CERVICAL NERVE ROOT "CYSTS" BY

DURING the last century brachial neuralgia has been extensively investigated but, amongst the many causes of pain described in the literature, cystic changes within the cervical nerve roots have been mentioned only once (Smith, 1962). Similar cystic lesions in the sacral nerve roots were first described by Marburg (1902) and Nageotte (1902), and subsequently Hinrichs (1932) reported their presence in the upper lumbar and thoracic nerve roots. The most detailed reports of lumbo-sacral nerve root cysts were, however, published in a series of papers by Tarlov in the years 1938-53, and, since this time, the lesions have been known as "Tarlov's cysts " or "perineural cysts. " This author based his conclusions on a study of 13 patients with cystic lesions of the lumbar and sacral nerve roots and, in a monograph published in 1953, presented a comprehensive discussion on the histology, the extent and frequency of occurrence and also the possible aetiology of these lesions. The clinical significance of sacral nerve root cysts was also first appreciated by Tarlov (1948) when he published a case report of a patient with pain radiating into the hip and thigh, which was attributable to a large cyst compressing one of the sacral nerve roots. Following this, several authors, notably Schreiber and Haddad (1951), Schurr (1955) and Abbott, Retter and Leimbach (1957) also presented clinical reports of patients with nerve root cysts, and, with the increasing use of myelography as a diagnostic aid, these lesions have now been demonstrated both in patients with radicular symptoms and occasionally in asymptomatic adults (Taheri, Riemenschneider and Ecker, 1952; Strully and Heiser, 1954; and Seaman and Furlow, 1956). In the present study, examination of the cervical nerve roots has also revealed the presence of cystic lesions which, from their histological appearance and constant situation at the junction of the posterior nerve root and the dorsal root ganglion, appear to be similar to those previously described in the lumbo-sacral nerve roots. by guest on