Tarlov cyst




Tarlov cysts are fluid-filled nerve root cysts found most commonly at the sacral level of the spine.



 They typically occur along the posterior nerve roots. 



The cysts can be valved or nonvalved. 



The main feature is the presence of spinal nerve root fibers within the cyst wall or in the cyst cavity itself.



Patients may be misdiagnosed with herniated lumbar discs, arachnoiditis and in females, gynecological conditions. 



An estimated 5 to 9 percent of the general population has an asymptomatic Taylor cyst.



In a Tarlov cyst survey: estimated 86.6 percent of respondents were female and 13.4 percent were male. 



The largest majority of respondents were ages 31 to 60, with a total of 80 percent in that age group.



An estimated 33 percent of patients had a cyst(s) present in other parts of the body, most commonly the abdomen or hand and wrists.



An estimated 3 percent of respondents have no pain; 4.2 percent categorized their pain as very mild; 7.6 percent as mild; 31.5 percent as moderate; 38.6 percent as severe; and 15.1 percent as very severe.



Symptoms can be increased by elevated pressure in or on the cysts.



Reclining on one side may provide relief of pain, while sitting, standing,walking and bending increase pain.



Symptoms are variable among patients and the process may periodically flare and then subside.



Symptomatic Tarlov cysts maymanifest as:



Pain in the area of the nerves affected by the cysts, especially the buttocks.



Weakness of muscles.


Difficulty sitting for prolonged periods



Loss of sensation on the skin



Loss of reflexes



Changes in bowel function



Changes in bladder function.



Changes in sexual function.



They may be discovered when patients with low back pain or sciatica have a magnetic resonance imaging (MRI) performed. 



Computed tomographic (CT) myelography are usually recommended to confirm diagnosis.



Nonsurgical therapies include lumbar drainage of the cerebrospinal fluid (CSF), and a newer technique involving removing the CSF from inside the cyst and then filling the space with a fibrin glue injection.



None of these procedures prevent symptomatic cyst recurrence.



Surgery involves exposing the cyst, opening and draining it.



To prevent the fluid from returning, the cyst is occluded with a fibrin glue injection or other matter.



Procedures include: simple decompressive laminectomy, cyst and/or nerve root excision and microsurgical cyst fenestration and imbrication.



Postoperative CSF leak is the most common complication.



There is a small risk of developing bacterial meningitis. 



The most common negative outcome is the failure of the surgery to eliminate the symptoms. 


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