Ultrasound - Guided C7 Nerve Root Injection for Radicular Pain Secondary to a Tarlov Cyst in a National Carrom Player

Dr. Yeluripati Ravali, Dr. Pavan Kumar Bichal, Dr. Kone Rekha

Abstract: Background: Tarlov cysts are nerve root cysts that contain cerebrospinal fluid (CSF) and are most commonly located at S2 - S3 level. They develop between the perineurium's protective layer and the endoneurium adjacent to the dorsal root ganglion. The majority of these cysts are asymptomatic, while few are symptomatic and are typically discovered incidentally through MRI scans. Case Presentation: A 42 - year - old male, national - level professional carrom player, presented with a 3months history of progressively worsening pain radiating down his right upper limb. Upon physical examination tenderness was noted over the posterior aspect of the cervical spine, particularly at C6 - C7 level. A magnetic resonance imaging (MRI) scan of the cervical spine, revealed a Tarlov cyst located at the C7 nerve root. The patient was treated conservatively with gabapentin, which provided slight relief from pain. Subsequently, an ultrasound - guided injection was planned by administering 4 mg of dexamethasone, 2 ml of 0.5% bupivacaine perineurally around the right C7 nerve root. Finally, patient reported sustained pain relief without significant exacerbation of pain. Conclusion: Targeted nerve root injection under ultrasound guidance serves as an effective method for managing symptomatic Tarlov cysts, while MRI serves as non - invasive technique for identifying Tarlov cysts.

Keywords: Tarlov cyst, MRI, Local anesthetics, Ultrasound - guided C7 nerve root injection