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Tarlov Cyst

(Perineural Cyst; Sacral Nerve Root Cyst)

Definition

Tarlov cysts are abnormal sacs of spinal fluid that usually form at the lower end of the spine (sacrum). What distinguishes Tarlov cysts is the presence of spinal nerve fibers within the cyst wall.
Sacrum
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Causes

The cause of a Tarlov cyst is unknown but may be related to:
  • Trauma to the spine
  • Increase in cerebrospinal fluid pressure
  • Blockage of cerebrospinal fluid
Research has shown that the condition may be linked to connective tissue disorders (eg, lupus , Marfan syndrome ). However, researchers are still studying this.
Once you have a Tarlov cyst, the following may cause it to become painful or cause other symptoms:

Risk Factors

Although gender may not be a risk factor, Tarlov cysts have more often been found in women than men.

Symptoms

Most of the time Tarlov cysts do not cause symptoms. Cysts may cause pain and other signs of nerve irritation, such as weakness, numbness, burning, and tingling. In some cases, it can cause problems with bladder and bowel function.
An increase in pressure in or on the cyst may increase symptoms and cause nerve damage. Symptoms can vary from person to person.
If you have any of these symptoms, do not assume it is due to Tarlov cysts. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
  • Bladder or bowel dysfunction
  • Sexual dysfunction
  • Nerve pain
  • Pain in the lower back, buttocks, legs and feet, vagina, rectum, or abdomen
  • Pain when coughing or sneezing
  • Weakness, cramping, or numbness in the buttocks, legs, and feet
  • Swelling, soreness, or tenderness around the lower end of the spine (sacral area)
  • Abnormal sensations in the legs and feet, or less commonly in the arms and hands
  • Sciatica symptoms, such as pain when sitting or standing
  • Headaches
  • The feeling of “sitting on a rock”
  • Pulling and burning feeling in the tailbone
  • Loss of sensation on the skin
  • Loss of reflexes

Diagnosis

Your doctor will ask about your symptoms and medical history. She will also do a physical exam. Depending on your symptoms, you may need to see a specialist, such as a neurosurgeon.
Tests may include the following imaging techniques:
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
  • Myelogram —an imaging test that uses a special dye to view the spinal cord
  • Aspiration of the cyst—a needle is used to remove fluid from the cyst

Treatment

If you are experiencing symptoms, talk with your doctor about the best treatment plan for you.
Treatment options might include:
  • Intramuscular corticosteroid injections or other medication injections —to relieve pain
  • Prescription medications —such as pain medications, antiseizure medications or antidepressants (both of these may be used to treat pain)
  • Lidoderm patches —applied to area of the spine where the cyst is located to provide temporary relief of pain and discomfort
  • Transcutaneous electrical nerve stimulation (TENS) —electrical impulses are delivered through the skin to help control pain
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) —to relieve pain and inflammation
  • Aspiration of the cyst plus fibrin glue injection —a needle is used to drain the cyst and then a special glue is injected into the cyst to try to prevent it from filling again
  • Surgery —done if symptoms are severe; nerve damage is worsening; bowel and bladder dysfunction are worsening; or if there is wearing down of the sacrum or other spinal bones

Prevention

There are no guidelines to reduce your risk of forming a Tarlov cyst. If you have a Tarlov cyst that does not cause pain or other symptoms, avoiding injury or heavy lifting may reduce your chance of developing pain or other symptoms.

RESOURCES

National Institutes of Health http://www.nih.gov/

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

Tarlov Cyst Disease Foundation http://www.tarlovcystfoundation.org/Home.asp

CANADIAN RESOURCES

HealthLinkBC http://www.healthlinkbc.ca/

MyHealthAlberta.ca https://myhealth.alberta.ca/

References

American Academy of Neurology Foundation. Tarlov cysts. American Academy of Neurology Foundation website. Available at: http://www.thebrainmatters.org/disorders/index.cfm?event=view&disorder%5Fid=1082 . Accessed May 12, 2009.

American Association of Neurological Surgeons. Tarlov cyst. American Association of Neurological Surgeons website. Available at: http://www.neurosurgerytoday.org/what/patient%5Fe/tarlov%5Fcyst06.asp . Updated November 2006. Accessed June 15, 2010.

Mayo Clinic. Tarlov cysts: a cause of low back pain? Mayo Clinic website. Available at: http://www.mayoclinic.com/health/tarlov-cysts/AN01603 . Updated May 22, 2009. Accessed May 12, 2009.

National Institute for Health and Clinical Excellence. Therapeutic percutaneous image-guided aspiration of spinal cysts. National Institute for Health and Clinical Excellence website. Available at: http://www.nice.org.uk/nicemedia/pdf/IPG223guidance.pdf . Updated August 2007. Accessed May 12, 2009.

National Institute of Neurological Disorders and Stroke. Tarlov cyst information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/tarlov%5Fcysts/tarlov%5Fcysts.htm . Updated March 12, 2009. Accessed May 12, 2009.

Tarlov Cyst Disease Foundation. Tarlov cyst information. Tarlov Cyst Disease Foundation website. Available at: http://www.tarlovcystfoundation.org/TarlovCystInformation.asp . Accessed June 10, 2010.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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