Tarlov cysts were first discovered and named in 1938. Approximately 5 – 9 percent of our US population is diagnosed with Tarlov cysts by MRI imaging of the spine. Tarlov (meningeal) cysts may or may not cause symptoms right away. Whether you have physical symptoms or not, you may want to become more informed by asking these four important questions:
What Are Tarlov Cysts?
Tarlov cysts, also termed meningeal cysts, are cerebrospinal fluid (CSF)-filled portions of the sacral nerve root outer layering. These fluid filled nerve root cysts typically develop along the posterior nerve roots. The increased volume of CSF in these sacral nerve cysts compresses (or pushes) other neighboring spinal nerves in the sacral area causing progressive physical symptoms.
What Causes Tarlov Cysts?
The exact cause of Tarlov cysts remains unclear. Research studies propose that they may develop as a result of trauma, inflammation, bleeding, ischemic degeneration (degeneration due to a shortage of oxygen secondary to restricted blood supply) connective tissue disorders (such as Marfans) or family history that alter the sacral nerve root structure, allowing CSF fluid to collect.
Some patients diagnosed with Tarlov Cysts report a history of injury or trauma at the sacrum, like falls or accidents involving the tailbone or the base of the spine. Other reports have mentioned blockage of CSF flow around the sacral nerve roots.
What are the Signs and Symptoms of Tarlov Cysts?
The fluid-filled sacral nerve cysts may result to nerve irritation, compression, or damage to neighboring sacral nerves. Sitting, bending over, standing, and walking may increase the pressure on the nerves causing pain and discomfort in the lower back area. Most of the time, the only position that can provide relief is resting flat on one’s back or side. Symptoms may vary from case to case and may flare up or subside depending on the size or severity of the Tarlov cysts and how many neighboring nerves are being compressed.
Other patients that have symptomatic Tarlov cysts may experience:
- Pain at the lower back, especially the buttocks (can be provoked by bending over, standing for extended periods or walking)
- Difficulty sitting
- Weakness of muscles of the lower limbs
- Loss of sensation on the skin from the lower back that may extend to the feet
- Loss of reflexes from waist downwards
- Changes in bladder or bowel function, such as constipation or urinary incontinence
- Changes in sexual function
How Can Tarlov Cysts be Treated?
Symptomatic Tarlov cysts are usually difficult to diagnose because many of the symptoms can mimic other disorders in the spine. Tarlov cysts may accidentally be discovered when patients with sciatica or low back pain undergo a magnetic resonance imaging (MRI) of the lumbar/sacral area. To be appropriately treated, a correct diagnosis is needed. Treatment options also vary depending on the size of the cyst, its location, and severity of the physical symptoms it causes. Interventions can be non-surgical or surgical, whichever is appropriate by patient’s individual condition.
Non-surgical treatment may include any of the following:
- Cyst fluid-aspiration – Drainage of the cerebrospinal fluid (CSF)
- Removal of the CSF from inside the cyst and injecting the cyst area with fibrin glue filling of the space
New surgical techniques may be any of the following:
- Permanent surgical removal of sacral nerve root fluid and treatment to return sacral nerve to original size
- Microsurgical cyst fenestration and imbrication
- Decompressive laminectomy
The benefits of surgical intervention should always be discussed and weighed carefully against its risks. Anyone seeking specific answers, neurosurgical advice, or assistance contact us to schedule an appointment. Our hospital, Pine Creek Medical Center, is conveniently located in Dallas, TX. We are a private, physician-owned hospital serving 3 million patients in Dallas and surrounding cities.
- “Tarlov Cysts: What Are They and How Can They be Treated?.” American Association of Neurological Surgeons. <http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Tarlov-Cyst>.
- “Tarlov Cyst: A diagnostic of exclusion – ScienceDirect.” com | Science, health and medical journals, full-text articles and books.Web. <http://www.sciencedirect.com/science/article/pii/S2210261217303681>.
- Edward , Benzel. “Chapter 115 Tarlov Cysts.” Spine Surgery. Elsevier Health Sciences, 2012. 1135-1136. Web. <http://pdfs.semanticscholar.org/3120/e30398c777fbd86e5c5f776b1f04a8f99b34.pdf>.