Tarlov Cyst

Definition

Tarlov cysts are abnormal sacs of spinal fluid that usually form at the lower end of the spine (sacrum). What distinguishes Tarlov cysts is the presence of spinal nerve fibers within the cyst wall.

Sacrum

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Causes

The cause of a Tarlov cyst is unknown but may be related to:

• Trauma to the spine
• Increase in cerebrospinal fluid pressure
• Blockage of cerebrospinal fluid

Research has shown that the condition may be linked to connective tissue disorders (eg, lupus, Marfan syndrome). However, researchers are still studying this.

Once 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

Risk Factors

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

Symptoms

Most of the time Tarlov cysts do not cause symptoms. Cysts may cause pain and other signs of nerve irritation, such as weakness, numbness, burning, and tingling. In some cases, it can cause problems with bladder and bowel function.

An increase in pressure in or on the cyst may increase symptoms and cause nerve damage. Symptoms can vary from person to person.

If you have any of these symptoms, do not assume it is due to Tarlov cysts. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

• Bladder or bowel dysfunction
• Sexual dysfunction
• Nerve pain
• Pain in the lower back, buttocks, legs and feet, vagina, rectum, or abdomen
• Pain when coughing or sneezing
• Weakness, cramping, or numbness in the buttocks, legs, and feet
• Swelling, soreness, or tenderness around the lower end of the spine (sacral area)
• Abnormal sensations in the legs and feet, or less commonly in the arms and hands
• Sciatica symptoms, such as pain when sitting or standing
• Headaches
• The feeling of “sitting on a rock”
• Pulling and burning feeling in the tailbone
• Loss of sensation on the skin
• Loss of reflexes

Diagnosis

Your doctor will ask about your symptoms and medical history. She will also do a physical exam. Depending on your symptoms, you may need to see a specialist, such as a neurosurgeon.

Tests may include the following imaging techniques:

• MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
• Myelogram —an imaging test that uses a special dye to view the spinal cord
• Aspiration of the cyst—a needle is used to remove fluid from the cyst

Treatment

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

Treatment options might include:

• Intramuscular corticosteroid injections or other medication injections —to relieve pain
• Prescription medications —such as pain medications, antiseizure medications or antidepressants (both of these may be used to treat pain)
• Lidoderm patches —applied to area of the spine where the cyst is located to provide temporary relief of pain and discomfort
• Transcutaneous electrical nerve stimulation (TENS) —electrical impulses are delivered through the skin to help control pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs) —to relieve pain and inflammation
• 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
• Surgery —done if symptoms are severe; nerve damage is worsening; bowel and bladder dysfunction are worsening; or if there is wearing down of the sacrum or other spinal bones

Prevention

There are no guidelines to reduce your risk of forming a Tarlov cyst. If you have a Tarlov cyst that does not cause pain or other symptoms, avoiding injury or heavy lifting may reduce your chance of developing pain or other symptoms.