Pine Creek Medical Center Dallas Medical Center Thu, 04 Oct 2018 17:33:26 +0000 en-US hourly 1 Can Sinus Surgery Help? Thu, 04 Oct 2018 17:33:26 +0000 Asthma, Sinusitis, and Allergies: Can Sinus Surgery Help?

In the recent years, there has been increasing cases of allergies, asthma, and sinus problems. While its primary cause is still unknown, many health professionals suspect that it might be due to the environment that is getting more and more polluted.

Some, however, debate that these conditions have to do with many people being ‘too clean’ to the point that they become sensitive to little amount of dirt or allergens. So, when they get exposed to it, the immune system immediately recognizes it as a ‘foreign substance’ and quickly develops a defensive reaction towards it.

Although it may, or may not be the real cause, certain strategies were developed to prevent the increasing number of asthmas, allergies, and sinusitis.

Asthma, Sinusitis, and Allergies

Allergies occur when an individual’s immune system reacts to the substances (allergens) in the environment that might be harmless to other people. These substances include dust, pollens, animal dander, and dust mite excretions. People with allergies to any of these allergens can develop an immune reaction called an ‘allergic reaction.’

When bad allergies are not treated immediately, they can lead to asthma or chronic sinusitis, which is the inflammation of the sinuses. These conditions cause airway problems.

What is a Sinus Surgery?

Unlike other forms of surgery, where a non-functioning part or a diseased organ is removed; sinus surgery involves the creation and re-routing of the pathways in the sinuses.

The old techniques for sinus surgery involve removal of the diseased or damaged sinus lining and tissues to improve the natural drainage of mucus, pus, and other exudates. This is done by creating a drainage pathway for the infected material to be removed and drained out from the sinus cavities.

Nowadays, surgeons employ the use of endoscopic techniques to allow better visualization without the need for a large external incision. As a result, there is less bleeding, swelling, discomfort, pain, and a faster recovery.

Sinus Surgery: How Does it Help?

Recent developments and discoveries in treatment techniques have proven that early intervention reduces the risk of disease progression. There are also many pieces of evidence that verify the many benefits of sinus surgery.

Some of the many advantages include:

  • Reduced pain
  • Less facial pressure
  • Decreased risk for infections
  • Better airway conditions
  • Prevention of inflammation
  • Fewer chances of having nasal drainage
  • Improved quality of life

While sinus surgeries do not necessarily cure someone from being allergic to specific allergens, they do help by opening up airways and help the sinuses be drained of certain exudates such as pus or mucus before the condition becomes worse from infection.


It cannot be stressed more strongly that management and care after surgery are as equally important as the process of the operation itself. Surgeons, physicians, and all the other healthcare staff can only do as much. Like with any other type of surgical procedure, it is always up to the patient to share on how the treatment plan goes because it is part of the patients’ responsibility as well.

When to Have Sinus Surgery

Even though sinus surgery can help you with your allergies, chronic sinusitis, or asthma, we recommend you to use conservative treatments like medications to treat your problems first. If all of the non-invasive treatments failed, or if they are not a good solution to your health concern, then sinus surgery can be an excellent treatment method. Remember, always try non-invasive first before going into any surgery.

In some cases, however, the sooner some individuals take this step (sinus surgery), the fewer health problems and complications arise due to the allergies. For example, if asthma causes chronic fatigue, secondary to being unable to sleep from blocked sinuses, you can talk to your physician and try to consider getting a sinus surgery.

Sinus Surgery at Pine Creek Medical Center

To figure out if you should have sinus surgery, contact Pine Creek Medical Center today. Book an appointment with any of our asthma, sinus, or allergy specialist so we can have your problems taken care of! Our physicians are highly trained to diagnose, manage, and treat any Dallas allergies.




  • “Allergen – Wikipedia.” Wikipedia, the free encyclopedia.  <>.
  • “Asthma and Sinus Surgery – Asthma Center – Everyday Health.” Everyday Health: Trusted Medical Information, Expert Health Advice, News, Tools, and Resources.  <>.
  • “Endoscopic Sinus Surgery: Symptoms, Risks & Complications.”Web. <>.
  • “Top 4 Benefits of Sinus Surgery – New York, NY Sinus Surgeon.” Top 4 Benefits of Sinus Surgery – New York, NY Sinus Surgeon.  <Https:// >.
  • “What is allergy? – Australasian Society of Clinical Immunology and Allergy (ASCIA).” Home – Australasian Society of Clinical Immunology and Allergy (ASCIA).  <>.
  • “Will Sinus Surgery Help My Allergies? – American Sinus Institute.” Balloon Sinuplasty – American Sinus Institute – San Antonio & Houston, TX.  <>.
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Appendectomy Thu, 23 Aug 2018 19:46:47 +0000 What is the Appendix?

The human appendix is a small, 3 to 4-inch tube attached to the cecum – the junction that connects the small bowel (intestine) to the large intestine. It is a worm-like appendage (hence the term appendix), that is also termed as ‘cecal appendix’ or ‘vermiform appendix.’

Do I Need My Appendix?

The function of the appendix has always been a topic for debate. Most of us have heard the word “appendicitis,’ and yet, many people are still unaware of the role that it plays in our digestive system.

Some researchers believed that the appendix of our primitive ancestors served as an organ to digest extra roughage. However, this is only a speculation based on the fact that early humans consumed barks of trees and other plants.

According to Oklahoma State University Physiology Professor Loren G. Martin, as published in Scientific American, the human appendix has a function, contrary to popular belief. He stated that our appendix has a role during fetal development. Around 11 weeks, the appendix appears to be endocrine cells, which is responsible for the production of amines and hormones—assisting homeostasis in the body of the fetus.

What is an Appendectomy?

