1132 - Cyst and Desist: Traumatic Unmasking of Symptomatic Tarlov Cysts

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AZ

Aaron Zell, DO

PM&R PGY-2
Nassau University Medical Center
Copiague, New York, United States

Co-Author(s)

NT

Naveed Tariq, DO

PM&R Resident
Nassau University Medical Center
East Hempstead, New York, United States
MF

Michael Fedorovsky, DO

PM&R PGY-2
Nassau University Medical Center
East Hempstead, New York, United States
AA

Aruba Asad, DO

PM&R PGY-2
Nassau University Medical Center
East Hempstead, New York, United States

Submitter(s)

AZ

Aaron Zell, DO

PM&R PGY-2
Nassau University Medical Center
Copiague, New York, United States

Case Diagnosis: perineural (Tarlov) cysts

Case Description: A 23-year-old male with a history of a high-impact motorcycle accident in June 2024 sustained multiple orthopedic injuries, including pelvic fractures and right femur, radius, and hand fractures requiring surgical repair. He presented to outpatient PM&R with persistent right lower extremity weakness, gait abnormality, and impaired ADLs. EMG studies (9/2024 and 2/2025) confirmed right-sided lumbosacral plexopathy with absent motor and sensory conduction. MRI (9/2024) showed traumatic edema engulfing the right extraforaminal L3–S1 nerve roots and multilevel Tarlov cysts displacing the thecal sac without significant foraminal stenosis. Follow-up MRI (3/2025) demonstrated severe foraminal stenosis at L2–L5 due to enlarging right-sided Tarlov cysts. The patient continues with physical and occupational therapy, osteopathic manipulative treatment, and awaits neurosurgical evaluation for potential nerve transplant. His recovery remains limited by persistent neuropathy.

Discussions: Symptomatic Tarlov cysts are a rare cause of lower extremity neuropathy and weakness in post-traumatic patients. These perineural cysts can cause nerve root compression, leading to pain, sensory deficits, and motor weakness. This patient’s right lumbosacral plexopathy and lower extremity dysfunction are likely exacerbated by Tarlov cyst-induced foraminal stenosis. Addressing these cysts requires a multidisciplinary approach, combining neurosurgical evaluation for potential decompression or nerve grafting with rehabilitation strategies focused on strength, mobility, and pain management. Physical and occupational therapies remain essential to optimize functional recovery, while symptom control with medications and osteopathic manipulative treatment may complement care. Early recognition and integration of these therapeutic modalities can improve outcomes for patients with Tarlov cysts complicating plexopathies after trauma.

Conclusions: A post-traumatic lumbosacral plexopathy in a 23-year-old male is complicated by worsening Tarlov cyst-induced foraminal stenosis, contributing to persistent lower extremity weakness. This case highlights the importance of multidisciplinary PM&R management—including therapy, pain control, and neurosurgical evaluation—in addressing complex neurologic impairments following trauma.