Tarlov Cysts

Tarlov cysts are fluid-filled lesions of the spinal nerve roots that are most commonly found at the lower levels of the spine. They are also referred to as perineural or sacral nerve root cysts. These cysts are either valved or non-valved. In valved cysts, there is a structure that prevents the outflow of fluid, whereas in case of non-valved cysts the fluid movement is free.

One of the features that distinguishes them from other spinal lesions, is the presence of spinal nerve root fibers, either in the walls of the cysts or in the cavity. These cysts compress the nerve roots, causing lower back pain, sciatica, urinary incontinence, headaches, constipation, or loss of feeling or movement in the leg or foot.

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

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 increased CSF pressure, obstruction of CSF fluid, and trauma to the spinal cord. Many times, they are caused due to unknown reasons.

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

Some of the symptoms of these cysts are:

• Pain due to any kind of movement
• Pain in lower back and buttocks
• Sitting for prolonged periods causes back 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 (tingling, burning, or prickling sensations in legs and feet)

It is to be noted that the symptoms of this condition often mimic other symptoms of spine problems. If a person is suspicious that he/she has this condition, then it is advisable to consult an experienced neurosurgeon.

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 performing scanning tests for other spine problems. For confirmation, it is recommended to undergo a computed tomographic (CT) myelograph.

Treatment is done either by surgical or nonsurgical methods. In the surgical method, the area of the affected spine (where the cyst is present) is disclosed first and the 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. Non-surgical treatments include lumbar CSF drainage and percutaneous cyst drainage.

Surgical technique is known to be beneficial for patients with cysts which are greater than 1.5 cm in size. However, there are certain post-operative complications such as CSF leak and bacterial meningitis. Also, one should be careful while opting for a non-surgical method as it is observed that about 75% of the patients who have undergone percutaneous drainage, developed post-procedural aseptic meningitis.

In some patients, it has been seen that administration of anti-inflammatory drugs and physical therapy reduces symptoms of this condition. It is always better to consult and seek advice from a physician before choosing any kind of treatment.

Disclaimer: This story is for informative purposes only, and should not be used as a replacement for expert medical advice.