Appendectomy is a surgical procedure performed by experts to remove an inflamed appendix due to appendicitis. An infected appendix can perforate (burst) anytime and release stool or bacteria in the abdominal cavity.

Signs and symptoms of Appendectomy may include:

  • Pain in the abdomen which usually begins at the umbilical area that extends to the lower right side
  • Loss of appetite
  • Increased pressure and pain when walking
  • Nausea or vomiting
  • Constipation or diarrhea
  • Difficulty standing straight

Why Undergo an Appendectomy?

Medication and therapy won’t cure an infected appendix. The only treatment option that can treat appendicitis is an appendectomy. This procedure will not affect long-term health even if it involves removal of the appendix.

It is better to remove the appendix while in the early stages of the disease than wait before it gets worse. If untreated, the appendix will perforate (burst) and release bacteria and other contents into the abdominal cavity, where the intestines and other digestive organs are located. Infection of the abdominal cavity can result in severe health issues.

What Happens Before an Appendectomy?

As with any surgical procedure, a thorough assessment and evaluation are needed before undergoing an appendectomy. Be sure to tell your nurse or physician if you have any allergies. Your surgeon will talk to you regarding the procedure, as well as expectations and possible complications.

What Happens During an Appendectomy?

You may be given intravenous fluids and certain antibiotics during the surgery. Your anesthesiologist and surgeon will also give you anesthetic medication to keep you sedated and unconscious during the entire procedure. This will also keep you pain-free, so you won’t get hurt when the surgeon starts cutting and removing your appendix.

Appendectomy can be done as:

  • Open Appendectomy – Also known as open surgery. This is performed by creating an incision that is about 3 inches long in the lower right side of the abdomen.
  • Laparoscopic Appendectomy – In a laparoscopic appendectomy, only small incisions are created to remove the appendix. A laparoscope (tiny tube with a built-in camera) is inserted through the incision. The camera helps the surgeon to view and monitor the abdominal contents. It will also serve as a guide during the

Possible Risks of an Appendectomy

Appendectomy is usually a safe procedure. But, like other surgical procedures, they have some risks such as:

  • Bleeding or infection on the incision site
  • Abscess or swelling in the abdomen
  • Bowel blockage
  • Leakage of bowel material
  • Hernia at the incision site
  • Paralytic ileus or slowness of bowel muscles
  • Risk of premature delivery (for pregnant individuals)
  • Death

What Happens After an Appendectomy?

The incisions will be closed either with staples or stitches. You may also have a temporary drainage apparatus in the abdomen. In most cases, patients can go home 1-day post laparoscopic/open appendectomy if there are no complications. If the appendix burst, your hospital stay may be extended.

Follow up visits may be scheduled in 1 to 2 weeks, depending on your surgeon/physician’s discretion.

Appendectomy at Pine Creek Medical Center

Having an appendectomy is the best way to treat infection and inflammation of the appendix. The danger of not treating your appendicitis is life-threatening. Therefore, if you suspect that you have an inflamed appendix, immediately call your family physician or book with one at Pine Creek Medical Center. You can entrust your appendectomy to our board-certified and highly-skilled surgeons.



  • “Appendectomy Diagnosis and Surgery.” My HealtheVet Veterans Health Library.  <>.
  • “Appendectomy Surgical Removal of the Appendix.” American College of Surgeons.  <>.
  • Johnson, Priya. “Appendix Function.” Wasatch County School District / Overview.  <>.
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Cholecystectomy Thu, 23 Aug 2018 19:38:04 +0000 What is the Gallbladder?

The human gallbladder is a small pear-shaped organ located at the upper-right side of the abdomen hiding under the liver. It stores a combination of fluids, some fats, cholesterol, and the bile.

How Does the Gallbladder Work?

The gallbladder’s principal function is to store bile, a substance that helps the digestive system in breaking down fats from the food we eat. The liver produces this substance (the bile) and sends them to the gallbladder for storage. Each day, about 3 to 5 cups of bile is produced by the liver. When we eat fatty cuts of pork, beef, dark chicken meat or high-fat dairy foods, the gallbladder squeezes out the stored bile through its small ducts towards the small intestine.

What is a Cholecystectomy?

Cholecystectomy is a procedure used to remove a diseased/ non-functioning/ infected, or sick gallbladder. It is also done to surgically remove a gallbladder with gallstones to stop pain or infection.

Why Undergo a Cholecystectomy?

Gallbladder stones are very common these days, and cholecystectomy is often the only solution to this problem. Gallstones are fragments formed from bile that varies in shape, size, and color.  They may cause infection of the gallbladder (Cholecystitis), abdominal tenderness, and pain that usually starts near the belly button or the right side of the abdomen.

Cholecystectomy is performed to treat gallstones and prevent any complications that they may cause. Your surgeon may suggest cholecystectomy if there is:

  • Gallbladder inflammation (Cholecystitis)
  • Gallstones in your gallbladder (Cholelithiasis)
  • Gallstones in your bile duct (Choledocholithiasis)
  • Gallstones causing inflammation of the pancreas (Pancreatitis)

What Happens Before a Cholecystectomy?

To be sure of the diagnosis and the need for gallbladder removal, your physician will ask you about the pain and other stomach problems that you may feel. He/she will also do a physical assessment or request further testing.

Additional tests may include any of the following: complete blood count, blood chemistry, coagulation profile, ultrasound, Hepatobiliary scan, Endoscopic retrograde cholangiopancreatography (ERCP), and MRI.

If you have other medical conditions or if you are taking any medications, be sure to inform your doctor to avoid complications.

What Happens During a Cholecystectomy?

You will be brought to the surgical unit/operating room and will be put under general anesthesia.

