Tarlov Cyst Institute

tarlov cyst institute

“TARLOV CYST INSTITUTE COMMITMENT TO A.C.T.”

Awareness & Medical Education
Contribution to Medical Knowledge Through Outcomes Research
Team Treatment for the Global Community

DEBILITATING BACK PAIN

Many patients who seek Dr. Feigenbaum’s expertise have experienced countless specialty physician visits, multiple surgeries and feel like they are at the end of their rope. With debilitating back pain, everyday life and activities become impossible. Tarlov cysts are dilations of the nerve root sheaths that create abnormal sacs filled with spinal fluid causing progressively painful radiculopathy (nerve pain). If left untreated, patients suffer incredible pain and dysfunction, because very few neurosurgeons can treat this disease, it is often undetected for far too long

SUCCESSFUL OUTCOMES

Dr. Feigenbaum has extensive, world-renowned experience treating 1500+ Tarlov and meningeal cyst patients.  His specialized techniques and outcomes research starting in 2007, singles him out as one of a few neurosurgeons worldwide to show statistical improvements in his patients.  Partnering with Sarah Cannon Research Institute and North Texas Institutional Review Board (IRB) at Medical City adds credibility and independent validation of these improvements.

Frank Feigenbaum, MD

Medical Director, Tarlov Cyst Institute

Dr. Feigenbaum specializes in the treatment of a variety of spinal conditions and performs several spine procedures including:

  • Tarlov & Meningeal Cysts

  • Complex Spine Disorders

  • Spine Tumors

  • Spine Instrumentation & Reconstruction

  • Minimally Invasive Spine Surgery

Dr. Frank Feigenbaum

NEUROSURGICAL EXCELLENCE

Frank Feigenbaum, M.D. is part of a unique multi-disciplinary team providing neurosurgical care with a strong focus on meningeal cysts, such as Tarlov cysts. Dr. Feigenbaum is the only neurosurgeon in the world who has treated over 1,500+ symptomatic Tarlov cyst patients with statistically significant outcomes study results. His refined surgical treatment incorporates the newest advances in neurosurgical care, including computer-assisted image guided and minimally invasive approaches to surgery.

Board-Certified Neurosurgeon

Dr. Frank Feigenbaum is a Board-Certified Neurosurgeon practicing in Dallas with extensive experience in treating Tarlov and meningeal cyst patients. Dr. Feigenbaum has developed and refined a surgical treatment for meningeal cysts with proven statistical results. Outcomes data reflect statistically significant improvement in a multitude of symptoms following surgery. He also specializes in minimally invasive spine surgery with extensive experience in both developing minimally invasive technology and teaching minimally invasive spine surgery techniques.Dr. Feigenbaum is fully bilingual in English and Spanish and received his medical and surgical training at Georgetown University Medical Center in Washington, D.C. He is Board Certified by the American Association of Neurological Surgeons. In addition, he serves on the Medical Advisory Board of the Tarlov Cyst Foundation. Dr. Feigenbaum is the author of numerous journal articles and book chapters on meningeal cysts as well as other neurosurgical disorders.

Dr. Feigenbaum’s personal interests include watching his children participate in numerous activities, travel, baseball, collecting contemporary art, golf, and Roman history.

 

Education

  • Medical: Georgetown University School of Medicine, Washington, D.C.

Training

  • General Surgery Internship: Georgetown University Medical Center, Washington, D.C.
  • Neurotrauma Externship : Shock Trauma Hospital, University of Maryland, Baltimore, Maryland
  • Neurosurgical Residency : Georgetown University Medical Center, Washington, D.C.
  • Research Fellowship: American Association of Neurological Surgeons

Professional Affiliations

  • Medical Advisory Board – Tarlov Cyst Foundation

  • American Association of Neurological Surgeons

  • American Board of Neurological Surgery

  • North American Spine Society

  • American College of Spine Surgery

  • American College of Surgeons

  • Texas Medical Association

Signs & Symptoms

Please take a few minutes to review the Tarlov Cyst screening questions. If you have an MRI indicating Tarlov cysts AND any combination of one or more listed symptoms, then please contact us for an initial evaluation.

