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SACRAL NERVE-ROOT CYSTS Another Cause of the Sciatic or Cauda Equina Syndrome By I. M. TARLOV, M.D.

SACRAL NERVE-ROOT CYSTS
Another Cause of the Sciatic or Cauda
Equina Syndrome
By
I. M. TARLOV, M.D.
Professor of Neurology and Neurosurgery
New York Medical College
New York City
CHARLES C THOMAS • PUBLISHER
Springfield • Illinois • U.S.A.
CHARLES C THOMAS • PUBLISHER
BANNERSTONE HOUSE
301-327 EAST LAWRENCE AVENUE, SPRINGFIELD, ILLINOIS, U.S.A.
Published simultaneously in the British Commonwealth of Nations by
BLACKWELL SCIENTIFIC PUBLICATIONS, LTD., OXFORD, ENGLAND
Published simultaneously in Canada by
THE RYERSON PRESS, TORONTO

Printed in the United States of America
TO MY WIFE
Preface
Schmorl and Junghanns'12 important study of the anatomy and pathology of intervertebral discs (1932) laid the groundwork for the later demonstration by Mixter and Barr (1934)8 of the discs' relation to back pain, sciatica and allied symptoms.
The work of these men led to the successful treatment of patients suffering from such syndromes. Removal of herniated intervertebral discs brought remarkable relief and
gave surgeons confidence in their ability to help sufferers through operation.
Occasionally, however, surgery resulted in negative explorations. It was one of these negative explorations, in fact, that led to my proof, in 1948, that perineurial cysts of the
sacral nerve roots are capable of causing identical symptoms, which can also be successfully treated by operation. Ten years earlier, in 1938, I had demonstrated this pathological condition at autopsy,20 but had set it down as a chance finding of
no known clinical importance. Since 1948 the frequency of perineurial cysts has been confirmed at both autopsy and operation. They have been shown to cause sciatica and various sacro-coccygeal syndromes. As physicians become more aware of the existence of these cysts, more of them will doubtless be found. The purpose of the present monograph is to sharpen this awareness by spreading knowledge of the cysts. Patients hitherto thought to be suffering from obscure and even psychological ailments, but actually
harboring cysts, will thus be given relief.

Contents
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
I. HISTORICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
II..
STRUCTURE OF NERVE ROOTS 12
Interstitial Tissue of the Central Glial Segment of the
Nerve Root . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Interstitial Tissue of the Peripheral Segment of the Nerve
Root . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Variations in Length of Central Glial Segments of Spinal
Nerve Roots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Differentiation of Sensory and Motor Nerve Roots . . . . . . . . . 23
Differences in the Nerve Fiber Centrally and Peripherally 29
Ectopic Ganglion Cells and Glial Cells . . . . . . . . . . . . . . . . . . . 29
III. STRUCTURE OF THE FILUM TERMINALE . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Gross Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Microscopic Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Analogies in Structure of Filum Terminale and Nerve
Root . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
IV. RELATION OF MENINGES TO NERVE ROOTS AND FILUM
TERMINALE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
V. LOCATION AND GROSS APPEARANCE OF SACRAL PERINEURIAL
CYSTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
VI. HISTOLOGY OF PERINEURAL CYSTS . . . . . . . . . . . . . . . . . . . . . . . . . . 56
VII. PATHOGENESIS OF PERINEURIAL CYSTS . . . . . . . . . . . . . . . . . . . . . . . . . 66
VIII. CLINICAL...

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