Currently, there are two main techniques to perform a cholecystectomy:

  • Open Cholecystectomy – This is done by creating a 6-inch incision along the abdomen’s upper right side. Then, the surgeon will cut through the muscles and the fat through the gallbladder. The gallbladder will be removed, and the remaining ducts attached to it will be clamped off. After that, the incision will be sutured or stapled closed. In some cases, 1 – 2 small drainage tubes may be placed in the abdomen to allow bile drainage that will be removed before discharge from the hospital.
  • Laparoscopic Cholecystectomy – Laparoscopic Cholecystectomy is a technique done by making small holes (keyholes) or incisions in the abdomen.

Typically, the surgeon inflates the abdomen with carbon dioxide to allow visualization of the internal organs. It is accomplished by placing hollow tubes or small ports in the incision. A lighted camera is used, and surgical instruments are inserted through the ports. Once the gallbladder is cut and removed, sutures or surgical glue/clips will be used to close the incisions.

Possible Risks of a Cholecystectomy

Some of the risks and complications of a laparoscopic or an open cholecystectomy include:

  • Wound Infection
  • Bleeding
  • Pneumonia
  • Heart Complication
  • Blood Clots
  • Urinary Tract Infection
  • Bile Leakage
  • Bile duct injury
  • Return to surgery
  • Pancreatitis
  • Retained Stone at common bile duct
  • Pregnancy complication/fetal distress/premature labor
  • Pneumonia
  • Injury to the nearby organs or other structures
  • Death

What Happens After a Cholecystectomy?

The procedure itself may cause you to feel uncomfortable or sore for a couple of days. You may also experience:

Pain on the surgical site – This may be felt once the effects of the anesthesia are gone. However, it is normal for any surgical procedures because the surgical wound/incision causes minimal tissue damage. To alleviate pain, your physician may prescribe pain medications as well as non-pharmacologic approaches to pain management. Because pain varies from individual to another, doses may differ per case.

Be sure to inform your surgeon if your medication doesn’t help in controlling your pain. In most cases, pain should improve each day after the operation.

Constipation – Decreased activity, anesthesia, and pain medications can contribute to the difficulty of emptying the bowels.

Be sure to drink 8-10 glasses of fluid each day (unless contraindicated) and eat vegetables, fruits, and grains because these foods are high in fiber. A diet high in fiber helps in managing constipation. Your doctor may also prescribe stool softeners and fiber supplements like Metamucil if necessary.

When to Contact Your Surgeon

Contact your surgeon/physician if you experience the following after your cholecystectomy:

  • Pain that worsens
  • Pain that doesn’t go away
  • Hyperthermia (fever) more than 101°F or 38.3°C
  • Persistent vomiting
  • Inability to eat properly
  • Jaundice (yellowing of the skin)
  • Foul smelling drainage from the incision site
  • Swelling and bleeding on from the wound site
  • No bowel movement 2-3 days post operation


You may be advised to do deep breathing exercises to prevent complications after surgery, such as pneumonia, blood clots, or fluid accumulation in the lungs.

Most patients can resume normal activities after a few days. Others go back to work within a week or two and return to exercise after one month.

Cholecystectomy at Pine Creek Medical Center

This information about cholecystectomy is published to offer education and guidance about the surgical procedure. This article is not intended to replace a discussion with a board-certified gallbladder specialist/surgeon who is trained in managing your condition. It is also important to note that each case is different, and the outcome of any surgical procedure depends on an individual’s general condition.

Talk to your physician or book an appointment with one at Pine Creek Medical Center. You can entrust your cholecystectomy to our highly-skilled surgeons and physicians.



  • “Anatomy Related to Cholecystectomy.” Bioline International Official Site (site up-dated regularly). Web. <>.
  • “Cholecystectomy (gallbladder removal) – Mayo Clinic.” Mayo Clinic – Mayo Clinic.  <>.
  • “Gallbladder Disease | MedlinePlus.” MedlinePlus – Health Information from the National Library of Medicine.  <>.
  • “Gallbladder removal – Complications – NHS.” Home – NHS. Web. <>.
  • “Gallbladder Removal Surgery Information | Cleveland Clinic.” Cleveland Clinic: Every Life Deserves World Class Care. <>.
  • “Gallstones – Symptoms and causes – Mayo Clinic.” Mayo Clinic – Mayo Clinic.  <>.
  • Jones MW, Deppen JG. “Gallbladder, Cholecystectomy, Open.” [Updated 2017 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Web. <>
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Splenectomy Thu, 23 Aug 2018 19:29:59 +0000 What is the Spleen?

The spleen is a lymphatic organ situated behind the lower ribs at the upper left side of the abdomen. It lies near the tail (tip) of the pancreas, beneath our diaphragm and at the back of the stomach.

Do I Need My Spleen?

The spleen plays a vital role as an organ of the immune system and lymphatic system. It aids in immunity by filtering bacteria, platelets, and dying red blood cells from the blood. As an organ of the lymphatic system, it acts as a regulator, controlling the blood flow to the liver. It is also responsible for storing certain blood cells in the body, including platelets.

What is a Splenectomy?

Splenectomy is a surgical procedure done to facilitate the removal of a diseased/ damaged/ overactive or tumor-invaded spleen. It is also indicated for individuals with hematological disorders, splenic abscesses, and non-cirrhotic portal hypertension with GI (gastrointestinal) bleeding.

Why Undergo a Splenectomy?

A splenectomy or surgical removal of the gallbladder is performed for assessment or treatment of certain diseases. It is also done to control signs and symptoms of some ailments like pain or bleeding from a traumatic injury. Other indications of splenectomy can be any of the following:

  • Treatment of disorders such as idiopathic thrombocytopenia purpura (ITP) and other auto-immune diseases
  • Diagnosis or treatment of certain cancers or lymphomas
  • Treatment of some blood disorders
  • Treatment from certain rupture or bleeding secondary to spleen trauma
  • Pain management

What Happens Before a Splenectomy?

