Tarlov Cyst

(Perineural Cyst; Sacral Nerve Root Cyst)

by Deanna M. Neff, MPH

Definition

Tarlov cysts are abnormal sacs of spinal fluid that usually form around spinal root nerve fibers at the lower end of the spine, which is called the sacrum.

Sacrum

Causes

The cause of a Tarlov cyst is unknown, but may be due to abnormal development of the nerve sheath.

Risk Factors

Although gender may not be a risk factor, Tarlov cysts have more often been found in women than men.

Tarlov cysts may be linked to connective tissue disorders such as systemic lupus erythematosus and Marfan syndrome.

Symptoms

Most of the time, Tarlov cysts do not cause symptoms. When symptoms do occur, they are associated with nerve root compression and may include:

Pain in the lower back, buttocks, legs and feet, vagina, rectum, or abdomen
Weakness, cramping, or numbness in the buttocks, legs, and feet
Abnormal sensations in the legs and feet, or less commonly in the arms and hands
Nerve pain such as tingling or sciatica
Loss of sensation on the skin
Pain when coughing or sneezing
Headaches
Swelling, soreness, or tenderness around the lower end of the spine
Pain when sitting or standing
Bladder or bowel dysfunction
Sexual dysfunction
Pulling and burning feeling in the tailbone
Loss of reflexes

If you have a Tarlov cyst, the following may cause it to become painful or cause other symptoms:

Traumatic injury such as a fall, automobile accident
Heavy lifting
Childbirth
Epidural anesthesia
Growth of the cyst

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Depending on your symptoms, you may need to see a specialist. Your doctor will also look for other conditions that could be causing symptoms.

Images may be taken of your bodily structures. This can be done with:

Treatment

If you are experiencing symptoms, talk with your doctor about the best treatment plan for you. Options may include:

Medications

To relieve inflammation and/or pain:

Over-the-counter or prescription pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs)
Topical pain relievers that are applied to the skin
Corticosteroid or other medicated injections

Other Treatments

Other treatments may include:

Aspiration of the cyst plus fibrin glue injection—a needle is used to drain the cyst and then a special glue is injected into the cyst to try to prevent it from filling again
Transcutaneous electrical nerve stimulation (TENS)—electrical impulses delivered through the skin
Surgery to remove the cyst may be done for severe or worsening symptoms, bowel or bladder dysfunction, or if there is damage to the affected area

Prevention

There are no current guidelines to prevent a Tarlov cyst.

RESOURCES:

National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov

Tarlov Cyst Disease Foundation
https://www.tarlovcystfoundation.org

CANADIAN RESOURCES:

Alberta Health
http://www.health.alberta.ca

HealthLink BC
https://www.healthlinkbc.ca

References:

Lucantoni C, Than K, Wang AC, et.al. Tarlov cysts: a controversial lesion of the sacral spine. Neurosurg Focus. 2011;31(6):E14.

Tarlov cyst information. Tarlov Cyst Disease Foundation website. Available at: https://www.tarlovcystfoundation.org/info. Accessed December 19, 2017.

Tarlov cysts. NORD—National Organization for Rare Disorders website. Available at: https://rarediseases.org/rare-diseases/tarlov-cysts. Accessed December 19, 2017.

Tarlov cysts. GARD—Genetic and Rare Diseases Information Center website. Available at: https://rarediseases.info.nih.gov/diseases/9258/tarlov-cysts/cases/27316. Accessed December 19, 2017.

Last reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 12/19/2017

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