Tarlov Cysts · What Are They, Treatment, and More

The exact cause of Tarlov cysts is unclear; however, several factors may play a role in their development. Research suggests some Tarlov cysts may be present from birth due to a weakness in the nerve root sheath, the protective covering that surrounds nerves. Other theories suggest trauma or injury to the spine, such as from accidents or falls, may contribute to the formation or enlargement of previously undiagnosed cysts. Finally, some cysts may have communication with the subarachnoid space that contains the cerebrospinal fluid (CSF). In such cases, a one-way valve mechanism may allow the entry of CSF into the cyst while preventing its drainage, thereby causing cyst growth.  

Tarlov cysts have been associated with connective tissue disorders, such as Marfan disease or Ehler-Danlos syndrome. For unknown reasons, they are more common in individuals assigned female at birth.  

First-line treatment for symptomatic Tarlov cysts includes physical therapy and pain-relief medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or pain modulators (like pregabalin and gabapentin). A procedure known as transcutaneous electrical nerve stimulation (TENS) may be used to relieve pain by using a mild electric current to modulate nerve impulses. 

Interventional procedures, such as draining the cerebrospinal fluid from the cyst with a needle may provide temporary relief; however, it is not a permanent solution as it doesn’t prevent the recurrence of the cyst. To prevent this, the cyst may be filled with a fibrin glue injection that seals the cyst closed, preventing it from increasing in size again. 

When symptoms are debilitating and persist despite conservative measures, surgery may be considered. Tarlov cyst surgery is a complex procedure that involves exposing the area of the spine where the cyst is located. Because these cysts contain nerve fibers, they cannot be removed easily like other meningeal cysts. Instead, surgery involves creating small openings, or fenestrations, in the cyst wall so that cerebrospinal fluid can drain into the spinal canal. The cyst can then be filled with fibrin glue, muscle, or other tissues to prevent it from refilling.  

Tarlov cysts are fluid-filled sacs that develop in the nerve root sheath of spinal nerves, most commonly in the sacral spine. Most Tarlov cysts are asymptomatic and diagnosed incidentally on imaging techniques, such as an MRI of the spine. However, they can sometimes grow large and cause compression of spinal nerve roots, resulting in lower back pain, numbness or tingling in the legs, muscle weakness, and bladder or bowel dysfunction. Treatment of Tarlov cysts depends on many individual factors and may include pain-relief medications, physical therapy, aspiration of the cyst, or surgical drainage.