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 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.