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Tarlov Cyst(Perineural Cyst; Sacral Nerve Root Cyst)
Definition

Tarlov cysts are abnormal sacs of spinal fluid that usually form at the lower end of the spine, which is called the sacrum. Tarlov cysts contain 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
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 lupus and Marfan syndrome.

Symptoms

Most of the time, Tarlov cysts do not cause symptoms. When symptoms do occur, they may include:

  • 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
  • Abnormal sensations in the legs and feet, or less commonly in the arms and hands
  • Pain when sitting or standing
  • Headaches
  • Pulling and burning feeling in the tailbone
  • Loss of sensation on the skin
  • Loss of reflexes

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

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, such as a neurosurgeon.

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.

Treatment options might include:

  • Intramuscular corticosteroid injections or other medication injections —to relieve pain
  • Prescription medications —such as pain medications, antiseizure medications, or antidepressants 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.

RESOURCES:

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

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

CANADIAN RESOURCES:

HealthLinkBC
http://www.healthlinkbc.ca

MyHealthAlberta
https://myhealth.alberta.ca

References:

National Institute for Health and Clinical Excellence. Therapeutic percutaneous image-guided aspiration of spinal cysts. National Institute for Health and Clinical Excellence website. Available at: http://www.nice.org.uk/nicemedia/pdf/IPG223guidance.pdf. Updated August 2007. Accessed November 25, 2013.

National Institute of Neurological Disorders and Stroke. Tarlov cyst information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/tarlov_cysts/tarlov_cysts.htm. Updated June 14, 2012. Accessed November 25, 2013.



Last reviewed November 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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