Minimally Invasive Interventional Therapy for Tarlov Cysts Causing Symptoms of Interstitial Cystitis

Background: Tarlov cysts (TC) are present in 4.6% of the population and representa potential source of chronic pain. When present at lumbosacral levels, symptomsare classically described as perineal pain/pressure, radiculopathy, and headache.Treatment outlined to date primarily includes cyst drainage with fibrin glue sealantand surgical interventions.Objectives: We present 2 cases in which TC presented with signs andsymptomatology consistent with interstitial cystitis who were treated with caudalepidural steroid injections.Methods: Patients with urinary bladder pain and urgency received urologicalworkups demonstrating hallmark features of interstitial cystitis including cystoscopicevidence of glomerulations. Radiographic imaging identified TC to be present onsacral nerve roots. Since pelvic pains could represent compressive radiculopathy ofsacral roots, a cautious trial of minimally invasive caudal epidural steroid injectionswas performed.Results: Both patients attained nearly 100% relief of pain for a period rangingfrom 6 months to 2 years following low volume, targeted caudal epidural steroidinjection. They continue to be followed clinically and continue to report benefit withthis treatment.Limitations: This limited case series is retrospective in nature and potentialcomplications have been noted by others in association with TC.Conclusions: Use of caudal epidural steroid injections proved beneficial in thetreatment of pelvic pain symptomatology and so may be considered as an option inpatients with identified sacral TC.Key words: Interstitial cystitis, pelvic pain, caudal epidural steroids, Tarlov cysts