Signs & Symptoms

What symptoms do Tarlov or Meningeal cyst patients have?

Symptoms can vary depending on the location of the cysts.

  • Sacral or tail bone pain or pressurea
  • Pain with sitting. May feel like you are sitting on a rock or an object
  • Avoidance of sitting type activity
  • Pain with standing
  • Pain in the legs and feet especially in the back of the thighs
  • Leg weakness or numbness
  • Bowel or bladder or sexual disfunction
  • Vaginal, rectal, pelvic and/or abdominal pain
  • Pain with sexual intercourse
  • Pain or numbness in the buttocks or between the legs
  • Headaches
  • Symptoms made better by lying down

RELIEF IS HERE

A symptomatic Tarlov cyst is a rare disease, but recovery is possible. It is a dilation of the outer covering of the nerve, allowing spinal fluid to get trapped, forming a cyst. The fluid in the cyst puts pressure on adjacent nerves, causing debilitating symptoms. Tarlov cysts are most prevalent in the sacrum or base of the spine, but could occur in the neck or upper back. The cyst is embedded in the nerve and should not be cut.

 

Tarlov Cyst Screening Questions

SACRAL TARLOV CYSTS

  • MRI reporting Sacral Tarlov Cyst(s)?
  • Bladder problems (incontinence, frequency, urgency, residual)?
  • Bowel problems (Constipation, lack of control)?
  • Sexual problems (genital pain, persistent arousal, numbness)?
  • Pain or swelling over the sacrum/low back area?
  • Sensation that you are sitting on a “rock”?
  • Trouble with sitting for extended periods of time?
  • Pain or numbness in the buttock area?
  • History of headaches?
  • Onset of sacral pain after a significant occurrence (fall, motor vehicle accident, lifting heavy object)?
  • History of connective tissue disorders (Marfan’s, lupus, multiple cysts, prolapses)?

THORACIC TARLOV CYSTS

  • MRI reporting Thoracic Tarlov cyst(s)?
  • Chest pain or mid-back pain (not related to a heart condition)?
  • Numbness wrapping around the middle of the back?
  • History of headaches?
  • Onset of thoracic pain after a significant occurrence (fall, motor vehicle accident, lifting heavy object)?
  • History of connective tissue disorders (Marfan’s Lupus, multiple cysts)?

CERVICAL TARLOV CYSTS

  • MRI reporting Cervical Tarlov cyst(s)?
  • Neck pain?
  • Pain or numbness radiating down arm, and possibly into hands?
  • History of headaches?
  • Onset of cervical pain after a significant occurrence (fall, motor vehicle accident, lifting heavy object)?
  • History or connective tissue disorders (Marfan’s Lupus, multiple cysts)?

Patient Testimonials

Discover what our patients have to say regarding their office visit, surgical experience or recovery process. We also encourage our existing patients to share their own experience!