To be certain of the diagnosis and the need for spleen removal, your physician will perform a physical exam and request diagnostic testing. You can help your care staff prepare for your surgery by informing them if you have other medical conditions or if you are taking any medications.

What Happens During a Splenectomy?

You will be assisted to the operating room and will be placed under general anesthesia. Currently, there are three different methods to perform a splenectomy.

  • Open Splenectomy – This is done by creating a vertical incision along the abdomen. Then, the surgeon will separate the spleen from the other organs and the attached blood vessels. After removing the spleen, the incision will be closed with sutures or staples.
  • Laparoscopic Splenectomy – Unlike open surgeries, laparoscopic splenectomy involves the creation of 3-4 tiny holes/incisions in the abdomen. Specialized surgical instruments are then used to visualize the abdominal area and remove the spleen. Once the procedure is completed, sutures will be used to close the small incisions.
  • Hand-Assisted Laparoscopic Splenectomy – This procedure is performed like the laparoscopic method. However, aside from the tiny incisions made for laparoscopy instruments to be inserted into the abdominal cavity, a large incision is also created to allow removal of a very large spleen.

Possible Risks of a Splenectomy

All surgical procedures have possible risks and complications. Splenectomy is not an exemption. The following risks and complications may occur during or after surgical removal of the spleen:

  • Infection
  • Bleeding
  • Injury to the bowel or other abdominal contents
  • Pancreatic leak
  • Sepsis (Blood infection)

What Happens After a Splenectomy?

The anesthesia and the procedure itself may cause you to feel sore or uncomfortable for a few days. After your splenectomy, you may experience:

Pain – Pain on the surgical site may be felt once the effects of the anesthesia are gone. The characteristic of pain may be different from one person to another.  However, it is normal and is common to any surgical procedures because of the tissue damage from the creation of incision.

Your surgeon will prescribe pain medications and will recommend non-pharmacologic methods of pain management. Some people need 1 to 3 doses of pain-relieving pills and others need more. Also, it is essential that you inform your surgeon if the medication doesn’t help in controlling your pain. In general, your pain should improve each day after your operation.

Constipation – This is pretty common among post-splenectomy patients. Constipation may occur as a side-effect of pain medication. Your doctor may recommend the use of a stool softener, as well as modifications to your diet. Vegetable, grains, and fruits may help you manage constipation because these foods are high in fiber.

Life Without a Spleen

Recovery – You will be advised to do deep breathing and, in some cases, move or exercise as tolerated. Deep breathing and exercise can help prevent complications after surgery, such as pneumonia, blood clots, or fluid pooling in the lungs.

Wound Care – Avoid touching the incision site if your hands are soiled. Be sure to wash your hands before and after touching the skin near the incision. Don’t soak in a bathtub until the stitches or staples are removed. You may take a shower two days after you were sent home unless you are advised not to.

Home Medications  Be sure to ask your physician about the medications you need after your operation. Aside from pain relievers, your surgeon might prescribe stool softeners if you are constipated, as well as antibiotics to keep at home in case you become ill from infections.

Immunizations/Vaccines – Because the human spleen works as part of our immune system, your defense system against some infections may be compromised once the spleen is removed. Although you may still be able to ward off some infections, there are chances that certain diseases may develop quickly. Immunizations might be helpful to prevent these infections such as Influenza, Meningococcal, and Pneumococcal.

Travel – Talk to your physician before traveling out of the country because special precautions may be necessary. If you are regularly spending time outdoors like camping or trekking, you may be more susceptible to rare infections like malaria and babesiosis. Wearing long sleeves and trousers may help you protect yourselves to cover exposed skin. If you become ill while on a camping trip, seek medical help promptly.

Splenectomy at Pine Creek Medical Center

If you were advised to undergo splenectomy due to a hematologic disease, splenic tumor or cysts, and other conditions, talk to your physician or book with one at Pine Creek Medical Center. You can entrust your splenectomy to our highly-skilled and board-certified surgeons and physicians.

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Tarlov Cysts: Could Cysts Be Causing Your Sciatica? Fri, 13 Jul 2018 22:04:47 +0000 An estimated 1 to 10% of the population have sciatica. In fact, many individuals have been affected by it. Aside from worrisome pain that radiates from the back to the leg, sciatica can cause sleep disturbance, difficulty with work or exercise, and interruption of normal activities.

What Is Sciatica?

Sciatica is a medical condition that occurs when the sciatic nerve (longest nerve in the body) gets compressed or pinched. This nerve starts from the base of the spine, through the buttocks, and ends at the feet. Most back pains are often blamed on sciatica. In fact, nowadays, when a patient experiences persistent back pain, physicians assume that it might be sciatica. They typically perform an assessment, and request for MRI scans to show the severity to which a spinal disc may be damaged.

However, according to the Radiological Society of North America, American Academy of Orthopaedic Surgeons, and the American Association of Neurological Surgeons, of the 1.5 million scans performed annually, there are only 20% of the total cases that show disc herniation.

Incidentally, some cases turn out to be due to symptomatic Tarlov (meningeal) cysts.

Tarlov Cyst

Tarlov cysts, also termed meningeal cysts, are cerebrospinal fluid (CSF)- filled portions of the sacral nerve root outer layers. 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.

