Tarlov cysts are fluid-filled nerve root cysts found most commonly at the sacral level of the spine – the vertebrae at the base of the spine. The main feature that distinguishes Tarlov cysts from other spinal lesions is the presence of nerve root fibers within the cyst wall, or in the cyst cavity itself.
Due to the close proximity to the lower pelvic region, patients may be misdiagnosed with herniated lumbar discs, arachnoiditis and in females, gynecological conditions. The condition affects women far more frequently than men. Small Tarlov cysts usually do not cause symptoms.
An increase in pressure in or on the cysts may increase symptoms and cause nerve damage. Sitting, standing, walking and bending are typically painful. Often, the only position that provides relief is reclining flat on one’s side. Symptoms vary by patient and may flare up and subside.
- Pain in the area of the nerves affected by the cysts, particularly the buttocks
- Weakness of muscles
- Difficulty sitting for prolonged periods of time
- Loss of sensation on the skin
- Loss of reflexes
- Changes in bowel function such as constipation
- Changes in bladder function including increased frequency or incontinence
- Changes in sexual function
Tarlov cysts are difficult to diagnose because many symptoms can mimic other disorders. They may be discovered when patients with low back pain or sciatica have an MRI performed. Follow-up radiological studies, particularly CT myelography, are usually recommended.
Patients should make necessary lifestyle changes and undertake a pain management strategy with a pain medicine specialist. Supervised pain management, as well as support groups, can help you cope and improve your quality of life.
Spinal selective nerve blocks or transforaminal epidural steroid injections may provide relief for some patients.
Nonsurgical treatment includes lumbar drainage of the cerebrospinal fluid (CSF), CT scan-guided cyst aspiration and a newer technique that removes the CSF from inside the cyst and fills the space with a fibrin glue injection. None of these procedures prevents recurrence of the cyst.
Surgery for Tarlov cyst involves exposing the region of the spine where the cyst is located. The cyst is opened and the fluid drained. To prevent the fluid from recurring, the cyst is closed with a fibrin glue injection or other matter.
Neurosurgical techniques for symptomatic Tarlov cysts include simple decompressive laminectomy, cysts and/or nerve root excision and microsurgical cyst fenestration and imbrication.
Source: Tarlov Cyst Association