Pine Creek Medical Center Dallas Medical Center Thu, 19 Jul 2018 02:50:25 +0000 en-US hourly 1 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.

]]> 0
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. <>.
]]> 0
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.  <>.


]]> 0
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. <>.
]]> 0
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. <>.

]]> 0
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.

]]> 0
How to Combat Allergies in Dallas Thu, 14 Jun 2018 17:35:42 +0000 Did you know that more than 50 million Americans suffer from nasal allergies? Allergies are a common condition. They are triggered by allergens that invade the mucosal surfaces in our noses. Our bodies then mount immune responses that result in characteristically uncomfortable symptoms of itchiness and sneezing. Most people associate allergies with spring and summer. However, the seasonal variation occurs largely because people spend more time outdoors during these seasons. Spring is also associated with a host of pollens and dust in the air, especially in cities like Dallas. Dallas ranks among the top cities in the United States for allergies according to The Asthma and Allergy Foundation of America. Living in DFW, it is important that you know the best ways of dealing with allergies. This article outlines some of those.

Get medication for seasonal allergies

There are several forms of medications that can be used to manage allergies. From eye drops to antihistamines, your choice of treatment will depend on the type of allergy you have. Although most prefer to use over the counter drugs, it is recommended that you visit a doctor to obtain a prescription for the most appropriate medication for you. Should you prefer not to go to the doctor’s, then it is advised that you read the medication label to ensure it is the best for you.

Clean your curtains and vacuum regularly

Dust usually settles on carpets and curtains and this can be a triggering factor. It is therefore important that you vacuum and clean your curtains. It is also important that you clean your countertops as dust also settles here. Consider wearing a mask or having  a cleaning crew vacuum for you, so you can avoid triggers.

Close the windows at home

While most people think that opening the windows to let free flow of air in and out of a room prevents allergies, it does quite the opposite. When the windows are open, dust flows in and settles on surfaces. It is recommended that you use a blower on the central air unit instead. It uses less power than the A/C and circulating air passes through a filter.

Avoid driving with your car windows open

Just like it is with the windows, it is recommended that you run the car ventilation system instead of lowering the windows down to recirculate the air.

Avoid allergy triggers such as irritating odors and fumes that can irritate the lining of your nose and eyes

There are several triggers to allergies. They include irritant chemical fumes from cleaning products, paints, gasoline, automobile exhaust, insecticides, and aerosol products. Avoid practices such as smoking especially in packed rooms. Depending on whether you are triggered, it is advised that you avoid scented soaps, perfumes

Avoid mowing the grass and cutting weeds!

While spring may be the most appropriate period to cut some weed and mow your lawn, it is advised that you avoid it. You can hire someone to help you do the activities that get you exposed to pollen.

]]> 0
Knee Replacement Surgery Thu, 31 May 2018 21:31:02 +0000

Knee replacement, also known as knee arthroplasty, is a form of surgery that is performed to replace the weight-bearing surfaces of a degenerated knee joint in a bid to reduce pain and increase mobility. There are several conditions and factors that can lead to the damage of the articular surfaces of the knee, arthritis being one of the most common, especially osteoarthritis. However, knee replacement can be performed to manage other forms of arthritis as well such as rheumatoid and psoriatic arthritis. These conditions usually cause immense pain and inflammation and can even lead to deformities.

Procedure Description

Basically, the surgery involves the replacement of damaged articular surfaces with a prosthesis. During the procedure, the surgeon exposes the knee joint by making an incision and detaching part of the quadriceps muscles from the patella and pushing the patella to the side. Once fully exposed the surgeon cuts the ends of the bones of the knee joint that is the femur and the tibia using cutting guides. The prosthesis, usually made of metal, is then attached to the ends of the bones using cement, and the joint reconstructed.

There are two types of knee replacement procedures depending on which parts of the knee joint are removed and replaced. They include:

  • Total knee replacement (TKR): This form of knee arthroplasty is the most common and involves the replacement of both sides of the knee joint.
  • Partial knee replacement (PKR): This form of knee replacement only replaces one side of the joint.

Possible Risks and Complications

All forms of surgery have some risks and complications, knee replacement included. One of the most serious complications following any surgical procedure is infection, especially due to poor wound care. Other complications include deep venous thrombosis which occurs as a result of prolonged periods of immobility. Accordingly, it is recommended that following any surgical procedure, the patient should ambulate as soon as possible. Some patients have experienced persistent pain or stiffness following the procedure and approximately 2% have reported prosthesis failure. Since the knee is a weight-bearing joint, it is usually advised that obese patients lose weight before the surgery can be performed.

Preparing for Surgery

In preparation for the surgery, a proper history of your current underlying condition will be documented for evaluation. It is important that you provide all the details, including any information on your current medication regimen.

Blood and urine samples will be taken for testing to ensure that you are hemodynamically stable with sufficient hemoglobin. The blood group is also tested so that you can quickly be transfused should the need arise.


Typically, a total knee replacement will take an estimated 2-3 hours after which you may need to stay in the hospital for several days. You will be prescribed medication to manage your pain. During your stay in the hospital, a physical therapist will have you up and about to get you started on your new, more mobile, life. This is particularly important for the prevention of deep venous thrombosis. At home, you will be required to avoid heavy lifting or standing for prolonged periods. You will likely use crutches or another device to offload weight from the affected knee for some time before you can resume normal activities.

Unmatched Experience and Ability

Surgery is typically a last resort option, after all other less invasive treatments and therapies have been exhausted. If your knee condition does require surgery, take heart in knowing that the doctors and specialists here at Pine Creek Medical Center combine unparalleled expertise and the latest medical technology in order to get you back to health faster.

Browse our Orthopedics and Pain Management pages to learn more about how we can help.

