sacral spine – Neurosurgery Blog

Neurosurgery 98:1156–1165, 2026

This prospective longitudinal study reports clinical and patient-reported health-related quality-of-life outcomes for 417 adults who underwent surgical treatment for symptomatic sacral Tarlov cysts, with standardized assessments at baseline and 3, 6, 12, and 24 months. Using the disease-specific TCQoL alongside SF-36, ODI, and VAS, the study demonstrates statistically significant and clinically meaningful improvements across most domains, low complication rates, and no radiographic cyst recurrence at early follow-up.

The authors detail a microsurgical posterior sacral laminectomy technique with cyst decompression, dural sleeve wrapping, and laminar reconstruction, and report sustained benefits through 2 years, including increased tolerated sitting time and reduced opioid use. Limitations include attrition and missing data addressed by imputation, and the paper advocates broader adoption of the TCQoL for standardized Tarlov cyst research.

Study aim Assess whether surgical treatment for symptomatic sacral Tarlov cysts improves validated general and disease-specific health-related quality of life (HRQoL) through 2 years post-op, and whether outcomes change from year 1 to year 2.

Design & cohort Retrospective analysis of prospectively collected longitudinal outcomes for adults undergoing first-time surgery for ≥1 sacral Tarlov cyst (2008–2023), performed by a single neurosurgeon; 417 patients (mean age 52.5, 91.1% female).

Outcome measures Primary outcome was the TCQoL (11-item disease-specific scale); secondary measures included VAS pain (rest/activity), ODI, and SF-36, collected pre-op and at 3, 6, 12, and 24 months.

Surgical technique Posterior sacral laminectomy with microsurgical dissection, cyst drainage to normalize root caliber, wrapping the cystic nerve root with bovine pericardium dural substitute sleeve to limit refilling, and covering the laminar window with a resorbable plate/screws.

2-year improvements (key metrics) Significant improvements from pre-op to 2 years in TCQoL (3.2→2.1), VAS pain at rest (4.5→2.3) and activity (5.7→3.1), and ODI (45.5→31.6) (all P<.001).

SF-36 domains Improvement occurred in 7/8 SF-36 scales (Physical Functioning, Physical Limitations, Bodily Pain, Vitality, Social Functioning, Emotional Limitations, Mental Health), while General Health was not statistically significant in the imputed analysis.

Year 1 to year 2 change Most subscales did not change significantly from 1 to 2 years; significant further gains were seen in physical functioning and social functioning (P=.040 and P=.016, respectively).

Sitting tolerance Median tolerated sitting time increased from 15 minutes pre-op to 45 minutes at 2 years post-op.

Operative Neurosurgery 30:379–384, 2026

This article validates the 11-item Tarlov Cyst Quality-of-Life (TCQoL) scale for male patients undergoing surgical treatment of sacral Tarlov cysts, demonstrating good internal consistency (Cronbach α = 0.85), significant postoperative improvement on nine items, and strong concurrent validity with ODI and SF-36 physical function and pain subscales. The TCQoL showed large responsiveness (SRM = 0.81) and correlated with VAS pain measures.

Methods include prospective preoperative and 3-month postoperative administration of TCQoL, ODI, SF-36, and VAS in 46 male patients treated surgically between 2016–2023, with detailed psychometric analyses assessing discriminative validity, construct validity, and responsiveness; limitations noted include small sample size, single-surgeon single-center design, and 20% attrition.

TCQoL Validation in Men: The Tarlov Cyst Quality-of-Life (TCQoL) scale, previously validated in women, was successfully validated for male patients undergoing surgical treatment for symptomatic sacral Tarlov cysts, demonstrating good internal consistency (Cronbach α = 0.85) and discriminative validity.

Study Population: The study included 46 male patients (final sample) with an average age of 48.4 years, mostly presenting with multiple sacral cysts and a median symptom duration of nearly 35 months.

Surgical Technique: Surgery involved a posterior approach with laminectomy, cyst drainage, and wrapping of the nerve root with a bovine pericardium sleeve to prevent refilling, followed by closure with a resorbable plate.

Symptom Improvement: Significant improvement was observed in 9 of 11 TCQoL items postoperatively, especially for discomfort while sitting, sacral pain, lower extremity pain, and weakness; sexual function items showed no significant change.

Correlation with Established Measures: The TCQoL showed strong positive correlation with the Oswestry Disability Index (ODI) (r = 0.63, P < .001) and moderate to strong negative correlations with key SF-36 subscales (physical function, bodily pain, vitality, and social functioning), indicating good concurrent validity.

Scale Responsiveness: The standardized response mean (SRM) for TCQoL was 0.81, indicating a large effect size and sensitivity to clinical change after surgery.

Limitations: The study is limited by a small sample size (reflecting the rarity of Tarlov cysts in men), single-center and single-surgeon design, and a 20% attrition rate; findings may not generalize to non-sacral or non-Tarlov cysts.

Clinical Utility: The TCQoL can now be used as a disease-specific HRQoL tool for both male and female patients with symptomatic sacral Tarlov cysts, supporting standardized outcome measurement in future research and clinical practice.

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