Development of Tarlov Cysts

The exact cause of Tarlov cysts is not yet fully understood. However, several investigations propose that they occur due to changes in the normal development of the spinal nerve sheath and spinal column at the lower back. Some of the numerous potential causes that may contribute to Tarlov cysts include:

  • Trauma or injury to the spine due to falls or
  • Connective tissue disorders (such as Marfans)
  • Family history of meningeal cysts
  • Inflammation of the surrounding areas due to nerve irritation
    Fluctuation in the CSF – abnormal decrease or increase in the levels of cerebrospinal fluid

Tarlov Cysts can Cause Excruciating Pain or No Trouble at All

Aside from being rare or unheard of, Tarlov cysts can be asymptomatic. Most people don’t realize they have Tarlov cysts. The only time they might be diagnosed is during an MRI scan of the back. Also, approximately 5% of patients with Tarlov Cyst may experience physical symptoms caused by nerve compression from these cysts.
Sciatic pain from Tarlov cysts typically appears only when the sacral nerves innervating down the legs becomes compressed from the pressure exerted by the increased volume of the Tarlov nerve cyst. Symptoms may differ by patient and may subside or flare up depending on the size of the Tarlov cysts or the severity of the compression it causes. Other patients with advanced Tarlov cysts may experience:

  • Lower back pain
  • Irritability or difficulty sitting for extended periods
  • Numbness or weakness of the lower limbs
  • Burning or prickling sensations at the feet or legs
  • Diminished reflexes from the waist downwards
  • Changes in bowel function – diarrhea or constipation
  • Changes in bladder function – difficulty in emptying of the urinary bladder/ painful urination/ urinary incontinence
  • Pain or discomfort at the genital area
  • Changes in sexual function

Tarlov Cysts Doesn’t Always Mean Surgery

Symptomatic Tarlov cysts may be difficult to diagnose because symptoms can mimic other disorders. If there are changes in bowel function, symptomatic Tarlov cysts may be misdiagnosed as a gastrointestinal problem. If the only presenting symptom is urinary incontinence, it might be mistaken as a genitourinary condition of some sort. To be able to select an appropriate treatment plan, a correct diagnosis is necessary.

Also, clinical interventions vary depending on the size or the location of the cyst, and the severity of the condition. Interventions can be non-surgical or surgical, whichever is suitable and more beneficial for the patient’s individual condition.

Non-surgical treatment may include medications NSAIDs like ibuprofen, Anti-inflammatory drugs, cortisone shots, cerebrospinal fluid (CSF) drainage or cyst fluid-aspiration, and removal of the CSF from inside the cyst and filling with a fibrin glue injection.

Tarlov Cysts and Surgery

Surgical treatment options may involve permanent surgical removal of sacral nerve root fluid and treatment to return sacral nerve to original size.

The benefits of any treatment option, especially surgical procedures, should always be deliberated and weighed accordingly against its risks.

Our physicians at Pine Creek Medical Center are highly-skilled to assess, diagnose, and treat symptomatic Tarlov Cysts. If you are looking for pain relief or just want to be sure you are free from Tarlov Cyst, contact Pine Creek Medical Center to schedule a consultation. Our hospital conveniently located in Dallas, TX.

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Hernia Repair Surgery Fri, 06 Jul 2018 16:41:16 +0000 Hernia Repair Surgery: Types and Recovery

Hernia occurs when a weak part in the connective tissue or surrounding muscle causes an individual’s intestine to protrude. These hernias are common and may cause certain issues and discomfort. Oftentimes, they are perceived as a bulge, but there are cases that hernias may go unnoticed until it is discovered by a healthcare professional.

Treatment for hernia varies depending on its type and severity. Here’s an overview of the types, symptoms, and most common causes of hernia.

Types of Hernia

The different types of hernia include:

Groin Hernias (Inguinal and Femoral)

The two hernias that occur in the groin are inguinal and femoral hernias. 96% of groin hernias are found in the inguinal area, and the remaining 4% accounts for femoral hernias.

The weak areas that cause inguinal hernias may be present at birth. These usually happen in children and become evident when intestines pass through the weak spot and form a bulge. In other cases, the weak area can develop over time.

Ventral Hernia

A ventral hernia is a hole or opening through a strong connective tissue and muscle on the abdominal wall. They can form anywhere in the abdomen.

Incisional Hernia

A hernia that forms on the abdominal area after surgery through the incision site is called incisional hernia. For instance, a long incision in the abdomen can cause small hernia anywhere along the incision line. Also, this type of hernia is sometimes called a ‘recurrent’ hernia. Recurrent hernias are hernias that have been repaired previously.

Umbilical Hernia

An umbilical hernia is caused by a weak spot in the abdomen around the belly button, otherwise known as the umbilicus. The weakness on these areas creates an opening, which allows protrusion of the intestines in the abdominal wall. It can also form a bulge under the skin in or around the umbilicus.

Hiatal Hernia

This type of hernia is different from others because instead of intestines, the stomach protrudes through the weak spot of the muscles and connective tissues. It happens when a portion of the stomach bulges through the diaphragm and the chest wall.

Most people with this type of hernia doesn’t experience symptoms like that of other hernias. Typically, the only complaint of patients who have a hiatal hernia is “heartburn.”

Common Signs and Symptoms of Hernia include:

  • A bulge or protrusion of intestine or stomach
  • Abdominal pressure
  • Abdominal pain
  • Symptoms that may worsen when straining or coughing

Causes and Risk Factors of Hernia:

  • Obesity
  • Chronic cough
  • Smoking
  • Pregnancy
  • Straining when lifting heavy objects
  • Premature birth
  • Certain medications like steroids

Surgical Treatment Options

There are two methods for hernia repair, the open technique, and the laparoscopic technique.

Open Technique

This is the traditional approach of performing surgery. To treat the hernia, an incision is created. Then the fat or intestine that is protruding through the opening is reduced into the abdomen. The defect is then repaired through the incision and closed.

There are two ways to repair a hernia with the open technique.

