Tarlov cysts, also known as sacral nerve root cysts or perineural cysts, are abnormal dilations of the nerve root sheaths at the dorsal root ganglion, filled with cerebrospinal fluid, and can lead to progressive nerve pain. While they can occur in anyone, they are more prevalent in women and are present in approximately 5-6% of the general population. These cysts can form in any section of the spine, including the cervical, thoracic, lumbar, and sacral regions.
Causes:
The exact causes of Tarlov cysts are still uncertain. However, conditions that increase spinal fluid pressure, such as trauma to the spinal cord or collagen mutations/connective tissue disorders, may contribute to their development.
Symptoms:
Symptoms of Tarlov cysts result from the compression of nerve roots and may vary based on the cyst’s location along the spine. Common symptoms include pain in the lower back, legs, chest, upper back, or neck, discomfort or pain while sitting, standing, or coughing, and dizziness or lack of balance. Other signs and symptoms may include vaginal or abdominal pain, ear noises, headaches, blurred vision, restless leg syndrome, loss of skin sensation, changes in bowel or bladder function, changes in sexual function, and loss of reflexes.
Diagnosis:
Due to the unclear etiology and overlapping symptoms with other conditions, diagnosing Tarlov cysts can be challenging. Experienced neurosurgeons may recommend magnetic resonance imaging (MRI) for patients with lower back pain. Computed tomography (CT) and myelography tests may also be performed to confirm observations.
Treatment:
Nonsurgical treatments may include draining the cerebrospinal fluid and aspirating the cyst. A newer technique involves filling the cyst’s empty space with substances like fibrin glue after removing the cerebrospinal fluid. However, these therapies may not prevent symptomatic cyst recurrence. Surgical options involve exposing the cyst region of the spine, draining the fluid, and occluding the cyst with fibrin glue injection to prevent fluid reaccumulation.