]]> 0
The Basics of Sports Medicine Thu, 31 May 2018 19:43:20 +0000

Sports Medicine is a specific branch of medicine that deals with the prevention and treatment of sports-related injuries. It also involves the application of scientific study methods to optimize health and athletic performance.

Increased participation in sporting activities by amateurs (or so-called “weekend warriors”) has resulted in the need to not only prevent and treat sports injuries, but to advance the scientific knowledge of the limits of human exercise performance and the causes of fatigue. Moreover, with increased training levels and specialization across the spectrum of recreational sports, there has been a parallel increase in career opportunities to support the care and training of athletes and physically active individuals, one of those being in the arena of sports medicine.

The Scope of Sports Medicine

Sports Medicine is practiced by specialized physicians who choose to pursue a residency in sports and exercise medicine after medical school. The residency involves extensive study of the musculoskeletal system as their practice will focus on muscles, ligaments, tendons, and bone conditions. In the course of their studies, an emphasis is also placed on chronic illnesses such as diabetes and asthma that can influence an athlete’s performance.

Branches of Sports Medicine

Just like all other medical branches, Sports Medicine has a long list of subspecialties that serve to bridge the gap between the academic disciplines of medicine and physical education. Although most people connect Sports Medicine only to orthopedics, several other medical specialties can be of great value in this field.

Medical physicians practicing pediatrics or internal medicine sometimes join the Sports Medicine industry by becoming team physicians. Obviously, participating in sports can be risky and there is always a chance an athlete can sustain an injury anywhere in the body. For example, athletes risk  head injuries that can result in concussions that may require a neurological consultation. An eye injury may require an ophthalmic consult, and so on. Several other professions round out the sports medicine industry, including sports nutritionists, sports psychologists, and sports podiatrists.

The Relationship Between Sports Medicine and Health

There is a very close link between physical activity and the general health of an individual. Several studies have shown that physical activity reduces the risk of getting chronic illnesses such as diabetes and hypertension. Aside from that, physical activities lead to cardiorespiratory endurance, muscle strength, muscular endurance, flexibility, agility, and body composition, all of which are key to an athlete’s performance, professional or not.

The U.S. government has published guidelines supported by scientific research on the proper amount of exercise required by the average adult. These guidelines suggest that a person should aim for at least 30 minutes of physical activity every day (ie. jogging, light exercise, etc) in order to help prevent a wide range of illnesses including cardiovascular disease, stroke, diabetes, hypertension (high blood pressure), certain types of cancer, and depression.

Keeping You Fit and Healthy

In the end, sports medicine is a field of study designed to help people keep fit and healthy, as well as treat any injuries stemming from sports-related activities. As you can see, the combination of pain management, orthopedics and physical therapy all converge into one cohesive medical niche that has become more and more necessary over time.

To learn more about this area of medical expertise and about orthopedic medicine in general, click here.

]]> 0
Total and Partial Hip Replacement Fri, 20 Apr 2018 18:07:57 +0000 About Hip Replacement

Hip replacement is a very common type of surgical procedure in which a damaged hip is replaced by a prosthesis (an artificial hip). The procedure is usually conducted to relieve pain caused by arthritis or correct fractures. Usually, hip replacements are done when all other forms of treatment have failed to reduce pain thus limiting one’s ability to perform daily routines and chores. There are two types of hip replacement procedures depending on the extent anatomical portions of the joint need to be removed and replaced. These are total hip replacement and partial hip replacement.

Relevant Anatomy

To understand how the procedure is conducted, it is imperative that one understands the functional anatomy of the hip joint. The hip joint is one of the largest joints in the body. It is a ball and socket joint consisting of a socket formed by the bony pelvis and a ball which is the femoral joint. These are surrounded by a synovial membrane. The bony surfaces are covered by a cartilage which cushions the bones allowing them to move smoothly as the range of movement changes. Within the joint is a small amount of synovial fluid that provides lubrication.

Conditions that result in wear and tear of the articular cartilages lead to chronic pain and disability. A common culprit for this is arthritis especially the osteoarthritis and rheumatoid arthritis. These are the common conditions that necessitate the need for hip replacements. Others include avascular necrosis of the femoral head due to trauma and childhood hip disease.

How is the procedure performed?

As stated, there are two types of hip replacement procedures. Total hip replacement involves the substituting a prosthetic implant for the acetabulum and the femoral head while partial replacement involves the replacement of only the femoral head.

Basically, a surgeon makes an incision along the side of the hip and the muscles surrounding the joint are separated to expose the bone. The surgeon then removes the head of the femoral bone by cutting through it using a saw. It is then replaced by a metallic stem that is placed on the hollow centre of the femur. A ceramic ball is attached to the upper part of the stem and used in place of the damaged femoral head. Depending on whether the procedure is total or partial, the acetabulum is removed and cement or screws are used to hold the socket.

Who will benefit from a hip replacement?

Hip replacement is a common procedure and can be conducted on any person depending on the degree of disability caused by the underlying condition. There is no age or weight limit for hip replacement. However, most people who undergo the procedure are between 50-80 years old. This is because of the increased predisposition in this population to conditions such as arthritis.

Preparing for the surgery

Before the day of operation, your doctor will want to take a medical history and perform a complete physical examination. It is important that you provide  details including any underlying illnesses from which you may be suffering and any current medications.

There are several medical tests you will undergo such as a “complete blood count” (CBC) which will involve drawing of blood, plus a urinalysis and possibly an electrocardiogram.

Sometimes, surgeons will recommend that you donate blood to  be stored and then used if needed during your operation.

Some problems affecting the hip joint are caused by excess weight. Accordingly, prior to surgery, the surgeon may ask you to lose some weight to lower the stress that will be put on the hip joint.