Clinical Findings of Tarlov Cyst According to Its Location and Level in Lumbosacral Spine on Magnetic Resonance Imaging

Background: Tarlov cysts are cerebrospinal fluid–filled sacs that most frequently arise in the lumbosacral region of the spine. Although often asymptomatic, they can present with a spectrum of neurological deficits when exerting mass effect on adjacent nerve roots. Symptoms such as numbness, pain, reflex loss, and bowel or bladder disturbances significantly affect patients’ quality of life. Magnetic resonance imaging (MRI) remains the gold standard for detection and characterization of these lesions, offering detailed insights into their location, size, and relationship with surrounding structures. Objective: To evaluate the clinical manifestations of Tarlov cysts in relation to their level and anatomical location using MRI in patients presenting with neurological deficits. Methods: A descriptive cross-sectional study was conducted at Ghurki Trust and Teaching Hospital, Lahore, enrolling 60 patients under 40 years of age who presented with neurological complaints. Patients with claustrophobia, pacemakers, cochlear implants, or metallic implants were excluded. Data were collected using structured questionnaires and standardized proformas, and all patients underwent MRI for assessment of Tarlov cysts. A non-probability convenient sampling technique was adopted. Statistical analysis was performed using SPSS version 25 and Microsoft Excel, with descriptive statistics applied to evaluate clinical features and cyst locations. Ethical approval was obtained, and informed consent was taken from all participants. Results: Of the 60 patients, 40 (66.7%) were female and 20 (33.3%) were male. The most common neurological symptom was numbness, observed in 50 patients (83.3%), followed by loss of reflexes in 40 patients (66.7%). Localized mass effects due to cyst compression were noted in 20 patients (33.3%), while bowel dysfunction occurred in 10 patients (16.6%). MRI revealed cyst localization most commonly in the sacral region in 28 patients (46.7%), followed by the lumbosacral region in 24 patients (40%), the cervical region in 14 patients (23.3%), and the lumbar region in 8 patients (13.3%). Conclusion: The study demonstrated that Tarlov cysts were more common in females, with the sacral and lumbosacral levels being the most frequently involved sites. The clinical burden was predominantly neurological, with numbness and reflex loss being the most prevalent deficits. MRI proved to be indispensable in diagnosis, highlighting the importance of early recognition to prevent chronic complications.