Tarlov Cysts and Back Pain

Patient experience explains what these cysts are, potential causes, symptoms, diagnosis and treatment options.

A Tarlov cyst (TC) is a fluid-filled sac that can develop anywhere in the spine affecting the nerve roots. These cysts are sometimes called perineural, meaning the cyst can surround (peri) a nerve (neural). They are also known as sacral nerve root cysts because TCs are more common in the sacrum. These cysts can compress spinal nerve roots causing pain, weakness and numbness that radiates (radiculopathy) into the lower extremities (eg, legs).
Magnetic resonance imaging (MRI) of a Tarlov cyst. Magnetic resonance imaging (MRI) of a Tarlov cyst. By Malisan.mrosa. Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8434925Roger’s Experience With Tarlov Cysts
Five years ago, I went to the doctor because of low back pain. The imaging test revealed Tarlov cysts around my sacrum, but my doctors told me not worry—the cysts were not the cause of my back pain (“asymptomatic”). Last year, I suffered a terrible fall down a flight of steps. That changed everything, as the fall aggravated my cysts. Suddenly, I began to experience debilitating nerve pain and weakness radiating down the bottom half of my body. Sitting and standing for more than a few minutes at a time was unbearable. What should I know about Tarlov cysts, and can anything be done?—Roger, Great Falls, MT

What Are Tarlov Cysts?
Tarlov cysts are fluid-filled cysts that can develop along the nerve roots in your spine. They are most often found in your sacrum, but they can occur at any spinal level.

Tarlov cysts can be asymptomatic (causing no symptoms) or symptomatic (causing symptoms). While large symptomatic Tarlov cysts are rare, the smaller asymptomatic variety is much more common—in fact, as much as 9% of the population have asymptomatic Tarlov cysts.

As Tarlov cysts grow, they can press on your spinal nerve roots—this is when symptoms develop. The primary symptom is radiculopathy, or nerve pain.

Women develop Tarlov cysts more often than men, though researchers aren’t sure why.

What Causes Tarlov Cysts?
Tarlov cysts were first identified in 1938, but the medical community still doesn’t know the exact cause of this spinal disease.

However, doctors believe they know why asymptomatic Tarlov cysts become symptomatic. Spinal trauma from a severe fall or car accident that impacts the low back and tailbone area may cause increased cerebrospinal fluid pressure. Cerebrospinal fluid is what fills Tarlov cysts, and this increased pressure may cause the cysts to grow and become symptomatic.

What Are the Symptoms of Tarlov Cysts?
As Tarlov cysts grow and put pressure on your spinal nerves, simple postures like sitting, standing, bending, and walking may become incredibly painful. Symptoms may vary based on where the cyst is located on your spine, but you may experience:

  • Radiculopathy (radiating nerve pain)
  • Sciatica
  • Pain near the site of the cysts
  • Muscle weakness
  • Difficulty maintaining certain postures (such as sitting or standing) for long periods
  • Poor or absent reflexes
  • A loss or change in skin sensation
  • Bowel and bladder dysfunction
  • Sexual dysfunction

Why Are Tarlov Cysts Difficult to Diagnose?
Doctors may struggle to accurately diagnose a Tarlov cyst because it’s a rare disease, and few doctors have a strong understanding of it. Secondly, the symptoms of Tarlov cyst mirror those of other much more common spinal problems (such as a herniated disc or degenerative disc disease).

A Tarlov cyst is usually confirmed by results of a magnetic resonance imaging (MRI), computed tomography (CT) scan, or myelogram. These imaging tests can illuminate the fluid-filled cyst around the spinal nerve roots.

Who Treats Tarlov Cysts?
As with most health concerns, your primary care physician (PCP) is often the starting point to securing a diagnosis and coordinating specialist referrals. If you are having pain in your lower back or in another part of your spine, don’t wait to see your PCP.

Your PCP may refer you to a neurologist and pain management specialist to help you understand your treatment options. If you have bladder dysfunction, your PCP may also refer you to a urologist, and in some cases a spine surgeon.

What Non-surgical Treatments Ease Tarlov Cysts Pain?
While there is no cure for Tarlov cysts, several non-surgical treatments may help you manage symptoms. No standard treatment plan exists for Tarlov cysts, so your health care team may recommend a combination of the following therapies:

Unfortunately, none of these therapies prevent a cyst from recurring.

Is Spine Surgery an Option for Tarlov Cysts?
If you have tried various non-surgical treatments with no success, your doctor may recommend spine surgery for your Tarlov cyst(s).

Surgery for Tarlov cysts involves opening the cyst and draining its fluid. The surgeon then injects the cyst with a fibrin glue to prevent the fluid from coming back.

Because Tarlov cysts develop alongside spinal nerves, your surgeon may use a spinal decompression technique, such as a laminectomy, to create space around the cramped nerves. Your surgeon may also remove the cyst and surrounding nerve roots.

Spine surgery may not fully alleviate your symptoms. Talk to your spine surgeon about the risks and benefits of surgery for you prior to undergoing a procedure.

Preserving Your Quality of Life with Tarlov Cysts
Symptomatic Tarlov cysts are a rare spinal disease, and you may feel like no one else understands your pain. But, you’re not alone. Joining a support group can be an extremely helpful coping strategy and staying in close contact with your pain management team is a strong defense against symptoms.

Updated on: 06/06/18
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