Tarlov Cysts

Tarlov cysts are fluid-filled lesions of the spinal nerve roots that are mostly found at the lower levels of the spine. They are also referred to as perineural or sacral nerve root cysts. Tarlov cysts are either valved or non-valved. In valved cysts, there is a structure that prevents the outflow of fluid, whereas fluid movement is free in case of non-valved cysts. One of the features that distinguishes Tarlov cysts from other spinal lesions, is the presence of spinal nerve root fibers, either in the walls of the cysts or in the cavity.

It is estimated that small Tarlov cysts are present in about 6-9% of the world's population. According to a recent Tarlov cyst survey, it was found that women have higher chances of developing Tarlov cysts than men. In the survey, more than 85% of the respondents were female, in which majority of them were of ages 31 to 60 years.

Causes and Symptoms of Tarlov Cysts

Tarlov cysts are caused due to dilations of the nerve root sheaths, which are later filled with cerebrospinal fluid (CSF). Some of the causes of cyst formation are due to increased CSF pressure, obstruction of CSF fluid and due to trauma to the spinal cord. Many times, they are caused due to unknown reasons.

Small Tarlov cysts are asymptomatic. However, symptoms appear when the cysts grow to a bigger size, resulting in increased pressure of spinal fluid in the cyst wall and on nerves in the cyst cavity. In most cases, symptoms of Tarlov cysts are developed due to neurological disorders. Symptoms vary from mild to severe. Some of the symptoms of Tarlov cysts are listed below

• Any type of movement causes pain
• Pain in lower back and buttocks
• Sitting for prolonged periods causes pain
• Weakness of muscles
• Headache
• Loss of reflexes
• Abdominal pain
• Problems in bowel movement (for e.g. constipation)
• Changes in bladder function
• Neurogenic claudication (pain in thigh due to lack of blood supply)
• Paresthesias (sensations in legs and feet)

It is to be noted that symptoms of Tarlov cysts often mimic other symptoms of spine problems. If a person is suspicious that he/she has Tarlov cysts, then it is advisable to consult a neurosurgeon who has experience in treating Tarlov cysts.

Diagnosis and Treatment of Tarlov Cysts

Tarlov cysts are detected after taking an MRI (magnetic resonance imaging) of the lumbar and sacral levels of the spine. It is common to have more than one Tarlov cysts. Very often, they are diagnosed incidentally while doing scanning tests for other spine problems. For confirmation of Tarlov cysts, it is recommended to undergo computed tomographic (CT) myelograph.

Treatment of Tarlov cysts is done either by surgical or nonsurgical way. In surgical method, the area of the affected spine (where the cyst is present) is disclosed first and fluid from the cyst is aspirated. Further, fibrin glue is injected in order to avoid recurrent development of the cysts. Other neurosurgical techniques include nerve root excision of the cyst, simple laminectomy (removal of lamina of the vertebral bone) and surgical cyst fenestration. Nonsurgical treatments of Tarlov cysts include lumbar CSF drainage and percutaneous cyst drainage.

Surgical technique is known to be beneficial for patients with Tarlov cysts greater than 1.5 cm. However, there are certain postoperative complications such as CSF leak and bacterial meningitis. Also, one should be careful while opting for a nonsurgical method as it is observed that about 75% of patients who have undergone percutaneous drainage developed postprocedural aseptic meningitis. In some patients, it has been seen that administration of anti-inflammatory drugs and physical therapy reduces symptoms of Tarlov cysts. It is always better to consult and seek advice from a physician before choosing any kind of treatment.