Tarlov cysts, also known as perineural or sacral nerve root cysts, are fluid-filled sacs that form around the nerve roots at the base of the spine, especially in the sacral region. These cysts are filled with cerebrospinal fluid (CSF) and can vary in size. While many Tarlov cysts are asymptomatic and discovered incidentally, some can cause significant symptoms by pressing on adjacent nerve roots and structures.
Why do Tarlov cysts form?
The exact cause of Tarlov cysts is not fully understood, but several factors can contribute to their formation:
Congenital Factors: Some individuals may be born with small cysts or may be predisposed to develop them due to abnormalities in the meningeal covering of the spinal nerves. These congenital factors may increase the likelihood of Tarlov cysts developing.
Trauma: Spinal trauma, such as falls, car accidents or heavy lifting, can cause Tarlov cysts to form or existing cysts to grow. Spinal trauma can trigger cyst formation by causing fluid to build up around the nerve roots.
Inflammation: Inflammatory conditions affecting the spinal meninges can lead to the formation of Tarlov cysts. Inflammation can promote cyst development by causing changes in the meningeal covering.
Increased Cerebrospinal Fluid (CSF) Pressure: Conditions that increase cerebrospinal fluid pressure, such as a spinal fluid leak or obstruction, can contribute to the formation and growth of Tarlov cysts. Increased CSF pressure can cause fluid buildup around the nerve roots.
Heredity: Some individuals may have a genetic predisposition that makes them more prone to developing Tarlov cysts. Individuals with a family history of Tarlov cysts may have a higher risk of developing them.
It is important to consult a specialist to learn more about Tarlov cysts and to assess your personal risk factors. Formation of these cysts
Understanding the causes is critical to determine treatment and management options.
What are the Symptoms of a Tarlov Cyst?
While many Tarlov cysts are asymptomatic, symptomatic cysts can cause a variety of symptoms depending on their size and location. Common symptoms include:
Localized Pain: Pain in the lower back, buttocks or legs.
Radicular Pain: Radiating pain that follows the path of the affected nerve.
Numbness and Tingling: In the lower extremities.
Weakness: in the legs or feet.
Bladder and Bowel Dysfunction: In severe cases, cysts can cause bladder and bowel control problems.
Sexual Dysfunction: Numbness or pain in the genital area.
How is a Tarlov cyst diagnosed?
Diagnosis of Tarlov cysts usually involves a combination of clinical evaluation and imaging studies:
Magnetic Resonance Imaging (MRI): This is the primary imaging method for diagnosing Tarlov cysts. MRI provides detailed images of the cysts and their relationship with surrounding nerve structures.
Computed Tomography (CT) Scan: Can be used to evaluate bone involvement and the precise anatomy of the cysts.
Myelography: An imaging technique used to better visualize cysts and their effects on the spinal cord and nerve roots by injecting contrast dye into the spinal canal.
Nerve Conduction Studies and Electromyography (EMG): To assess the functional impact of the cysts on the nerve roots.
How is Tarlov's Cyst Treated?
Conservative treatment options may be sufficient for asymptomatic or mildly symptomatic Tarlov cysts:
Observation: Regular monitoring with periodic imaging studies to monitor cyst growth and progression of symptoms.
Painkillers: NSAIDs, acetaminophen or stronger analgesics for pain management.
Nerve Pain Medications: Gabapentin or pregabalin for neuropathic pain.
Muscle Relaxants: To relieve muscle spasms.
Physical Therapy: Exercises and stretching to improve mobility, strength and relieve pain.
Activity Modification: Adjustments including avoidance of activities that worsen symptoms and periods of rest.
Epidural Steroid Injections: To reduce inflammation and pain in the affected area.
Surgical Treatment
Surgical intervention may be considered for symptomatic Tarlov cysts that do not respond to conservative treatments or cause severe neurologic deficits. Surgical options include the following:
Microsurgical Cyst Fenestration: A method of making a small opening into the cyst to drain cerebrospinal fluid and reduce pressure on the surrounding nerves.
Cyst Wall Resection: Decompression of the affected nerve roots by removing part or all of the cyst wall.
Fibrin Adhesive Injection: Injection of fibrin glue to close the cyst and prevent fluid accumulation.
Shunt Placement: Placing a shunt to divert cerebrospinal fluid from the cyst to another part of the body.
Laminectomy: Removal of part of the vertebral bones to allow access and decompression of the cyst.
Postoperative Care
Postoperative care for patients with Tarlov cysts usually includes
Rehabilitation: Physical therapy to restore strength, mobility and function.
Pain Management: Medications and techniques to manage pain after surgery.
Regular Follow-up: Imaging studies and clinical evaluations to monitor for cyst recurrence or complications.
Tarlov cysts are often asymptomatic, but when symptomatic can cause significant discomfort and neurologic deficits. Understanding the pathology, etiology and available treatment options is critical for effective management. Conservative treatments can provide relief for many patients, but for some, surgical intervention may be required when there are severe or persistent symptoms. A comprehensive approach with regular monitoring and individualized treatment plans is essential to achieve the best outcomes for patients with Tarlov cysts.
