Dr. Isadore Max Tarlov is especially remembered for his 1938 description of the eponymous perineural
'Tarlov cyst', discovered during an autopsy study. (Tarlov IM: Perineurial cysts of the spinal nerve roots,
Arch Neurol Psych 40:1067–1074, 1938).
Unfortunately, his first publication is still rememberd, and which appeared in the textbooks. The words "not of clinical significance" or "incidental finding" are still referred to among physicians, and with these words still patients are send off home, without proper examination and diagnosis (with the mere few). BUT DID TARLOV WROTE THAT THEY WERE INCIDENTAL FINDINGS AND OF CLINICAL SIGNIFICANCE? NO - HE DID NOT
What is the definition of an incidental finding? An incidental finding is "a finding concerning an individual research participant who has potential health or reproducivity interest and is discovered while conducting research, but falls outside the scope of the study" (Wolf, Managing Incidental Findings in Human Subjects Research, J Law Med Ethics, 2008).
The tarlov study involved an autopsy study of the filum terminal of 30 adult subjects, in which he had found perineural cysts. Cysts that were already found by Marburg, who described 4 cases (1902) of cysts of the spinal ganglia. The cysts were solitary in 3 cases and several in the fourth. Hinrichs (1932) recorded a case in which 3 cysts occurred on the posterior thoracic and lumbar roots, in the area of crossing the root and ganglion. The exact location of origin of the cysts were not determined by either in the reported cases.
Dr. Tarlov found this experience worth capturing, especially since in these cases it was possible to determine the place of origin of the cysts.
YOU CAN'T REALLY CALL THE DISCORVERY OF THESE CYSTS INCIDENTAL, RESEARCH INVOLVED 30 CADAVERS OF ADULTS AND IN WICH THESE CYSTE WERE FOUND IN 5 OF THEM.
What did dr. Tarlov find out more in his first study?
Tarlov: as far as I was aware of, no symptoms or signs referring to cysts. Although the cysts did not appear to have clinical significance in these cases, one wonders whether they are not responsible for the discomfort in
certain cases of sciatica or nerve root pain in which other pathological causes are excluded. This awaits
further studies with clinical and pathological correlations.
Histological examination of the cyst showed no evidence of recent or ancient bleeding, which, if present, would have explained a traumatic origin. In cases where nerve fibres or ganglion cells completely or partially surrounded the cyst, EVIDENCE OF DEGENERATIVE CHANGES WAS PRESENT. Disintegration of myelin shells and nerve fibers was seen in Refuse-Pal and Gros-Bielschowsky preparations and cresyl violet spots revealed chromatosis (a reactive change that occurs in the cell body of damaged neurons) of ganglion cells.
Accumulations of phagocytes (white blood cells) filled with fat or blood pigment occurred, and mucicarmine
revealed a few drops of mucine in large round cells. THERE WAS FAILURE OF NERVE CELLS IN THE CORRESPONDING GANGLION, with prolefartion (growth) of fibroblasts and formation of connective tissue scars. (fibroblasts: cells that produce collagen fibers, these are non-stretchy fibers that ensure firmness of our tissues. In addition, they also create other components of the soil substance, or extracellular matrix, in the connective tissue).
AGAIN, YOU CANNOT TALK ABOUT CLINNICALLY NOT RELEVANT, GIVEN TARLOV'S REACTION, DEGENERATIVE AND NERVE CEL DEATH, AND NECESSARY FURTHER STUDIES.