Perineural (Tarlov) cysts are most often found in the sacral region and are rare 
in the cervical spine. Although they are usually asymptomatic, a small number of 
those at the lumbosacral level have been known to produce localized or radicular 
pain. Few reports are available on symptomatic perineural cysts in the cervical 
spine and it has not been discussed how they should be managed. We present here 
a case of cervical perineural cysts with persistent radicular pain where the 
pain was adequately managed with repetitive transforaminal epidural steroid 
injection (TFESI). The patient had experienced intractable pain in the posterior 
neck and left upper extremity for more than 7 years. The nature of the pain was 
cramping and a tingling sensation, which was aggravated in the supine position. 
Magnetic resonance imaging revealed a perineural cyst in the neural foramen of 
left C7 root. The patient underwent three repetitive TFESIs targeted at the 
root. Each injection provided incremental relief, which lasted more than 
6 months. Follow-up image revealed shrinkage of the cyst. This case illustrates 
in detail the clinical manifestation of a rare symptomatic perineural cyst in 
the cervical region and to our knowledge is the first to report the beneficial 
effect of repetitive TFESI.