What are Tarlov cysts?
Tarlov cysts, also known as perineural or nerve root cysts, are fluid-filled sacs that occur most commonly at the sacral spine level, between the perineurium and endoneurium of the nerve roots. These cysts are often found near the dorsal root ganglion, a cluster of nerve cells on the posterior root of a spinal nerve. The cerebrospinal fluid (CSF) constitutes the content of these cysts [1, 2, 3, 4, 5].
Symptoms of Tarlov cysts
Tarlov cysts are usually asymptomatic and are often detected incidentally during imaging studies. However, when they increase in size and exert pressure on nerve roots, they can cause symptoms such as low back pain, radiculopathy (nerve root dysfunction), and bowel and bladder dysfunction.
In some cases, they can lead to more severe symptoms like cauda equina syndrome, a serious condition characterized by lower back pain, weakness in the legs, and bowel or bladder incontinence.
Causes of Tarlov cysts
The exact causes of Tarlov cysts remain unclear, with several theories proposed. One theory suggests that these cysts may be related to trauma-induced bleeding into the subarachnoid space, which is the area between the spinal cord and its protective covering. This bleeding could lead to the formation of these cysts [15].
Another theory proposes that Tarlov cysts could be due to congenital abnormalities. This means that these cysts could be present from birth, possibly due to genetic factors or issues during the development of the spinal cord [8].
In addition, some researchers believe that Tarlov cysts may be associated with collagen disorders, which affect the tissues that support the body's organs and other structures. These disorders could influence the formation of these cysts [16].
Furthermore, evidence suggests that an increase in cerebrospinal fluid pressure could lead to the dilation of nerve roots, resulting in the formation of Tarlov cysts [4].
It's important to note that these are just theories, and more research is needed to understand the causes of Tarlov cysts fully.
Treatment of Tarlov cysts
Several treatment options are available for symptomatic Tarlov cysts, and the choice of treatment often depends on the severity of the symptoms and the patient's overall health.
Surgical method: One treatment option is surgical intervention. This can involve partial excision and oversewing of the cyst wall, along with filling the sacral bone defect formed by the cyst with methylmethacrylate to prevent cyst recurrence [17].
Neuroendoscopic-assisted surgery is another effective surgical method for symptomatic Tarlov cysts. This technique combines the fenestration, leakage sealing, and tamponade of the Tarlov cyst, providing immediate pain relief in many patients [18].
Cyst remodelling: Another surgical technique involves cyst remodelling around the root using titanium clips, effectively avoiding cerebrospinal fluid leakage and resolving bladder dysfunction when urinary symptoms are incomplete and discontinuous [19].
CT-Guided Aspiration and Fistula Sealing: A less invasive treatment option is CT-guided cyst aspiration with an injection of fibrin glue. This method has been used in many cases and has resulted in symptom improvement in many patients [20]. Using a balloon-assisted fistula sealing procedure in treating Tarlov cysts has also been successful [21].
Puckering of the cyst: A novel surgical technique called "puckering of the cyst" has also been described, which involves microsurgical puckering of the cyst to prevent recurrence. This technique is safe and easy to perform, with a high patient recovery rate [22].
It's important to note that the treatment choice should be individualized, considering the patient's symptoms, overall health, and preferences.
Exercises to avoid when you have Tarlov cysts
High-impact activities like running or jumping may exacerbate symptoms by increasing pressure on the affected nerves. In one case report, a patient's cyst increased in size after delivery, causing acute sciatica. This suggests that activities putting excessive strain on the lower back should be avoided.
Patients with symptomatic Tarlov cysts may benefit from low-impact exercises that do not strain the lower back or increase spinal pressure. However, specific recommendations should be individualized based on cyst location, symptoms, and overall health. Consultation with a spine specialist and physical therapist is advised to develop an appropriate exercise plan.