Managing Chronic Pain from Tarlov Cysts on The Spine

Insight Neurosurgery – As many as nine percent of Americans are affected by Tarlov cysts, sac-like structures that often form along weakened areas of the spinal nerve roots in the lower spine. Most people diagnosed with Tarlov cysts experience no symptoms and will only learn about their presence after undergoing imaging tests for an unrelated condition. However, others endure ongoing debilitating pain that can radiate from the lower back to the posterior and medial thigh, loss of reflexes, and even changes in bowel or bladder function. 

The symptoms of Tarlov cysts can mimic that of other problems of the lumbar spine, such as herniated discs and stenosis. It is not uncommon for patients to be misdiagnosed until they consult with an experienced neurosurgeon specializing in spinal conditions. An accurate diagnosis is the first step in treating this complex condition successfully, and patients often have many questions about what treatments are available and when they can get back to doing the things they love, pain-free. 

Here are five questions to ask your neurosurgeon after being diagnosed with Tarlov cysts that will help you learn more about your condition and make an informed decision about the treatment plan that is best for you. 

How can I be sure my symptoms are from a Tarlov cyst?

Tarlov cysts are usually difficult to diagnose without imaging studies. They are relatively rare and their symptoms are so similar to other conditions in the lower spine. In most cases, a primary care physician will refer patients to an experienced neurosurgeon after ruling out other factors, or in some cases, right away if Tarlov cysts are expected. 

In order to diagnose Tarlov cysts, patients will undergo magnetic resonance imaging (MRI) and computed tomographic (CT) studies. This will allow the physician to accurately pinpoint the location of the cyst(s) and make a determination based on the symptoms you are experiencing. 

What causes Tarlov Cysts to form?

Tarlov cysts were first discovered in 1938 and the development of Tarlov cyst may be related to congenital dural or arachnoid diverticulum, connective tissue disorders, or nerve root sheath duplication. It is believed that asymptomatic cysts first develop and then communicate with the spinal subarachnoid space before filling with cerebrospinal fluid. Tarlov cysts become symptomatic when cysts increase in size, causing impingement of nerve root fibers and ganglion cells located in the inside the cysts or in the adjacent nerve roots. Researchers also know that most patients with Tarlov cysts are women between the ages of 31 and 60. In more than a quarter of these patients, the cysts are present in other parts of the body, including the abdomen, hands, and wrists. 

Can Tarlov cysts be treated without surgery?

If you have been diagnosed with Tarlov cysts and are asymptomatic, it is likely that the cysts will be monitored closely for any changes and will not require treatment. For patients experiencing complications, there are several non-surgical treatment options available to help manage symptoms. Your healthcare provider may recommend a combination of medications and other pain management techniques, such as physical therapy, before considering surgery. 

Will I need surgery for Tarlov cysts?

If non-surgical treatments are unsuccessful or it is believed that pressure and irritation from the Tarlov cyst could lead to permanent nerve damage, your neurosurgeon may recommend surgery. At Insight, Dr. Dali Yin is one of only a few neurosurgeons in the U.S. specializing in an advanced neurosurgical intervention called wrapping surgery, which includes the removal of fluid in Tarlov cysts. Studies have shown that patients with Tarlov cysts benefit most from wrapping surgery. This technique is safe and effective in relieving symptoms and preventing the regrowth of cysts. The risk for complications, including CSF leakage and recurrence, is also lower with this procedure. 

What can I expect after surgery?

Patients are advised to follow post-operative instructions and maintain a good support system of family and friends after surgery. In order to experience positive results, it is also important for patients to make any necessary lifestyle changes that are recommended by their neurosurgeon. This includes maintaining a healthy weight, obtaining proper nutrition, and walking daily (as tolerable). A series of post-operative appointments will be scheduled to monitor your recovery process and ensure recurrence of Tarlov cysts has not taken place.
For most people, Tarlov cysts do not cause discomfort or require treatment. But for patients dealing with pain, numbness, and other symptoms, finding a physician who specializes in diagnosing and treating this complicated condition is the difference between chronic pain and a healthy, active lifestyle. Fortunately, with new treatments like wrapping surgery, patients have more options to alleviate symptoms with better success and fewer complications. For more information on Tarlov cysts and treatment options, contact Insight Neurosurgery today to schedule an appointment with Dr. Yin.