Tarlov Cyst Institute - Scott’s Story

Tarlov Cyst Institute - Barbara & Tom’s Story

YOUNG GIRL’S TARLOV CYST JOURNEY

...Click Here To Read More Testimonials

KIM R.
TARLOV CYST SURGICAL TREATMENT

“All I can say is “thank you, thank you, thank you Dr F and staff!” After nearly 7 months of severe Tarlov Cyst pain, and an ineffective Fibrin Glue Injection at Johns Hopkins, I am up and walking 30-45 minutes a day with no tailbone pain/pressure, no numb legs, and no sciatic nerve pain. On May 11, 2012 I felt like I met the miracle worker! Dr F was on time, very cordial and immediately looked at my MRIs and noticed not just the 1 Tarlov Cyst I was told I had by other doctors and surgeons, but 3 Tarlov cysts. After performing some in-office tests and asking a series of questions he concluded the cysts were definitely the symptoms of pain and recommended and explained the Tarlov cyst treatment procedures and recovery restrictions. Liking Dr F immediately, and feeing 100% confident he is THE BEST in this field, I went home and consulted with my husband and family, and called to schedule surgery the next day. Everyone on his staff was extremely professional and very kind. His surgery coordinator Laura could not have been any more helpful and nicer. Dr. Feigenbaum and his staff actually started my surgery almost an hour early. They explained everything crystal-clear to everyone with me, and made sure that not only I, but also my mother, had no questions and eased any anxiery or fears we may have had pre-surgery. My recovery was much easier than I was expecting. The staff at Pine Creek were fabulous and attended to all of my needs – most of which were pain med requests. I was expecting to want/need heavy pain relievers every four hours to be comfortable. However, the pain was much more manageable and was different than my pain before surgery. I had no pain/pressure in the tailbone, no numbness in my legs/feet and no lower back pain or sciatic nerve pain. The main pain I felt was near the incision site, which was to be expected. I was up and walking the 2nd day after surgery, and was released on Friday. I am obeying post-op surgery recommendations to a T and so far this has been much easier than I expected. I would tell anyone I know who is going through any TC pain to not even question Dr. Feigenbaum’s recommendations. He is definitely the best in this field, and a life-saver who has given me my life back. So very very worth it! I am walking 30-45 minutes a day, able to sit 45-60 minutes with no tailbone pain (more muscle back pain due to inactivity for 7 months), and I can feel my calves and feet again! I have not taken any pain medication since August 25, 2012 (ten days after surgery). Occasionally at night I take 2 Advil, but more for sore muscle pain from slowly getting back into more movement that my body was deprived of for so long prior to surgery.”

DALE K.
TARLOV CYST SURGERY

“ I had Tarlov Cyst surgery last Nov 6th, 2012. As I pass this one year “anniversary”, I would like to share my experiences in hopes of helping others. By the time I had the surgery I had been through many doctors and tests, procedures and wrong diagnoses for my increasing and debilitating pain. When a radiology report revealed a Tarlov Cyst and suggested follow up, my husband googled it and though the symptoms fit like a glove, the pain management Dr( a spine specialist) refused to believe it. I have since found this ignorance common and frightening. I sent my info. to Hopkins and the diagnosis was confirmed. I had the fibrin glue treatment there in July 2012 and it actually increased my symptoms. I went downhill till my surgery with Dr Feigenbaum.

Immediately after the surgery, when first allowed up, I could finally put one foot in front of the other to walk. (I had been only hobbling side ways before.) I actually had tears of joy. However a long road still was ahead. Improvement for the severe nerve damage the cyst incurred is a painstakingly slow and uneven journey. However Dr Feigenbaum prepared me and gave me not only his amazing skill and compassion, but the gift of hope. He warned me about the upcoming months(3-6, although mine continued an extra month!), when I would be able to do more but it would hurt more…as advertised! By January 2013, I realized I could walk close to a half mile. Around month 8, the pain began to ebb more and I started to realize how much more I could do. The “sharp rocks” feeling when I sat, the constant stinging and pain in the thighs, hips and private areas faded. Pain began to centralize at the sacral site. Progress was still uneven, but very noticeable. At 12 months, while still hoping for further progress, I can walk about a mile at one time and sit for longer periods. I am down to 1-2 50 mg Tramadol a day for pain, with a very occasional Tylenol thrown in. I also have been using acupuncture with a trained medical doctor which has provided temporary respites from the pain.

I wish I could spread the word to every Tarlov sufferer about Dr Feigenbaum and his wonderful, compassionate and always helpful staff. Help is there. I thank him in my heart and mind every single day and with each step I take.”

MENINGEAL PT FROM CA
MENINGEAL DIVERTICULUM

“My son was 12 years old (2012) when we discovered he had a large meningeal diverticulum at his sacral spine. The MRI showed that it extended from L1 to almost the bottom of his sacrum. The cyst was compressing his sacral nerve roots and had already eroded some of his bone.
Reta Hiers from the Tarlov Cyst Foundation led us to Dr. Feigenbaum. My son had surgery 16 months after diagnosis. Being out of state, it took some planning and we had to ask for authorization from our insurance. We were apprehensive to have this major surgery done with a doctor we never met in person, however we trusted Reta. We had a phone consultation with the doctor in which he asked to speak to our son as well. Afterwards we felt that it was in our son’s best interest to have the surgery done before any other damage would occur.

Our experience with Dr. Feigenbaum and his staff was excellent. This was a very delicate surgery and Dr. Feigenbaum performed it with expertise and precision. Our stay at Medical City Hospital and the care we received there was very good.

