Microsurgical reinforced radiculoplasty for symptomatic sacral Tarlov cysts in children: a retrospective study assessing safety and efficacy.

Symptomatic sacral Tarlov cysts are rare in the pediatric population. Traditional surgical methods are associated with high recurrence rates and risks of neurological injury. Microsurgical reinforced radiculoplasty (MRR), which focuses on reconstructing the nerve root sleeve to obliterate the cerebrospinal fluid communication, may offer a superior alternative. This study aimed to evaluate the safety and efficacy of MRR in children. We conducted a retrospective analysis of 24 consecutive pediatric patients (<18 years) with symptomatic sacral Tarlov cysts who underwent MRR at our institution between March 2021 and August 2025. The primary outcome was the change in the Japanese Orthopaedic Association (JOA) score for low back pain. Secondary outcomes included symptomatic improvement rates, cyst reduction on MRI, and perioperative complications. The mean age was 15.14 ± 2.63 years. The mean preoperative JOA score significantly improved from 19.58 ± 1.47 to 24.04 ± 2.01 at the final follow-up (mean 18.68 ± 11.33 months) (P < 0.001). All JOA subscales except bladder function showed significant improvement (P < 0.05), with no statistical significance in bladder function (P=0.16). Symptom improvement rates were 89.47% for lumbosacral pain, 87.5% for sensory disturbances, 83.33% for limb weakness, and 100% for both bowel and urinary dysfunction. Postoperative MRI demonstrated significant cyst reduction or resolution in all patients, with no recurrence observed during the follow-up period. Two minor complications (wound fat liquefaction and CNS infection) occurred and resolved with conservative management; no serious surgery-related neurological deficits were observed. In this preliminary study, MRR appears to be a safe and effective treatment for symptomatic sacral Tarlov cysts in children, resulting in significant neurological functional improvement and excellent cyst control with a favorable safety profile. It represents a promising nerve-sparing surgical strategy for this challenging pediatric condition based on preliminary clinical evidence. Further large sample, multicenter prospective studies with long-term follow-up are urgently needed to validate these short-term findings.