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Treatment for Your Tarlov Cysts

Tarlov cysts, also known as perineural cysts or sacral nerve root cysts, are tiny sacs filled with cerebrospinal fluid that develop on nerve roots in your spine. While they can be found anywhere along your spine, they're most often found in the sacrum, the triangular-shaped bone located at the base of your spine.

As long as the cysts remain small, they don’t cause any symptoms. They’re actually pretty common, affecting up to 9% of the population. However, if they grow, they can compress the nerve roots, causing pain, weakness, and numbness that radiates into the legs and feet. Larger Tarlov cysts are actually quite rare and easily misdiagnosed due to physician unfamiliarity with the condition.

Our neurosurgeons at Apex Spine and Neurosurgery, however, have years of experience diagnosing and treating both small and large Tarlov cysts. We’ve helped numerous patients who visit our offices in Roswell, Alpharetta, and Bethlehem, Georgia, to overcome the chronic pain associated with the large variety. 

Here’s what you need to know about the cysts and how we treat them.

The potential causes of Tarlov cysts

Tarlov cysts were first identified in 1938, but while many theories exist about what causes them to develop, experts haven’t pinpointed any specific reason.

However, doctors are fairly certain they understand why asymptomatic, small Tarlov cysts become large and symptomatic. It’s due to spinal trauma to the lower back and sacral area, which increases cerebrospinal fluid pressure. The trauma can come from a severe fall, a car accident, giving birth, or even an epidural injection. Since cerebrospinal fluid fills Tarlov cysts, the increased pressure may cause the cysts to grow and become symptomatic.

Tarlov cyst symptoms

As Tarlov cysts put pressure on your spinal nerves, everyday functions like sitting, standing, walking, and bending can become incredibly painful. 

Symptoms vary based on where on your spine the cyst is located, but you may experience:

Most people find they can only get relief from the pain when lying on their side.

Tarlov cyst diagnosis

Accurately diagnosing a Tarlov cyst may prove difficult for a couple of reasons. First, it’s a rare condition, and that means few doctors have a complete understanding of it. Second, the symptoms of large Tarlov cysts resemble those of other, more common spinal problems, such as degenerative disc disease or a herniated disc.

A Tarlov cyst diagnosis can be confirmed by an MRI scan, CT scan, or myelogram. The images illuminate the fluid-filled cysts that surround the spinal nerve roots.

Tarlov cyst treatments

We may help alleviate your pain and other symptoms with pain relievers, anti-inflammatory medications, or treatments such as transcutaneous nerve stimulation (TENS). However, the primary treatment for Tarlov cysts is draining the fluid from the cyst, which we do by fine needle aspiration — inserting the needle and withdrawing the fluid.

Since the cysts gradually refill after aspiration, we may also fill the space with an injection of fibrin glue. While the glue may slow a recurrence of the problem, the cyst may eventually return.

Surgery is another potential treatment option. We may recommend a laminectomy to decompress the nerve and create space around it. Your neurosurgeon may also remove the cyst and surrounding nerve roots or perform microsurgery to remove the cyst and prevent cerebrospinal fluid from flowing into the area again.

If you’re suddenly besieged by radiating lower back pain, muscle weakness, and tingling, or if you’re unable to find any comfortable position other than lying on your side, you need to see a neurology specialist. Give us a call at any of our three offices to schedule a consultation, or book online with us today.

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