  1. Herniorrhaphy (Herniated Tissue Repair). The first method makes use of sutures to connect the muscles and tissues back together. For larger hernias, this can cause tension (in the repaired hernia) which may result in a failed hernia repair and cause a recurrence. Herniorrhaphy involves making a long incision over the site of the hernia using surgical tools to access the displaced intestine or other organs. The surgeon will then return these protruded or displaced parts to its original location. The area will be sterilized and closed.
  2. Hernioplasty (Mesh Repair). Mesh is a flexible, soft, woven, plastic-like material that has been used for hernia repair for many years. This approach has dramatically reduced hernia recurrence. Many surgeons recommend the use of mesh for umbilical hernia repairs, but others only recommend the use of mesh in larger hernias. There are also different types of mesh, but most are well-accepted by patients’ bodies, and usually allow tissues to grow into them. Hernioplasty is also known as ‘tension-free hernia repair.’

Laparoscopic Technique

The laparoscopic technique is a form of minimally invasive surgery where 3 to 4 small incisions are made in certain areas of the abdomen. Then, a long, thin instrument called a laparoscope with a video camera is inserted. The surgeon will then temporarily inflate the abdomen with gas to have space to work in the abdominal wall.

Hernia Repair Recovery

If there are no complications from surgery, patients may go home the same day. Pain medications may be given because post-operative pain may be experienced. Recovery time varies from patient to patient. Some may only need pain medication the day after surgery, but others may require a couple of days.

Patients may go back to work few days after the operation, as long as the job does not require heavy lifting or strenuous physical activity. Full recovery may be delayed up to 6 weeks post-surgery.

At present, surgery is the only way to fix hernias, but not all types of hernias need to be treated with surgery. If you don’t have symptoms, treatment may be unnecessary. However, if signs and symptoms of hernia bother you, you may talk to your doctor or set up an appointment with one at Pine Creek Medical Center. We have highly-skilled surgeons who perform hernia repairs right here at one of the best in hospitals in Dallas, Texas.


  • “Carolinas Hernia Handbook.” Carolinas HealthCare System is Atrium Health .  <>.
  • “Common Types of Hernia.” Tufts Health Plan – Health Insurance in MA and RI.  <>.
  • “Open Hernia Repair.” Welcome — UNC School of Medicine. <>.
  • “Definition of Herniorrhaphy.” Web. <>.
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Gallbladder Removal Fri, 06 Jul 2018 16:16:36 +0000 Gallbladder Removal: Purpose, Risks, and Procedure

Gallbladder stones are very common and surgical intervention is usually advised to treat this problem. Cholecystectomy is the surgical removal of the inflamed or problematic gallbladder. To understand the purpose, risks, and the procedure, let us review the following information on the gallbladder, gallstones, and the procedure itself.

About the Gallbladder

The gallbladder is the small pear-shaped sac that lies under the liver in the right upper abdomen. It stores the bile produced by the liver and is responsible for proper digestion of lipids or fats.

The liver produces about 3 to 5 cups of bile every day. The bile travels through the common hepatic (liver) duct and the cystic duct, and finally to the gallbladder for temporary storage. When we eat food, especially those that are high in fats, the gallbladder secretes the bile into the small intestine.

About Gallstones

Cholelithiasis, the medical term for the formation of gallstones, is usually associated with a diseased gallbladder that is not functioning correctly. Gallstones are stone-like debris that are formed from the bile stored in the gallbladder. They vary in color, shape, and sizes. The most common type mainly consists of excess fats called cholesterol. They may also enlarge over the years or may be squeezed out of the gallbladder into the duct. Gallstones in the common bile duct are termed as Choledocholithiasis.

Gallstones that are stuck in the ducts can block the flow of the bile or cause Cholecystitis – the inflammation of the gallbladder.

Signs and Symptoms of Gallstones

The presence of gallstones may cause any of the following depending on the severity:

  • Pain on right abdomen
  • Fever
  • Nausea or Vomiting
  • Bloating, heartburn, or indigestion
  • Yellowing of the skin (Jaundice), if the gallstones are in the common bile duct

Cholecystectomy: The Surgical Treatment for Gallstones

An operation is the only treatment for acute cholecystitis and may be recommended for gallbladder pain due to gallstones.

Purpose of Gallbladder Removal (Cholecystectomy)

While the gallbladder may not be consider as an essential organ necessary to maintain good health, the bile can cause blockage in the ducts where it usually empties causing pain and/or other medical concerns. Here are some of the most common reasons why a gallbladder removal procedure is performed:

  • To treat Cholelithiasis
  • To treat Choledocholithiasis
  • To treat Cholecystitis
  • To prevent complications
  • To prevent further attacks of pain due to gallstones

Risks of Gallbladder Removal (Cholecystectomy)

Cholecystectomy, like any other surgical procedures, has risks. However, your surgeon will do everything to prevent or minimize the risks associated with cholecystectomy.

  • Infection – infection occurs in less than one out of 1000 patients who undergo laparoscopic procedures
  • Bleeding – this is rare, but if you have chronic biliary disease, you may have a problem with clotting (anti-bleeding) factors
  • Deep Vein Thrombosis – deep vein thrombosis or blood clots in the veins may occur due to immobilization during surgery. In rare cases, it may also travel to the lungs or other parts of the body.
  • Pneumonia lack of breathing exercises, administration of general anesthesia, and immobility are possible causes of pneumonia after surgery
  • Death – this is very rare for healthy patients. Statistics say that for every 1000 patients, 0 to 1 patients die due to gallbladder removal.

The Two Types of Gallbladder Removal (Cholecystectomy)

There are two techniques to perform gallbladder removal (Cholecystectomy): Open Cholecystectomy and Laparoscopic Cholecystectomy.

Open Cholecystectomy

In an Open Cholecystectomy, the gallbladder is removed by creating an incision on the right side of the abdomen under the rib cage. If you choose to undergo an open cholecystectomy, your surgeon will create an approximately 15 – 16 centimeter incision in the upper right side of the abdomen. He/she will cut through the muscles and fats to the gallbladder. The gallbladder is then removed, and the ducts connected to it are clamped off.

Suture or staples will be used to close the site, and a small drain may be placed from the inside of the abdomen. Typically, this procedure takes about 1 to 2 hours.

