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What is a Tarlov Cyst?

A Tarlov cyst is a fluid-filled sac that affects the nerve roots of the spine, especially the sacral region, the group of bones at the base of the spine. The main difference with Tarlov cysts compared to that of other spinal lesions is the presence of spinal nerve root fibers in the cyst cavity itself or within the cyst wall.

What are the Causes of Tarlov Cysts?

The exact cause of the Tarlov cysts is unknown.  However, there are theories that suggest that falls or accidents involving the tailbone area of the spine can cause previously undiagnosed Tarlov cysts to flare up.

What are the Symptoms of Tarlov Cysts?

Tarlov cysts, in some cases, do not cause any pain and may go unnoticed. If symptoms do occur, they vary greatly among patients. An increase in pressure within or on the cyst may increase symptoms and cause damage to the nerve. Standing, sitting, bending, and walking are typically painful and the only position that may provide relief is reclining flat on your side. If you have symptomatic Tarlov cysts, any of the following may be present:

  • Pain, especially in the buttocks
  • Muscles weakness
  • Difficulty sitting for long periods
  • Loss of reflexes
  • Loss of sensation on the skin
  • Changes in sexual function
  • Bowel function changes such as constipation
  • Increased frequency or urinary incontinence

How are Tarlov Cysts Diagnosed?

Because of the limited awareness of the disease among doctors, and because the symptoms can mimic other disorders, diagnosing a Tarlov cyst can be difficult and take a long time.

Your doctor may diagnose a Tarlov cyst by an MRI and/or CT myelogram performed due to pain. Sometimes it is diagnosed following tests by a urologist due to problems in the bladder. The standard urological tests help find out if the patient has a neurogenic or malfunctioning bladder. A neurogenic bladder shows excessive muscularity. The tests may include:

  • Urodynamics involves filling the bladder with water through a catheter and then noting the response.
  • Cystoscopy involves inserting a tube with a miniature video camera into the bladder via the urethra. 
  • A kidney ultrasound allows your doctor to see if urine is backing up into the kidneys.

What are the Treatment Options for Tarlov Cysts?

Most often, a Tarlov cyst does not require treatment and may disappear on its own. Many different therapies have been tried and include:

  • Cysts may be drained and shunted to relieve pressure and pain
  • Corticosteroid injections following fluid drainage to reduce inflammation and pain
  • Medications may be prescribed to treat chronic pain and depression
  • Injecting with fibrin glue may also provide temporary relief of pain. Fibrin glue is a combination of naturally occurring substances based on the clotting factor in the blood.
  • Surgery such as microsurgical removal of the cyst may be an option in people who do not respond to conservative treatment measures and who continue to experience pain or progressive neurological damage

Depending on your condition, your doctor will determine the best treatment that will help alleviate your symptoms of a Tarlov cyst.

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