MRI

• Sacral Tarlov cysts 2.5% (67/2669)

• Cysts located below sacral S3 level (n = 21)

• Lower lying terminations of dural sacs (below the S3 sacral vertebrae) were found in 1.6% of the 2669 cases

• The abnormal position of the dural sac termination results in an more inferiorly extended spinal cavity and presence of Tarlov cysts in the sacrum presented an increased risk of dural puncture with caudal blocks

Kuhn [36]

2017

France

• 1000 adults (604 women, 396 men) age range 18–94 years and 100 children and adolescents (age range 2 months–17 years

• Underwent 1100 consecutive sacral 1.5 T MRI

• Sacral Tarlov cysts 13.2% (132/1000)

• Cysts (n = 263) were found in 132 adults (101 women, 31 males), none were found in children or adolescents

• Prevalence of cysts increased by age

• Mean cyst size 12.8 ± 5.6 mm and mean cyst number was 2.0 ± 1.2 per patient, maximum number was 6 cysts

• Cysts mainly affected the S2 (n = 71) and S3 (n = 3) sacral nerve roots

• Unusual cyst architecture occurred: endocystic nerve fiber crossing (n = 28), septations (n = 5), bone erosions (n = 70), endopelvic extension (n = 13)

Langdown [37]

2005 Australia

• Over 5 years, 3535 patients

• Investigations for lower back pain, sciatica or spinal stenosis

• Underwent lumbosacral MRI

• Sacral Tarlov cysts 1.5% (54/3535)

• 54 sacral cysts (38 women, 16 men)

• Symptoms included low back pain (n = 30), nerve root pain (n = 17), leg pain (n = 9), neurological loss (n = 5), spinal claudication (n = 5) with durations from months to years

• Identified 3 groups based on relationship of symptoms to pathology: group 1, symptoms thought unrelated to sacral cyst (n = 38); group 2, sacral cyst possibly contributory but thought not to be primary cause (n = 9); group 3, sacral cyst directly responsible (n = 7)

Park [13]

2011 South Korea

• Between January 2007 and October 2009, 1268 patients (847 women, 421 men)

• Presenting symptoms of chronic back pain and radiating pain

• Underwent lumbar 1.5 T MRI for clinically suspected herniated intervertebral disc

• Overall incidental findings

8.4% (107/1,268)

• Sacral Tarlov cysts

2.1% (27/1,268)

• Occurrence of pathologies – fibrolipoma (3.2%), Tarlov cysts (2.1%), vertebral hemangiomas (1.5%), synovial cyst (0.8%) and sacral meningocele (0.8%)

Paulsen [5]

1994 Unite States

• 500 consecutive patients (265 women, 234 men) age range 11 to 89 years

• Underwent lumbosacral MRI for low back pain

• Sacral Tarlov cysts 4.6% (23/500)

• 22% (5/23) of sacral cysts were thought to have symptoms consistent with cyst location

Senoglu [38]

2012

Turkey

• Between January 2010 and 2012, 1000 patients (641 women, 358 men)

• Patients referred to a neurosurgical outpatient clinic primarily for low back pain and/or sciatica

• Underwent lumbar MRI

• Evaluated for sacrococcygeal abnormalities and the risk of dural sac puncture during caudal epidural blocks

• Sacral Tarlov cysts 1.3% (12/1000)

• Majority of cysts (10/12) were at or below the S3 level

• Dedicated sacral MRIs were not performed

Shoyab [39]

2021

Bangladesh

• Between January 2017 and December 2019, 384 patients (202 women, 182 men)

• Underwent 3.0 T MRI at all spinal levels (cervical, thoracic, lumbar, sacral) for back pain

• Overall Tarlov cyst

6.5% (25/384)

• Sacral Tarlov cysts

6.0% (23/384)

• Majority of cysts were in the sacral region, 1 was in the thoracic and 1 in the cervical spine levels

• Prevalence of Tarlov cysts was similar for men (6.0%) and women (6.9%)

• Cysts were single level cysts in majority of patients (72%) and occurred mainly (60%) at S1/S2 sacral root level

• Mean cyst diameters were significantly greater in the craniocaudal (24 ± 10.25 mm) than the sagittal (9.5 ± 2.07 mm) or transverse (12 ± 2 mm) dimensions