Tarlov Cysts: Perineural or Sacral Nerve Root Cysts

Orthopaedic & Spine Center

Image of Dr. Mark McFarland

Mark Due west. McFarland, Exercise

The man torso is comprised of well-nigh 60% water, all of which is independent in our claret, soft tissues and even in our bones.  Nigh of the fourth dimension, bodily fluids are contained within their own specific areas of the body and serve a particular purpose, like synovial fluid is contained within and lubricates joints.  Occasionally, the fluid will leak or go into an area where information technology isn't meant to be and class a fluid filled pocket or sac, called a cyst.

A Tarlov Cyst (TC) typically forms at the base of the spine (sacrum) at the nervus roots, near the nervus roots or inside the nerve root itself, although the TC can form in the cervical, thoracic or lumbar region, likewise. These cysts are unique considering they make full with cerebrospinal fluid, a articulate and colorless liquid that is contained in the brain and spinal column.  Another feature that sets them apart from other types of spinal cysts is that they contain nerve root fibers within the walls of the cyst or inside the cyst itself.

Most Tarlov Cysts are asymptomatic and people are unaware of their existence.  Unremarkably, they have an MRI scan for an unrelated medical reason and the TC is visualized past the Radiologist.  Those with no symptoms may be told of the being of the TC or not, depending on what relevance the Radiologist feels it has on the diagnosis for which their MRI was ordered.

No one is exactly sure why Tarlov Cysts form.  It is theorized that they develop because of a build-up of too much fluid, genetic malformation or from injury, disease or inflammation in the spine.  TCs that are asymptomatic may become painful after an injury nigh the tailbone or stupor to the body, even after lifting something heavy. A person can have one or multiple TCs and females get them more than oftentimes than males.  People who develop a TC are more than likely to also have other types of cysts within their trunk, such as a ganglion cyst at the wrist.

When symptomatic, the Tarlov Cyst can cause radicular nerve pain because it causes pinch of the nervus root.  The hurting will correspond to the vertebral level at which the TC is located. Most often nosotros see them located about the sacrum, which are the five bones that comprise the base of operations of the spine.  As the TC enlarges and fills with fluid, the pain and dysfunction tin go more than intense.

Symptoms range from mild discomfort to weakness or difficulty sitting.  As the cyst enlarges, patients can experience a loss of sensation on the peel or a loss of reflexes.  In rare cases, the patient may loss bladder or bowel control, be constipated, have great difficulty walking and may experience severe pain, unless lying flat on their side.  The patient may also have noticeable areas of bone erosion and degradation nigh the cyst.

Diagnosis of a Tarlov Cyst tin exist difficult, because symptoms often mimic those of a herniated spinal disc, gynecological problems or other conditions.  MRI imaging is usually our best resource for locating these cysts.

Treatment by an OSC Spine Specialist would entail giving the patient a Caudal Epidural steroid injection.  The needle is inserted nigh the sacrum, at the top of the buttock crease, through a pocket-size opening into the epidural space, and bathes the compressed nerve(s) in anti-inflammatory medication.  The TC patients whom I treat often find that these injections work well for them to salve their hurting and dysfunction.

For those whom the injections do not work, I would refer the patient to a neurosurgeon for treatment.  One treatment choice is aspiration of the cyst (drawing out the cerebrospinal fluid with a needle) and an injection of a fibrin glue to fill the cyst.    Tarlov Cyst surgery has evolved recently and involves cyst removal, partial removal of the bones of the sacrum through laminectomy, and techniques to ensure the cyst does non reform, chosen fenestration and imbrication.  This surgery cannot be guaranteed to work permanently and cysts may reform.  Surgery is usually a very final resort and patients should seek the advice of neurosurgeons who have feel in surgically treating Tarlov Cysts.