It is now 6 months post-op. My son is experiencing some nerve sensations such as numbness, tingling, burning, etc. We were told these are normal feelings that will subside over time. We trust that he will continue to improve as time goes on.

Overall our experience with this surgeon has been very positive and we would highly recommend him to anyone who has a Tarlov cyst or meningeal diverticulum. We are truly grateful to Reta from the Tarlov Cyst Foundation for leading us in the right direction and to Dr. Feigenbaum and his staff for helping our son.

EVELYN H
SACRAL CYSTS

“I had been in pain management for almost ten years when I discovered that I had Tarlov Cysts. I had gone to many spine specialists who recommended injections, physical therapy, hydrotherapy, strength training, a TENS unit and even a back brace. Some questioned whether I was really in pain. Because the pain I was describing didn’t fit with where they said my pain SHOULD be, I was made to feel as if I was dreaming up symptoms. After finding out about the cysts, I asked my pain management/spine doctor if he had known about the cysts before. He told me that he did know about them, but since they were believed to be totally benign that he had chosen not to tell me about them.

I had quit going to family gatherings and spent much of my time in bed because that was the only place I could get at least a measure of relief.

A totally unrelated emergency situation caused me to be referred to a neurologist. After addressing the other problem, which was temporary, he did a total neurological workup in which he found that I had no reflexes in my legs. After viewing my latest MRI, he said that he had found the source of my sacral pain and likely the absence of reflexes. Then he showed me three large cysts. He recommended that I see a spine surgeon. I made an appointment with the spine surgeon who had been treating patients from my pain management clinic. He told me that Tarlov Cysts were benign anomalies of the spine and that they didn’t cause pain, but that if I wanted to pursue the matter further, there was a neurosurgeon in Dallas who had founded an institute dealing with Tarlov cysts. I called and made an appointment, and from that first appointment it was only about three months until my surgery.

I had bowel and bladder problems that I had endured for years without knowing they were directly connected to the location of the cysts on my spine. At one year out from my surgery, these have almost completely abated and the reflexes in my legs are now completely normal.

After the surgery, I had to find a new pain management clinic since my other pain doctor had moved out of the area. The new one stated that he was sure I had wasted my money on the surgery since Tarlov cysts don’t cause pain and implied that I was just seeking drugs. Although I now have to travel for over an hour to get to his office, I found a doctor who was familiar with Tarlov cysts, and who will work with me until I no longer need narcotic pain medication.

Although I am still in pain management, I am taking less than half the pain killers than I was before the surgery, and I am having more and more pain-free days. I am getting out more and have begun new projects that would have been impossible to complete before I had the surgery.

Dr. Feigenbaum and his staff have been extremely kind, considerate and professional, and the hospital experience was one of the best I have ever had.

I would recommend that if you are diagnosed with Tarlov cysts you should seek the services of Dr. Feigenbaum and his staff.

ANNE O
TARLOV CYSTS

I am writing this letter to acknowledge the outstanding professional care that I received from each member during my stay at Pine Creek Medical Center from May 19, 2015 to May 22, 2015. Upon entering the facility on the morning of my operation, I was well taken care of and respectfully treated by each person – from the chaplain at the main desk and the intake person to the nurses and doctors who were involved in my procedure and care. Because of the professional and competent demeanor of all staff members, I was able to overcome my anxious feelings while at the same time increase my confidence that all would go well. During recovery, I could not have been treated any better. Each nurse clearly understood all aspects of my procedures, as well as the expectations and medical protocol that were to be followed. They executed these steps adeptly and skillfully. Each nurse catered to my every need and not once, hesitated to go above and beyond the call of duty. The specialists (i.e., respiratory therapists, physical therapist) provided me with important information and patiently answered all of my questions. They along with the nursing administrator checked on me to ensure that I was progressing and that I was receiving adequate care. Even the food service personnel took into consideration my requests, acknowledging the guidelines of the interstitial diet I was choosing to follow and preparing each meal according to my instructions. Each meal was nicely presented and tasted delicious. Finally, I found Dr. Feigenbaum and his nurse, Katie, the accompanying physicians, Dr. Patel (anesthesiologist) and the hospital’s intern, to be excellent, highly skilled, and extremely competent in their fields. I was also impressed by their taking time out to ensure my well-being and to address any concerns that I had.

