From the Guidelines
Lumbar perineural cysts can cause pain, although the provided evidence does not directly address this condition, and the relationship between these cysts and pain is based on general medical knowledge and other studies not included in the provided evidence. When considering the potential causes of lumbosacral plexopathy, as discussed in the study by 1, it's essential to recognize that entrapment neuropathies, inflammatory, autoimmune, hereditary, ischemic, and idiopathic etiologies can all contribute to pain and other symptoms. While the study 1 focuses on the differential diagnosis for nontraumatic lumbosacral plexopathy, including entrapment, inflammatory, autoimmune, hereditary, ischemic, and idiopathic etiologies, it does not specifically mention lumbar perineural cysts as a cause of pain. However, based on general medical knowledge, lumbar perineural cysts, also known as Tarlov cysts, can cause pain due to the compression of adjacent nerve roots, leading to both mechanical pressure and inflammatory responses. Key points to consider in the management of pain potentially associated with lumbar perineural cysts include:
- Conservative management with pain medications (e.g., NSAIDs) and physical therapy
- Activity modification to reduce symptoms
- Interventional procedures for persistent symptoms, such as cyst aspiration with fibrin glue injection
- Surgical options like cyst fenestration or resection in severe cases It's crucial to diagnose these cysts accurately, typically through MRI imaging, as they can be missed on other imaging modalities. Ultimately, the decision to treat should be based on the impact of symptoms on the patient's quality of life rather than the size of the cyst alone.
From the Research
Lumbar Perineural Cysts and Pain
- Lumbar perineural cysts can cause pain, as evidenced by studies that have reported cases of patients experiencing pain due to these cysts 2, 3.
- The pain caused by lumbar perineural cysts can be neuropathic in nature, and may be characterized by sharp, burning, or radiating pain 2, 3.
- The size and location of the cyst can affect the type and severity of pain experienced by the patient, with larger cysts or those that compress the dural sac or nerve roots potentially causing more severe pain 3.
Treatment of Pain Caused by Lumbar Perineural Cysts
- Gabapentin and pregabalin are anticonvulsant medications that have been used to treat neuropathic pain caused by lumbar perineural cysts, and have been shown to be effective in reducing pain in some patients 2, 4, 5.
- Surgical removal of the cyst may also be an effective treatment option for patients who do not respond to conservative treatment, as evidenced by a case report of a patient who experienced significant improvement in pain after surgical removal of a lumbar perineural cyst 3.
Prevalence and Characteristics of Lumbar Perineural Cysts
- Lumbar perineural cysts are relatively rare, and are more commonly found in the sacral region than in the lumbar region 6.
- The majority of patients with lumbar perineural cysts are women, and the average age of patients is around 54 years 6.
- The size of lumbar perineural cysts can vary, with an average longest dimension of around 11 mm 6.