Laparoscopic Cholecystectomy (Lap-Chole)

Laparoscopic Cholecystectomy also known as “keyhole” cholecystectomy, involves surgery with the use of a tiny camera that is inserted through small incisions. It is done to remove gallbladder without having to create a large opening (cut/incision) in the abdomen. A laparoscope is a narrow tube telescope with a light and video camera. This provides visualization of the gallbladder through a monitor.

The surgeon will remove the gallbladder through the small incisions. The sites are closed with surgical sutures, clips or staples, and steri-strips as necessary.

Laparoscopic cholecystectomy may take about 1 to 2 hours.

Expectations Before, During, and After Gallbladder Removal

Before Cholecystectomy

Before your scheduled cholecystectomy, be sure to inform your surgeon or healthcare staff about other medical problems you have. You may also give a list of all medications you are taking.

You should also tell your surgeon about any allergies, history of stroke or epilepsy, or if you smoke, use drugs, alcohol, and herbal medications.

On the day of your operation, you will be advised not to eat or drink for at least few hours before the surgery to reduce the risk of aspiration and other complications from anesthesia.

During Cholecystectomy

An intravenous line or IV fluid will be started to give you fluids and pre-operative medications. This medication will make you feel sleepy. Nurses and patient attendants will be sent to your room to assist you and bring you to the operating room. You’ll be given anesthesia before the surgeon performs the operation. Once the operation is done, you will be transferred to a recovery room.

After Cholecystectomy

Usually, if you do not have complications, you may go home the same day as your laparoscopic cholecystectomy. For an open cholecystectomy, hospital stay may last 2 to 3 days. Also, you will not be allowed to drive immediately after the procedure.

At home, it is important for you to monitor your condition. If you have stomach cramping, yellowing of the skin, absence of bowel movements for >3 days, vomiting, chills, severe pain, high fever, and foul odor or abnormal drainage from the incision; you should call your physician/surgeon.

It is imperative to remember that each person and his/her condition is different. The patient information written above should never replace professional advice of a surgeon who is an expert in the field. If you have questions that are not covered in the topics above, you may call and visit Pine Creek Medical Center – one of the best surgical hospitals in Dallas, Texas.


  • “Bile – Wikipedia.” Wikipedia, the free encyclopedia.  <>.
  • “Cholecystectomy – procedure, recovery, blood, tube, removal, pain, complications, infection.” Encyclopedia of Surgery: A Guide for Patients and Caregivers. <>.
  • “About Cholecystectomy: Surgical Removal of the Gallbladder.” Oxford University Hospitals.  <>.
  • “Cholecystectomy: Surgical Removal of the Gallbladder.” American College of Surgeons.  <>.
  • “A Guide to Gallbladder Surgery.” MUHC Patient Education | MUHC.  <>.


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4 Questions to Ask If You’ve Been Diagnosed with Tarlov Cysts Thu, 21 Jun 2018 15:42:50 +0000 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.  <>.
  • “Tarlov Cyst: A diagnostic of exclusion – ScienceDirect.” com | Science, health and medical journals, full-text articles and books.Web. <>.
  • Edward , Benzel. “Chapter 115 Tarlov Cysts.” Spine Surgery. Elsevier Health Sciences, 2012. 1135-1136. Web. <>.
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Low Back Pain? It Might Be Tarlov Cysts! Thu, 21 Jun 2018 15:29:57 +0000 Symptomatic Tarlov cysts (sacral meningeal cysts) are a rare cause of low back pain. However, it is possible. In the US, there is a small percentage of patients with low back pain whose MRI imaging study results showed the presence of Tarlov cysts in the sacral nerve roots.

So, What Are Tarlov Cysts?

Tarlov cysts are membranous sacs filled with cerebrospinal fluid (CSF). They slowly develop at the base of sacral nerve roots in the spinal column. These sacs typically develop along the posterior sacral nerve roots, causing compression of numerous sacral nerves in the immediate area.

What are the Clinical Manifestations of Tarlov Cysts?

Tarlov cysts usually result to nerve irritation, compression, or damage (radiculopathy). This means that activities such as bending over, sitting, standing, or walking may cause pain and discomfort in the lower back area. Some patients with Tarlov cysts say that the only position that can provide relief is lying flat on their back or on their side. Symptoms may vary by patient and may subside or flare up depending on the size and amount of neighboring sacral nerve compressing caused by the Tarlov cysts.

Other patients with symptomatic Tarlov cysts may experience:

  • Lower back pain – pain at the lower back, usually at the buttocks that can be provoked by movement such as bending over or walking and standing for long periods
  • Irritability or difficulty sitting for extended periods
  • Pain, discomfort or numbness in the genital area
  • Abnormal burning or prickling sensations at the feet or legs
  • Loss of sensation that may extend to the feet
  • Weakness of muscles of the lower limbs
  • Diminished reflexes from the waist downwards
  • Changes in bladder function – painful urination, difficulty in emptying of the urinary bladder, or urinary incontinence
  • Changes in bowel function – diarrhea or constipation
  • Changes in sexual function

How Do Tarlov Cysts Form?

The etiology of Tarlov cysts is not yet fully known. However, several studies propose that they occur due to changes in the healthy development of the spinal nerve sheath found at the lower back. It may develop as a result of:

  • Trauma or injury due to falls or accidents involving the base of the spine
  • Inflammation of the surrounding areas as a result of nerve irritation
  • Hemorrhage or bleeding secondary to trauma and other causes
  • Ischemic degeneration – degeneration of the nearby tissues due to a shortage of oxygen from a restricted blood supply in the sacral area
  • Blockage of CSF flow at the perineural area (peri = around; neural=nerve)
  • Genetic: Hereditary connective tissue disorders such as Marfans.

What are the Treatment Options for Tarlov Cysts?

