Tarlov Cysts (Perineural Cysts, Sacral Nerve Root Cysts)

What are Tarlov Cysts?

Tarlov cysts are fluid-filled sacs that most often affect nerve roots in the sacrum, the group of bones at the base of the spine. These cysts can compress nerve roots, causing lower back pain, sciatica (shock-like or burning pain in the lower back, buttocks, and down one leg to below the knee), urinary incontinence, sexual dysfunction, and some loss of feeling or control of movement in the leg and/or foot. Pressure on the nerves next to the cysts can also cause pain. Tarlov cysts may become symptomatic following shock, trauma, or exertion that causes the buildup of cerebrospinal fluid. Women are at much higher risk of developing these cysts than are men.

Is there any treatment?

Tarlov cysts may be drained to relieve pressure and pain, but relief is often only temporary and fluid build-up in the cysts will recur. Corticosteroid injections may also temporarily relieve pain. Other drugs may be prescribed to treat chronic pain and depression. Filling the cysts with fat has not been shown to work. Injecting the cysts with fibrin glue (a combination of naturally occurring substances based on the clotting factor in blood) may provide temporary relief of pain. Some scientists believe the herpes simplex virus, which thrives in an alkaline environment, can cause Tarlov cysts to become symptomatic; making the body less alkaline, through diet or supplements, may lesson symptoms. Surgical resection may be needed when the cysts cause continued pain or progressive neurological damage.

What is the prognosis?

Most Tarlov cysts do not cause pain, weakness, or nerve root compression. The cysts do not appear to recur following complete resection by an experienced neurosurgeon. Acute and chronic pain may require changes in lifestyle. If left untreated, nerve root compression can cause permanent neurological damage.
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