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:
- 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.
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• “Tarlov Cyst: A diagnostic of exclusion – ScienceDirect.” ScienceDirect.com | Science, health and medical journals, full-text articles and books. Web. <http://www.sciencedirect.com/science/article/pii/S2210261217303681>.
• Edward, Benzel. “Chapter 115 Tarlov Cysts.” Spine Surgery. Elsevier Health Sciences, 2012. 1135-1136. Web. <http://pdfs.semanticscholar.org/3120/e30398c777fbd86e5c5f776b1f04a8f99b34.pdf>.
• “Tarlov Cysts – NORD (National Organization for Rare Disorders).” Home – NORD (National Organization for Rare Disorders). Web. <http://rarediseases.org/rare-diseases/tarlov-cysts/>.
• “Tarlov cysts: A cause of low back pain? – Mayo Clinic.” Mayo Clinic – Mayo Clinic. Web. <http://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/tarlov-cysts/faq-20058086>.