Perineural cysts or sacral, lumbar, thoracic or cervical nerve root cysts are also called Tarlov Cysts.
Tarlov cysts are fluid-filled sacs that affect the nerve roots of the spine, especially near the base of the spine (sacral region). There can be multiple cysts of varying size. Symptoms depend on the size and location of the cyst. Generally, the larger the Tarlov cyst the more likely it is to cause symptoms.
Symptoms include:
Small, asymptomatic cysts can slowly increase in size eventually causing symptoms. The exact cause of Tarlov cysts is unknown.
Not everyone with Tarlov cysts has symptoms. They grow in size and eventually compress and damage adjacent nerve roots or nerves contained within the cyst (radiculopathy).
Chronic pain is a common with symptomatic Tarlov cysts. Pain from lumbo-sacral cysts may affect the lower back, especially below the waist, and spread to the buttocks and legs.
Pain may be worsened by walking. Symptoms may become progressively worse. In some individuals sitting or standing may worsen pain. Leaning, resting, or reclining may relieve pain. In some cases, pain can also affect the upper back, neck, arms and hands if the cysts are located in the upper spine. Pain may worsen when coughing or sneezing. Those affected also reported vulvar, testicular, rectal, pelvic and abdominal pain.
As Tarlov cysts can affect the nerves, symptoms relating to loss of neurological function can also develop including leg weakness, diminished reflexes, loss of sensation on the skin, and changes in bowel or bladder function such as incontinence or painful urination (dysuria).
Some individuals may have difficulty empting the bladder and suffer with constipation or bowel incontinence. Changes in sexual function and orgasm can also occur.
Some develop abnormal burning or prickling sensations (paresthesias) or numbness and decreased sensitivity (dysesthesia), especially in the legs or feet. Tenderness or soreness may be present around the involved area of the spine.
Some report chronic headaches, blurred vision, pressure behind the eyes, dizziness, and dragging of the foot when walking due to weakness of the muscles in the ankles and feet (foot drop). Some individuals demonstrate progressive thinning (erosion) of the spinal bone overlying the cysts.
The exact cause of Tarlov cysts is unknown. Some arise from an inflammatory process within the nerve root sheath. Trauma that injures the nerve root sheath and causes leaking of cerebrospinal fluid (CSF) can cause a cyst to form. Tarlov cysts contain cerebrospinal fluid. Doctors speculate that normal fluctuations in CSF pressure may lead to an increase in cyst size and a greater likelihood of developing symptoms.
In many cases, Tarlov cysts develop symptoms following trauma or activities that raise cerebrospinal fluid pressure such as heavy lifting. Some reports suggest that those with connective tissue disorders are at a greater risk of developing Tarlov cysts than the general population.
Women are at a higher risk of developing Tarlov cysts than men. The cysts often go unrecognized or misdiagnosed. Thus many have treatments which are unnecessary over long periods of time before the eventual cause is found.
The total number of Tarlov cyst patients (symptomatic and asymptomatic) is estimated at 4.6 to 9 percent of the adult population.
A clinical evaluation, detailed patient history with identification of characteristic symptoms and a neurological examination is needed to diagnose. An x-ray or MRI scan investigation is key.
A myelogram which uses a special dye can be used to identify Tarlov cysts. A magnetic resonance imaging (MRI) of the lumbar region and computed tomography (CT) can also reveal Tarlov cysts. Erosion of the sacrum or vertebral bone by the cyst can also be shown.
Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to treat nerve irritation and inflammation. A procedure known as transcutaneous electrical nerve stimulation or TENS may also be used to relieve nerve pain.
Cerebrospinal fluid can be drained from the cyst (aspiration). Results vary and the cysts eventually fill up with cerebrospinal fluid again. Once drained a Tarlov cyst can be filled with another substance such as fibrin glue, fat, or muscle. This prevents cerebrospinal fluid from refilling the cysts and reduces pressure on the surrounding nerves.
Fibrin glue injection is a minimally invasive procedure that can assist with Tarlov cysts. Fibrin glue is used to seal or “glue” the cyst closed once drained. This prevents the cysts from filling up again. Complications can occur when the cyst communicates readily with the spinal fluid containing space.
Surgical removal of Tarlov cysts is also effective. Various techniques have been used with different success rates and side effects. Surgical intervention depends upon numerous factors such as the progression of the disorder; the degree of nerve root compression; the size of the connection between the subarachnoid space and the cyst; an individual’s age and general health.
If you think you may have a claim for a delay to diagnosis or misdiagnosis of Tarlov Cysts then call us in confidence to discuss your issue. We are happy to talk through what has happened and advise you on a potential claim. Call us for FREE on 0800 470 2009 or email Dr Victoria Handley at vhandley@handleylaw.co.uk