Many of the symptoms of Tarlov cysts mimic other disorders involving the nerves or the spinal column. For this reason, symptomatic Tarlov cyst may be challenging to diagnose. To be able to select an appropriate intervention, a correct diagnosis is needed.

Treatment decisions also vary depending on the nature or size of the cyst, its location, and the extent of the condition. Intervention options are non-surgical or surgical, whichever is suitable and more beneficial for the patient’s individual condition. It may include any of the following:

Non-surgical treatment:

  • Drainage of the cerebrospinal fluid (CSF)
  • Cyst fluid-aspiration
  • Removal of the CSF from inside the cyst and filling with a fibrin glue injection

Surgical treatment options:

  • Decompressive laminectomy – treatment of the cyst to remove fluid and reduce cyst size to normal

The benefits of any surgical treatment option should always be deliberated and weighed accordingly against its risks. Back pain can remarkably be troubling and debilitating. However, with a proper understanding of what causes back pain, and how can it be treated, you may be able to find comfort and relief from your pain.

Please be sure to be adequately informed about the pros and cons of surgery, before deciding to get one. As leaders in the field of spinal surgeries, our surgeons at Pine Creek Medical Center in Dallas, TX are ready to help patients find pain relief. If you suspect you may have a symptomatic Tarlov Cyst, contact us to schedule an appointment with one of our specialists. Our hospital is conveniently located in Dallas, Texas.




• “Tarlov Cysts: What Are They and How Can They be Treated?.” American Association of Neurological Surgeons. Web. <>.

• “Tarlov Cyst: A diagnostic of exclusion – ScienceDirect.” | Science, health and medical journals, full-text articles and books. Web. <>.

• Edward, Benzel. “Chapter 115 Tarlov Cysts.” Spine Surgery. Elsevier Health Sciences, 2012. 1135-1136. Web. <>.

• “Tarlov Cysts – NORD (National Organization for Rare Disorders).” Home – NORD (National Organization for Rare Disorders). Web. <>.

• “Tarlov cysts: A cause of low back pain? – Mayo Clinic.” Mayo Clinic – Mayo Clinic. Web. <>.

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Tarlov Cyst Disease: What are Tarlov Cysts & What are Tarlov Cyst Treatments? Thu, 14 Jun 2018 17:43:25 +0000 Tarlov cysts, also referred to as perineural or sacral nerve root cysts, are cerebrospinal-fluid filled sacs that occur as dilatations of nerve root sheaths at the dorsal root ganglion. They commonly occur at the sacral spine especially around S1, S3. However, they can occur at any level of the spine. In fact, approximately 11% of people with the condition have multiple cysts distributed along the cervical, thoracic, and lumbar vertebrae as well.

Tarlov cysts are relatively rare with an annual incidence of approximately 5 % and are more common in women than in men. The etiology and the process of formation of these cysts are not well defined. However, several hypotheses have been postulated, including the obstruction of venous drainage in the perineum due to the deposition of hemosiderin as a result of trauma, congenital origin and hemorrhagic infiltration of spinal tissue following trauma.

Signs and Symptoms of Tarlov Cyst

The condition has no obvious signs and symptoms and, in most cases, people with the condition will not realize that they have it. Therefore, it frequently goes undiagnosed. However, as time progresses, the cerebrospinal fluid within the cyst builds up resulting in the compression of surrounding nerve roots. Signs and symptoms such as intense lower back pain, sciatica (following the compression of the sciatic nerve), urinary incontinence, headaches, sexual dysfunction, constipation, and some loss of feeling or control of movement in the leg and/or foot are indications. These symptoms can also be triggered by several other conditions including trauma, heavy lifting, epidural, and childbirth.

Treatment of Tarlov Cysts

There are several treatment and management options for Tarlov cysts.  These can either be conservative (non-surgical) or surgical. Conservative management involves only symptomatic treatment through the administration of analgesics to reduce pain, muscle relaxants to reduce muscle tightness and physiotherapy. Surgical treatment is only offered to individuals who have gone through conservative management but did not respond appropriately. It is also recommended for patients with much more complicated symptoms such as urinary retention. Studies have shown that only a few patients who undergo conservative management eventually get full relief of their signs and symptoms.

Surgical Management of Tarlov Cysts

There are several surgical techniques that can be used in the management of Tarlov cysts. The choice of technique will depend on factors such as the patient’s age and general health condition, the progression of the disease and the compression on surrounding structures. They include:

Fibrin Glue Therapy

This form of treatment aims to deflate the cyst in order to relieve its compression effects on surrounding tissues. It involves the aspiration of cerebrospinal fluid and the application of a fibrin glue at the puncture point to prevent the continuous leakage of CSF. However, this form of treatment is quite risky as the glue can dislodge easily and travel to other locations along the spinal canal where it could cause a condition known as adhesive arachnoiditis. Adhesive arachnoiditis is characterized by pain that is spread over different dermatomes.

Microsurgical Excision of Tarlov Cyst

This involves the surgical removal of the cyst. A study conducted to evaluate its effectiveness in the management of the condition showed that 82 % (9/11) of test participants had significant symptomatic relief. This study published in the journal Neurosurgery Journal in 2007 involved 11 patients who had undergone the surgical procedure and were followed post-surgically for 6 months to 10 years depending on year of surgery.

Surgical Clipping of Tarlov Cyst

This method is mainly used for very large cysts. It involves removal of vertebral bones over the cyst to expose it. The cyst is then incised and drained. Its walls are then collapsed and circumferentially reinforced and sutured or the surgeon could decide to pack the region with fat or tissue adhesive to prevent it from filling with CSF again.  A Study that involved 19 patients who had undergone the procedure showed that none of the patients had signs of CSF leakage even 25 years after the procedure. It is, therefore, one of the most effective methods in the management of Tarlov Cysts.

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