Insight Neurosurgery – Tarlov cysts, also known as perineural sacral cysts, are fluid-filled sacs that commonly impact nerve roots at the lower part of the spine in the sacral region. Unlike other conditions, such as spinal lesions, Tarlov cysts contain spinal nerve root fibers within the cyst wall or inside the cyst cavity and can lead to permanent nerve damage and chronic pain if left untreated. 

Most people diagnosed with Tarlov cysts are unaware of their existence and only learn about them after undergoing an MRI for an unrelated reason. However, some people experience debilitating lower back pain caused by the compressed nerve roots. It is not uncommon for patients to be misdiagnosed with herniated lumbar discs or gynecological conditions in females due to similar symptoms and proximity in the lower pelvic area. 

What Causes Tarlov Cysts?
Tarlov cysts were first identified in 1938 and currently affect approximately five to nine percent of Americans, according to data from the American Association of Neurological Surgeons. Researchers are still unsure of the exact cause of Tarlov cysts. However, it is known that women are much more likely to experience the condition, and it primarily affects people between the ages of 30 and 60. Physicians believe a number of factors may result in the development of Tarlov cysts becoming symptomatic, including trauma from falls or accidents and overexertion. 

What are the Symptoms of Tarlov Cysts?
Symptoms of Tarlov cysts are generally brought on by pressure in the cysts that leads to nerve damage. Whether you’re sitting, standing, or walking, it is not uncommon to experience pain in most positions. Patients often can only find relief when lying flat on one side of the body. Fortunately, most pain is not long-lasting and is usually experienced during flare ups, similar to sciatica. 

Although pain varies from patient to patient, common symptoms include: 

  • Pain, usually concentrated in the lower back/buttocks 
  • Muscle weakness
  • Changes in reflexes
  • Lost sensation or tingling of skin
  • Trouble standing
  • Sexual dysfunction
  • Bowel dysfunction
  • Incontinence 


How are Tarlov Cysts Diagnosed?
Due to the limited research currently available on Tarlov cysts and the similarities of symptoms between this and other conditions in the lower spine region, it can be difficult to accurately make a diagnosis. In most cases, your physician will refer you to a neurosurgeon who specializes in diagnosing and treating this condition. To verify the presence of Tarlov cysts, a neurosurgeon will use MRI imaging to locate the exact location in the lower back/spine region and determine the appropriate treatment method. 

How are Tarlov Cysts Treated?
If you are diagnosed with Tarlov cysts but are experiencing no symptoms, your physician will likely recommend monitoring the cysts closely for changes or the development of symptoms. For patients experiencing mild to moderate symptoms, non-surgical treatment may be recommended. This includes medications and other pain management techniques, such as physical therapy. In certain situations, patients may be at risk of permanent nerve damage due to pressure and irritation caused by the cysts and surgery could be required.  

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. Whether you’ve been diagnosed with Tarlov cysts but are asymptomatic or are experiencing radiating pain in the lower extremities and other complications, neurosurgeons specializing in Tarlov cysts can help you understand your condition and determine the best options to successfully alleviate your symptoms. For more information on Tarlov cysts and treatment options, including wrapping surgery, contact Insight Neurosurgery today to learn more and schedule an appointment with Dr. Yin.