Tarlov Cysts: Are They Symptomatic?
Dynamic Chiropractic, Jan 29, 2006 by Pate, Deborah
The etiology of perineural sacral cysts (Tarlov's cysts) is not well-understood. The best description is that they are a dilatation of arachnoid and dura of spinal posterior nerveroot sheath, containing nerve fibers. They are most commonly diagnosed on MRI. These lesions have been estimated to affect 4.6 percent to 9 percent of the adult population1 and are generally reported as incidental findings on CT or MR studies. It was originally thought that all Tarlov cysts were asymptomatic, but a small percentage can cause progressive painful radiculopathy. The statistical data are very inconsistent; I have seen reports of as high as one-fifth of Tarlov's cysts causing some symptoms.2

These cysts can occur anywhere in the spine, but the most common areas affected are the S-2 and S-3 nerve roots. Sacral cysts have been reported to cause sacral radiculopathy, hip, leg or foot pain, perineal pain, paresthesias, and bowel or bladder dysfunction. Symptoms can mimic a disc herniation.

There are many variations of Tarlov cysts. Some can become quite large - up to 6 cm. They can be multiple. As you might suspect, there is some confusion over the precise definition of Tarlov cysts and how they are different from other spinal cysts. The distinctive feature of the Tarlov perineurial cyst is the presence of spinal nerve root fibers within the cyst wall or cyst cavity itself.

The nomenclature becomes daunting because the etiology of this lesion is still not agreed upon and unfortunately, there is no consensus on the optimal management of symptomatic Tarlov cysts. The good news is that most remain asymptomatic.

Treatment recommendations for symptomatic Tarlov cysts vary widely depending on the symptoms. They can be drained of CSF; in fact, draining the CSF also can be a useful diagnostic tool to determine if symptoms are indeed due to the Tarlov cyst. There are two ways of draining these cysts: one is via a lumboperitoneal shunt; the other is percutaneous drainage. Unfortunately, the cysts re-form over time with percutaneous aspiration.

Surgical treatment involves complete cyst removal and excision of the affected posterior root and ganglion. As you can imagine, there are several ways of doing this complete excision, which I will not describe here.

Thank you for the information that you posted. What is working right now is accupuncture and adjustments from my Chiropractor. I can conclude within my own body that something dramatically changed in my spine recently resulting in extreme symptoms. After two weeks of pain, and MRI was performed showing the perineural cysts. I am still jumping through HMO hoops so I have yet to receive answers. All I know is I can't afford to be in pain or to get out of pain.

I hope you soon find relief....Please look into using one of the doctors listed to find relief.

That's a good article! Thanks for posting it...as I need all the info I can get these days.

I have recently gotten an MRI and they "found" that I have Tarlov cysts among other disk issues.

The neurologist I see increased the Lyrica as he thinks a lot of my "pain and cognitive issues" are the result of my lack of decent sleep. I have my doubts, but I'll give it a try. I also suffer from autoimmune issues and I don't know where one starts and the other ends KWIM?

If the neurologist doesn't address my pain issue soon, then I'll have to see if I can a referral to Georgetown or Hopkins.

Patze

Good luck with your quest....Make certain you visit both facilities..Georgetown and Hopkins that is....I think you will find that it is good to get two opinions when it comes to the Tarlov cyst. I do not know that the doctors use very different approaches when treating the cyst. It is good to hear both approaches to treatment and listen to both docs. Both have had good and bad results with their treatments and some docs say it is best to just not do anything at all when it comes to the Tarlov cyst. Again, good luck with whatever you decide...

I've had two surgeries in the last 12 months, and my last MRI shows a Tarlov Cyst. Doctor's tell me "it's nothing to worry about", but my pain is increasing to the point I can barely get out of bed. I take pain medicine every day, but nothing is helping. My last surgery was in December, and things have steadily declined. The pain I'm having is the same as the herniated disc. I've always been incredibly healthy and active. I'm at wits end and some days don't think I can go on any longer. I have a 2 year old son that I can't even play with many days, and I don't know where to turn. Any suggestions? I tried Johns Hopkins, but Dr. Donlin Long's office referred me to another physician there for a spinal cord stimulator. I can do that anywhere, I want to be sure the cyst is nothing to worry about???

Hello
Although I do not suffer from tarlov cysts I would like to let you know that there is a physician in France who is the patron of an organization of Tarlov Cysts also in France. He is an expert in tarlov cysts. He is working with Dr. Long from the USA who is also a specialist in this field. They have created a safe surgery for tarlov cysts patients. Some of them have their pain disappear.
Some patients had surgeries by different neuro surgeons who did not know about the new technology. These patients are now crippled for life unfortunately.
The person is charge of the forum for tarlov is Claudine, she is from france, speaks english and french. You may contact her for some information

Before suggesting yourself to any surgeries please contact her, she is very knowledgeable as she suffers from it. Claudine is the person who has fought to make Tarlov Cysts recognized as a legal entity in the medical field in France.

Louise
arachnoiditiscanada.com

Louise,

I too suffer with Tarlov cyst and have had the surgery with Dr. Long at Johns Hopkins in Baltimore. If anyone would like to ask me questions about the surgery please do not hesitate to contact me...

my daughter is being evaluated now by Dr. Long for tarlov cysts. what were your sympoms relating to the cysts and was the surgery successful? Do you recommend?

What is the name of the doctor in France, where is he located, and how can I find out more ? Thanks.