I would not hesitate to recommend Pine Creek Medical Center to any individual considering undergoing the medical procedures for which the facility specializes. I truly believe that I found Pine Creek Medical Center to be an outstanding medical facility because of its excellent staff and its caring practices. It is truly a facility that should stand as a model to be followed. Thank you.

Patient / Practitioner Education

Dr. Frank Feigenbaum discusses Tarlov Cysts

Outcomes & Study Statistics

BACKGROUND

Under the supervision of Sarah Cannon Research Institute and Medical City – Dallas IRB (Independent Review Board), Dr. Feigenbaum has been gathering and analyzing Tarlov cyst surgical outcomes since 2007. To date, over 1500 Tarlov cyst patients have been involved in Dr. Feigenbaum’s study which measures and reports patient outcomes for two years post-surgery. Patient outcomes are captured using four standardized self-assessment questionnaires: Visual Analog Scale, SF-36, Oswestry and Feigenbaum questionnaires. Study patients send in their completed self-assessments at specific intervals: Pre-op, 3 months, 6 months, 12 months and 24 months following surgery.

Analysis of patient outcome data reveals the following demographics:

  • Age distribution
  • Sex distribution

PROVEN SURGICAL TECHNIQUE

  • 12 months following surgery, 70% of patients had improvement in lower extremity pain and numbness
  • 12 months following surgery, more than 70% of patients had improvement in sacral pain

CONCLUSION:

  • Leg pain (91.4%), sacral pain (89%), and leg numbness (87.5%) were the three most commonly reported preoperative symptoms. There was improvement in all areas 3 months following surgery.
  • The responses from the four unique self-assessments of pain, quality of life, and functionality indicated a trend toward improvement in all areas following surgery

REFERENCE ARTICLES:

  • Tarlov Cysts, published 2012 (PDF)
  • Giant sacral meningeal diverticulum containing a thickened filum with lipoma with lipoma in an adult with spinal cord tethering, published September 2008 (PDF)
  • Giant sacral meningeal diverticula: surgical implications of the “thecal tip” sign, published 2006 (PDF)

Frequently Asked Questions

WHAT ADDITIONAL TESTS CAN I EXPECT WILL BE NEEDED BEFORE DETERMINING IF I AM A SURGICAL CANDIDATE?

Some patients will need a dedicated MRI of the sacrum or flexion/extension x-rays of the lumbar spine to look for instability.

DO I HAVE TO NOTIFY MY INSURANCE COMPANY TO GET APPROVAL FOR MY SURGERY?

Our office will do any necessary pre-authorization and contact you if there is anything you must do.

AT WHAT FACILITY WILL THE PROCEDURE BE PERFORMED?

Surgery is scheduled either at Pine Creek Medical Center in Dallas, Texas, Medical City Dallas Hospital in Dallas, Texas or St. Luke’s South in Overland Park, Kansas. Patient needs and insurance coverage will determine the location.

HOW MANY DAYS WILL I BE IN THE HOSPITAL?

Generally three to four days.

CAN A FAMILY MEMBER STAY WITH ME IN THE HOSPITAL?

Yes.

HOW LONG WILL I NEED TO STAY IN TOWN AFTER MY SURGERY ONCE I'VE BEEN DISCHARGED FROM THE HOSPITAL?

Seven to ten days.

WHAT IS A TYPICAL SCENARIO FOR THOSE COMING OUT OF TOWN FOR SURGERY?

For example, if your surgery is planned for a Wednesday, this is a typical day by day plan.

If you have not met Dr. Feigenbaum in person, you will need to travel to Texas either on Sunday or early Monday, meet Dr. Feigenbaum on Monday and do any pre-admission items at the hospital, have surgery on Wednesday, be discharged to the hotel on Friday or Saturday, and be seen in the office for a post-operative appointment on Friday. If you are doing well, it may be possible to move your appointment earlier. You can plan to travel home after your post-operative appointment or the day after your visit.

