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Pain and Spine Medicine

Spinal Cord Stimulation as a Minimally Invasive Alternative to Spinal Surgery for Refractory Tarlov Cyst-related Pain: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Primary Author(s)

  • Michelle Nwufo, MS

    Medical Student
    University of California, Los Angeles David Geffen School of Medicine
    Los Angeles, California

    • Co-Author(s)

  • AB

    Alexandre Bourcier, Other

    Medical Student
    University of California Los Angeles David Geffen School of Medicine
    Los Angeles, California

    • Poster Presenter(s)

  • Christina Im, Other

    Medical Student
    David Geffen School of Medicine at UCLA
    Los Angeles, California

    • Co-Author(s)

  • Jane Phan, Other

    Medical Student
    David Geffen School of Medicine
    Westminster, California

  • MH

    Miad Hadaegh, DO

    Interventional Spine Fellow
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Santa Monica, California

  • CM

    Colton Malesovas, MD

    Spine Fellow
    University of Colorado PM&R Program
    Denver, Colorado

  • JJ

    Jae H. Jung, MD

    Professor
    VA Greater Los Angeles Healthcare System (UCLA) PM&R Program
    Los Angeles, California

  • KY

    Kyle Yang, MD

    Assistant Fellowship Director
    UCLA Spine Center Spine Medicine Fellowship
    Los Angeles, California

  • JD

    Jonathan Droessler, MD

    Interventional Spine Physiatry
    UCLA
    Los Angeles, California

Disclosure(s):
Michelle Nwufo, MS: No financial relationships to disclose
Christina Im, Other: No financial relationships to disclose
Jane Phan, Other: No financial relationships to disclose
Case Diagnosis: A 77-year-old female with a history of severe right lower extremity radicular pain in the setting of an identified perineural (Tarlov) cyst in the right S1 nerve root sleeve.

Case Description or Program Description: Patient presented to clinic with right lower extremity radicular pain due to a large, compressive S1 Tarlov cyst refractory to conservative treatment. Transforaminal epidural steroid injection targeting S1 foramen provided minimal pain relief. Due to high risk of cerebrospinal fluid (CSF) leakage, patient was deemed ineligible for surgery. Alternatively, she underwent a spinal cord stimulator (SCS) trial. Patient reported >70% pain reduction and improved walking tolerance with Fast-Acting Sub-Perception Therapy (FAST) programing. Optimal coverage spanned the T10 vertebral body. She then underwent implantation of percutaneous SCS leads with non-rechargeable implantable pulse generator (IPG). At one-month post-op, patient reported persistent right upper buttock discomfort due to IPG pocket site pain prompting a revision procedure exchanging the IPG with a smaller rechargeable IPG into a deeper pocket.

Setting: Academic Spine Center

Assessment/Results: Patient reported immediate relief of pocket pain and sustained improvement in right lower extremity radicular symptoms. At one-month and three-month follow-ups, she continued to demonstrate significant pain reduction, allowing her to taper off opioid analgesics. Additionally, she experienced improved functional mobility, enabling independent performance of activities of daily living (ADLs).

Discussion (relevance): To our knowledge, this is the first reported case of percutaneous SCS implantation for Tarlov cyst-associated pain without prior surgical intervention. This case provides insight into the potential efficacy of SCS as a minimally invasive alternative to spine surgery for Tarlov cyst-induced radiculopathy.

Conclusions: SCS may serve as a viable treatment option for patients with Tarlov cyst-related pain who are not surgical candidates. It has the potential to offer sustained pain relief, reduction in opioid analgesic use, and functional improvements.