A nerve root cuff cyst is a benign pathologic lesion located in the nerve root and is usually not serious.
Nerve root cuff cysts, which mostly occur in the lumbar and low lumbar nerve root cuffs, are characterized by the formation of a cystic structure containing cerebrospinal fluid between the lining of the nerve root and the fasciculus, and are a special type of epidural spinal cysts (i.e., Tarlov’s cysts) that contain spinal nerve root fibers.
Asymptomatic patients are usually followed up for observation; symptomatic first-time patients may be treated conservatively with nonsteroidal anti-inflammatory drugs, painkillers, hormones, and physical therapy.
For symptomatic patients who require minimally invasive treatment, refuse surgery, or have contraindications to surgery, CT-guided percutaneous simple cyst aspiration (currently this technique is not recommended as a means of treatment, but as a means of diagnosis) and percutaneous aspiration, fibrin glue injection and tamponade are feasible.
The surgical modalities used for the treatment of this cyst are partial excision of the cyst wall + nerve root cuff plasty, autologous fat/muscle-protein capsulorrhexis microfilling, and cyst shunting.
The choice should be made on a case-by-case basis. The cyst may recur after aspiration or partial excision, whereas the symptoms can be relieved in most patients after complete excision.