What is a Tarlov cyst?

Tarlov cysts (also known as perineural cysts) are fluid-filled sacs that form at the nerve root, usually in the sacral level of the spine (at the bottom of the spine). It’s possible to be affected by several cysts of different sizes at one time.

People can unknowingly have Tarlov cyst(s). Spinal nerve roots are connected to the spinal sac - with spinal fluid circulating between the root and sac. However, when the spinal fluid that enters the nerve root becomes stuck, it accumulates and causes the cyst to grow - resulting in the compression of adjacent nerve roots. This is usually when the cyst becomes symptomatic and treatment is required.

Can you live with a Tarlov cyst?

They aren't life threatening. The outlook of a Tarlov cysts can be managed but this depends on symptoms. You may be offered physiotherapy or pain management to help until you have surgery to remove the cyst if required.

What are the symptoms of a Tarlov cyst?

In most cases, Tarlov cysts are asymptomatic (they show no symptoms), but once cysts become larger and begin to compress the nearby spinal nerves, symptoms can appear. These include:

• Pain in the legs, bottom or lower back
• Weakness in the legs, bottom or lower back
• Numbness
• Bowel incontinence
• Bladder incontinence

Symptoms vary between people and depend on where in the spine the Tarlov cyst is located.

If a Tarlov cyst develops in the lower pelvic region, it could be misdiagnosed with a herniated lumbar disc and arachnoiditis, a painful disorder caused by inflammation of the arachnoid membrane. In women, symptoms from a Tarlov cyst in the pelvic region could be confused with a gynaecological condition. This is because Tarlov cysts usually occur at the bottom of the spine in the sacrum, which is very close to the pelvis.

How is a Tarlov cyst diagnosed?

A doctor will take a detailed patient history and perform a neurological evaluation. Patients may require an MRI scan or a CT scan to detect and visualise the cyst(s).

Sometimes, Tarlov cysts are coincidentally identified during routine imaging scans for other reasons.

What causes a Tarlov cyst?

It is unknown why Tarlov cysts form. One theory is that a traumatic injury to the tailbone from a fall or accident can cause a small and asymptomatic Tarlov cyst to swell and grow.

What is the best treatment for Tarlov cyst?

If a Tarlov cyst has been identified during a routine scan but it isn’t causing symptoms, it will be monitored.

If a cyst has been identified because it caused symptoms, you might be recommended non-surgical and/or surgical treatments, depending on your cyst and if non-surgical means don’t prove effective.

Non-surgical treatment options involve draining the cyst of fluid to alleviate the symptoms as well as physical therapy and anti-inflammatory medication to manage symptoms. Nerve stimulation is another option and this pain management technique delivers electrical impulses through the skin to the nerves. However, symptoms can still flare up despite trying these methods. To fully remove a Tarlov cyst, surgical removal is required.

What aggravates Tarlov cysts?

Asymptomatic Tarlov cysts become symptomatic due to spinal trauma. A severe fall or a car accident that impacts the low back and tailbone area may cause increased pressure in the cerebrospinal fluid. This is what fills Tarlov cysts, and the increased pressure may cause the cysts to grow and cause symptoms.     

What should be avoided if you have one?

If you have a Tarlov cyst, you should avoid:

• Heavy lifting, straining or pulling that may increase pressure on the low back
• Spending prolonged periods of time sitting or standing

Placing Ice and/or heat packs in the affected area, as well as cushions to minimise pressure on the perineum, can help in pain relief. 

Learn more about Tarlov cyst on the Tarlov Cyst Disease UK website