Tarlov cyst: All you need to know about treatment (serious or not?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

Le Tarlov cyst is a rare and little known condition. Asymptomatic for a long time, it is often responsible for lumbar pain, back pain, sciatica ou cruralgia if it compresses a nerve root.

What is a Tarlov cyst? Is it a serious condition? What treatment for tarlov cyst ? We answer these questions in this article.

Definition and anatomy of the spine

La spine is the protective structure of the spinal cord. The latter terminates in bundles of nerves at the level of the first vertebrate lumbar.

On either side of each vertebrate, nerve roots arise from the spinal cord. They are responsible for the sensory and motor innervation of various parts of the body, in particular the upper and lower limbs.

Like the brain, the spinal cord is surrounded by 3 envelopes called the meninges. Inside these envelopes is a biological fluid: the cerebrospinal fluid.

Le Tarlov cyst ( perineural cyst) refers to a sac filled with cerebrospinal fluid that forms at the level of nerve roots. It is more common in the sacred, in the basin, but it can be found all along the spine. Cysts can vary in size and number.

It is sometimes classified into 3 types:

• 1 Type: extradural meningeal cyst without involvement of cord fibers or nerve roots
• 2 Type: extradural meningeal cysts with involvement of cord fibers or nerve roots
• 3 Type: intradural meningeal cysts (within the spinal cord itself)

Prognosis and evolution: Is it a serious disease?

Le Tarlov cyst can evolve in silence for a long time. As long as it does not interfere with the nerves that surround it, it does not cause any noticeable sign on the outside. It is for this reason that this condition is little known.

When the size of the cyst becomes so large that it irritates a nerve root or causes an inflammatory process, symptoms appear. Fortunately, however, these signs remain reversible if treatment is instituted quickly.

Otherwise, the compression of nerves and neighboring structures can lead to more or less serious consequences, including aggravation of symptoms.

Symptoms of the disease 

After being asymptomatic for a long time, the Tarlov cyst can manifest itself by the following signs:

• back and pelvic pain;
• type pain sciatica ou cruralgia ;
• swelling in the sacrum;
• difficulty walking;
• loss of sensitivity and reflex;
• muscle weakness in the lower limbs (going as far as paralysis);
• inability to remain in a seated position;
• pins and needles, tingling or numbness in the limbs;
• headaches and migraines;
• intestinal, urinary (incontinence) or sexual disorders…

When it becomes symptomatic, it is called Tarlov disease.

How to diagnose a Tarlov cyst?

Le Tarlov cyst is difficult to diagnose. In the majority of cases, the diagnosis is made only after the manifestation of symptoms. Or, it is discovered by chance at themedical imaging after the patient complains of pain in the back or along the lower extremities. From exams who can diagnose this disorder include: 

• An MRI (magnetic resonance imaging) allows the discovery of lesions in the tissues.
• Myelography (or myeloscanner) helps to detect pathologies of the spinal cord. It's an x-ray of the spinal cord with an injection of an iodinated contrast product.
• A myelogram is useful for analyzing cerebrospinal fluid.
• Finally, an electrophysiological assessment is essential to know the effects of the cyst on the nerve roots.

To better appreciate the extent of the symptoms and their functional implication, the doctor will carry out a neurological examination complete (strength, sensitivity, coordination, etc.).

Natural and Surgical Treatment of Tarlov Cyst 

To date, there is no well-defined medical consensus for the Tarlov cyst treatment. This is because it is a rare condition, and many practitioners overlook the diagnosis. In France, it should be noted that the reference center for this pathology is theLouis Pasteur hospital in Colmar.

The doctor has the choice between various types of treatments, and their effectiveness varies according to the patients:

Conservative treatment (natural)

Taking analgesics

Painkillers can be enough to calm back pain and relax the muscles. Morphic derivatives are especially recommended, especially if the pain is incapacitating.

Physiotherapy and osteopathy

Without necessarily acting on the cause, kinesitherapy (physiotherapy) and osteopathy will improve the quality of life and the functional capacities of the affected patient.

Analgesics and massages will control pain and reduce muscle tension.

