Tarlov Cyst

Tarlov cysts are fluid-filled sacs that form on the nerve roots of the spine, most commonly in the sacral region at the base of the spine. They can compress surrounding nerve roots and cause a variety of neurological symptoms.

Tarlov cysts are one of several spinal conditions that can cause lower back pain, leg pain, and bladder dysfunction by compressing nerve roots. Related conditions include Spinal Stenosis, which also narrows the space around spinal nerves, Foraminal Stenosis, and Cauda Equina Syndrome, which represents the most severe form of sacral nerve root compression and requires urgent evaluation.

Causes

Congenital factors.

Tarlov cysts are believed to develop as a result of abnormalities in the protective covering (meninges) around the spinal nerve roots. Many people are born with a predisposition to developing these cysts, though the exact cause is not fully understood.

Other contributing factors

Trauma, injury, or inflammation along the spine may trigger cyst formation or cause existing cysts to enlarge and become symptomatic. Increased cerebrospinal fluid (CSF) pressure has also been associated with cyst growth.

Symptoms

Many Tarlov cysts are asymptomatic and discovered incidentally on imaging. When symptoms do occur, they may include pain in the lower back, buttocks, or legs (sciatica), as well as numbness or tingling in the pelvic region or lower extremities. Patients may also experience bladder or bowel dysfunction, sexual dysfunction, and pain when sitting or standing for prolonged periods.

Diagnosis

A thorough physical and neurological examination is performed to assess reflexes, sensation, and strength in the lower extremities.

The primary imaging tool for diagnosing Tarlov cysts is lumbar spine MRI, which can visualize the cysts along the sacral nerve roots and assess their size and relationship to surrounding structures. CT myelography may also be used to confirm communication between the cyst and the spinal fluid.

Because many cysts are found incidentally, careful correlation between imaging findings and clinical symptoms is essential before pursuing treatment.

Cyst Classification

Tarlov cysts are classified based on their relationship to the nerve root and surrounding tissues.

• Type I: Extradural meningeal cysts without spinal nerve root fibers.
• Type II: Extradural meningeal cysts with spinal nerve root fibers (classic Tarlov cysts).
• Type III: Spinal intradural meningeal cysts.

Treatments

Treatment is guided by symptom severity and the degree to which the cysts are affecting quality of life. Asymptomatic cysts typically do not require treatment.

For patients with mild symptoms, conservative management is typically recommended first, including pain medications, anti-inflammatory drugs, and physical therapy to relieve pressure and strengthen surrounding musculature.

Conservative treatment options: Physical therapy, pain management with NSAIDs or neuropathic medications, and steroid injections may help reduce inflammation and alleviate discomfort.

Minimally invasive and surgical options

For patients with significant or debilitating symptoms that do not respond to conservative care, procedural interventions may be considered. CT-guided aspiration and fibrin glue injection can be used to collapse and seal the cyst. Surgical options include microsurgical cyst fenestration or imbrication, which aims to decompress the affected nerve roots while minimizing damage to surrounding tissue.

Ongoing monitoring

Patients with known but asymptomatic Tarlov cysts are typically monitored with periodic imaging to track any changes in size. Lifestyle modifications, including avoiding prolonged sitting and high-impact activities, may help prevent symptom onset or progression.

Related Spine Conditions

• Spinal Stenosis
• Foraminal Stenosis
• Cauda Equina Syndrome
• Synovial Cysts
• Disc Herniation
• Back to all Spine Conditions