If you have already met Dr. Feigenbaum, you will need to travel to Texas on early Tuesday so that you can do any pre-admission items with the hospital on Tuesday; these are walk-in appointments, but please arrive before 4 P.M.

WHAT FOLLOW UP IS DONE AFTER THE SURGERY?

Local patients: are seen at 3 weeks, 3 and 6 months, and one and two years after surgery. The post-operative appointment is mostly with the nurse. An MRI is done at 3 months and one and two years after surgery. Post-operative surveys or questionnaires are filled out by patients at 3 and 6 months and one and two years after the surgery.

Out of town patients: are seen in the office approximately one week after surgery. An MRI is done at 3 months and one and two years after surgery. Post-operative surveys or questionnaires are filled out by patients at 3 and 6 months and one and two years after the surgery. These items need to be mailed to our main office in Texas to be reviewed by Dr. Feigenbaum.

HOW ARE THE CYSTS REMOVED?

These unique cysts are the nerves and therefore are not removed but rather opened, explored and treated under an operating microscope while the nerves are continuously monitored. For other types of cysts such as a meningeal diverticulum it is possible to resect the cyst as long as there are no nerves attached.

WHAT IS THE PLATE MADE OF THAT IS PLACED OVER WHERE THE BONE WAS?

In your consultation, Dr. Feigenbaum may have mentioned a “man-hole” cover. This plate looks like a clear plastic mesh and is made of a polymer called poly L-lactide-co-glycolide. Over a few years is breaks down to water and your body will absorb it. Over time your body will form a tough scar on top of where the plate used to be.

WHAT CAN I DO TO ENHANCE MY RECOVERY FROM SURGERY?

While the recovery can be a long one and very different than other types of surgery there are some things you can do to make it the best possible recovery.

  • Follow all your post-operative instructions
  • Do not smoke
  • Maintain a good support system of family and friends
  • Follow your restrictions
  • Have a positive outlook and have a motivation to get better
  • Eat a healthy balanced diet to obtain proper nutrition
  • Maintain a healthy weight
  • Don’t spend too much time focusing or talking about your pain or symptoms
  • Have realistic expectations and be patient with yourself and the recovery
  • Walk daily as you tolerate

I HAVE TROUBLE SITTING, CAN YOU RECOMMEND A SEAT CUSHION?

We provide a cushion to our patients during their visit in our office that can be purchased on line. It is called a “Tush-Cush.” The “car-cush” size is quite ideal. It is available at tushcush.com or amazon.com.

HOW MANY TARLOV/MENINGEAL CYST SURGERIES HAS DR. FEIGENBAUM DONE?

Dr. Feigenbaum has treated over 1,500 Tarlov and meningeal cyst patients.

ARE HEADACHES A SYMPTOM OF TARLOV CYSTS?

No, but some patients state they have headaches, and that after surgery, it decreases. Some patients tighten their jaw because of pain which can lead to headaches. A previous surgical patient found it helpful to use a mouth guard during sleep to relieve symptoms.

One Patient's Journey

THE TARLOV CYST DISEASE FOUNDATION

Mission : The Tarlov Cyst Disease Foundation is a volunteer-based, 501(c)(3) non-profit foundation dedicated to the research, improved diagnosis and development of successful treatments and outcomes for symptomatic Tarlov cysts.

The Foundation is incorporated exclusively for scientific, educational, and charitable purposes that will seek to improve the level of understanding, diagnosis and treatment of Tarlov cysts.

ADVANCES IN NEUROSURGICAL CARE

Minimally Invasive Spine Surgery (MIS): Dr. Feigenbaum is fully trained in surgical techniques which involve making smaller incisions and reducing the amount of tissue damage beneath the skin. In neurosurgery, minimally invasive surgery is accomplished with the aid of specially designed instruments which assist in visualization of the surgical field.

Image Guided Surgery: Dr. Feigenbaum keeps current with new advances in computer assisted technologies for image analysis, diagnostic/preoperative planning and surgical navigation using 3D virtual image of the surgical field.

 

tarlov cyst institute -pine creek

9080 Harry Hines Blvd, Ste 220
Dallas, Texas 75235

Phone (214) 351-8450
Fax (214) 351-8451

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