Therapeutic exercises and stretches will reduce nerve pressure, increase the strength of affected muscles, and restore optimal function.

Tools and accessories

In addition to the treatments mentioned above, there are several products and accessories available on the market to relieve the pain caused by the Tarlov cyst. It should be remembered that these tools usually provide temporary relief, do not address the source of the problem, and should therefore be used sparingly.

Among the products recommended by our professionals, we have:

• acupressure mat
• Heated lumbar belt
• Postural T-Shirts
• Ergonomic back cushion
• massage gun
• Dorsal stretcher
• Spinal decompression table

Surgical treatment

In some cases, more drastic approaches must be used to treat the Tarlov cyst. Potential indications for surgical treatment are:

• Confirmation of the existence of a Tarlov cyst by medical imaging
• Significant size of the cyst (upper diameter 1,5 cm)
• Significant signs and symptoms that affect the quality of life of the affected person
• Lack of improvement despite well-conducted conservative treatment (usually 3-6 months)

Surgical modalities used include:

Drainage of cerebrospinal fluid

Lumbar cerebrospinal fluid drainage involves removing the fluid by puncture to reduce the growth.

Aspiration of the cyst

Aspiration of the cyst is guided by scanner images.

Partial or total excision of the Tarlov cyst

Partial or total excision of the cyst is more complicated, because the wall of the cyst contains nerve cells.

Decompressive laminectomy

La laminectomies involves removing a small posterior part of the vertebra (the lamina) to release the compression of the nerves by the cyst.

Injection of biological glues

It eliminates the effect of the compression of the cyst on the nerve roots. Essentially, the cyst is emptied and biological glue is placed under a scanner. However, considering the potential complications, some Ministries of Health in some countries currently discourage the use of this intervention.

Nesting

Nesting is a neurosurgical technique. It consists of opening the cyst and plugging it with fat taken from elsewhere, from the patient himself. Cystic fenestration is another microsurgical technique to close the cyst.

Post-operative complications

Like any surgical procedure, the operation to treat a Tarlov cyst has potential risks. This is all the more true since it is a delicate surgery involving nerve endings (spinal cord, spinal nerves, etc.). It is therefore essential to assess the risks and weigh them against the benefits before starting any procedure.

Noted post-operative risks include:

• Neurological deficits (temporary or permanent)
• Infections
• headaches
• Incontinence disorders
• Leakage of cerebrospinal fluid (CSF)
• And many more functions

Tarlov cyst, occupational disease?

In some cases, patients with Tarlov cyst may experience symptoms that prevent them from carrying out their professional activity.

At present, Tarlov's disease is not included in the list of 30 long-term conditions (ALD), nor recognized as a rare disease. This means that patients cannot benefit from a disability pension. On the other hand, the most severe forms can be registered as off-track ALD if the manifestations of the symptoms are prolonged, and require long and expensive treatments.

In addition to the recognition of occupational disease, patients benefit from benefits under the invalidity insurance when they have become unfit to pursue their professional activity. A request to the departmental office of People with Disabilities also allows them to obtain the PCH (disability compensatory benefit).

Conclusion

Finally, it should be remembered that the Tarlov cyst remains asymptomatic for a long time. It can become serious if it compresses a nerve root. Its diagnosis is difficult, mainly because it can be confused with several other spinal conditions causing similar symptoms.

In the presence of symptoms, it is always advisable to carry out the necessary examinations to eliminate or confirm the diagnosis of the perineural cyst.

Resources – testimonials

Testimonials from people with a Tarlov cyst

References

• https://www.senat.fr/questions/base/2018/qSEQ180706085.html
• https://leparticulier.lefigaro.fr/jcms/p1_1613813/la-maladie-de-tarlov-peut-etre-reconnue-comme-une-affection-de-longue-duree#:~:text=Toujours%20est%2Dil%20que%20m%C3%AAme,patients%20qui%20en%20sont%20atteints.
• https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Tarlov-Cyst#:~:text=Tarlov%20cysts%20are%20fluid%2Dfilled,can%20be%20valved%20or%20nonvalved.