Tarlov Cyst


Fact: Women are at a higher risk of developing Tarlov cysts than men

What is a Tarlov Cyst?
Tarlov cysts are fluid-filled sacs that affect the nerve roots of the spine, especially near the base of the spine (sacral region). Individuals may be affected by multiple cysts of varying size. In most cases, Tarlov cysts do not cause symptoms (asymptomatic).

However, symptoms can occur depending upon the size and specific location of the cyst. Generally, the larger a Tarlov cyst is, the more likely it is to cause symptoms. Symptoms sometimes caused by Tarlov cysts include pain in the area served by the affected nerves, numbness and altered sensation, an inability to control bladder and bowel movements (incontinence), impotence, and, rarely, weakness in the legs. Small, asymptomatic cysts can slowly increase in size eventually causing symptoms. The exact cause of Tarlov cysts is unknown, but they may occur due to variation in normal development of the nerve sheath. Tarlov cysts were first described in the medical literature in 1938.



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, and often, the only position that provides relief, is reclining flat on one’s side. Symptoms vary greatly by patient, and may flare up and then subside. Any of the following may be present in patients that have symptomatic Tarlov cysts.

  • Pain in the area of the nerves affected by the cysts, especially the buttocks
  • Weakness of muscles
  • Difficulty sitting for prolonged periods
  • 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

Affected Populations
Women are at a higher risk of developing Tarlov cysts than men. The exact incidence or prevalence of symptomatic Tarlov cysts in the general population is unknown. Because these cysts often go unrecognized or misdiagnosed, determining their true frequency in the general population is difficult. However, the total number of Tarlov cyst patients (symptomatic and asymptomatic) is estimated at 4.6 to 9 percent of the adult population.

Diagnosis

Tarlov cyst is difficult to diagnose because of the limited knowledge about the condition, and because many of the symptoms can mimic other disorders. Most primary care physicians would not consider the possibility of Tarlov cyst. It is best to consult a neurosurgeon with experience in treating this condition.

Tarlov cysts may be discovered when patients with low back pain or sciatica have a magnetic resonance imaging (MRI) performed. Follow-up radiological studies, in particular, computed tomographic (CT) myelography are usually recommended.

If a patient has bladder problems and seeks medical help from an urologist, there are tests that can help diagnose Tarlov cyst. The standard urological tests for Tarlov cyst help determine if the patient has a neurogenic (malfunctioning) bladder. In urodynamics, the bladder is filled with water through a catheter and the responses are noted.

Cystoscopy involves inserting a tube with a miniature video camera into the bladder via the urethra. A neurogenic bladder shows excessive muscularity. A third possible test is a kidney ultrasound to see if urine is backing up into the kidneys.

Treatment

Nonsurgical Treatment
Nonsurgical therapies include lumbar drainage of the cerebrospinal fluid (CSF), CT scanning-guided cyst aspiration, and a newer technique involving removing the CSF from inside the cyst and then filling the space with a fibrin glue injection. Unfortunately, none of these procedures prevent symptomatic cyst recurrence.


Surgery
Tarlov cyst surgery involves exposing the region of the spine where the cyst is located. The cyst is opened and the fluid drained, and then in order to prevent the fluid from returning, the cyst is occluded with a fibrin glue injection or other matter.

Neurosurgical techniques for symptomatic Tarlov cysts include simple decompressive laminectomy, cyst and/or nerve root excision, and microsurgical cyst fenestration and imbrication.

The authors of one study found that patients with Tarlov cysts larger than 1.5 cm and with associated radicular pain or bowel/bladder dysfunction benefited most from surgery. The benefits of surgery should always be weighed carefully against its risks.



​Information on this page taken directly from:
American Association of Neurological Surgeons
National Organization for Rare Diseases (NORD)

Want to learn more?

The following are organizations and/or websites dedicated to providing information and education surrounding Tarlov Cysts. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.

American Association of Neurological Surgeons
Genetic and Rare Diseases Information Center
Medscape
National Organization for Rare Diseases (NORD)
Tarlov Cyst Foundation