WHAT IS A TARLOV CYST or PERINEURAL CYST?
A Tarlov Cyst or Perineural Cyst is a dilated nerve root sheaths, which forms a sac filled with cerebrospinal fluid. They are also referred to as perineural cysts. Tarlov cysts (Perineural Cysts) are found most commonly in the sacral region and to be more specific, at the S2-S3 level of the spine. Nevertheless, people get a Perineural Cyst (Tarlov Cysts) in other areas of the spine, and it could be present in multiple areas as well. The key point to understand is that a Tarlov cyst is not the source of pain in patients with neck pain, upper back pain, mid back pain, low back pain or extremity pain.
In 98% of diagnosed cases, the Tarlov Cyst or Perineural Cyst is not the source of pain. However, a Perineural Cyst can become the source of pain or an aggravating factor in cases where there are no other clinical findings, and in those that present with a severely enlarged Tarlov cyst. Most often, the Perineural Cyst is looked at as an aggravating factor rather than the actual cause. If the Tarlov Cyst or Perineural Cyst is too big and is putting pressure on neural structures nearby, the occurrence of a radiculopathy will happen to cause a person to feel severe pain.
How is Tarlov Cyst (Perineural Cyst) Diagnosed?
The only acceptable means of diagnosis for a Perineural Cyst is through an MRI. MRI is the gold standard for spine related condition and when it comes to a Tarlov cyst, there is nothing better. The best MRI view of a Tarlov cyst is the T2-weighted MRI images. The T2-weighted images enhance fluid levels as such making the diagnosis of a Tarlov cyst relatively easy.
On a T2-weighted MRI, a Tarlov Cyst will appear to be a white ballooned/dilated area of the sheath that covers the exciting sacral nerve roots. It can be seen as in the images below.
Dilation of the nerve root sheaths which are directly connected to the subarachnoid area of the spinal column in which the cerebrospinal fluid flows will lead to the occurrence of a Tarlov Cyst. There are three meningeal layers covering the brain and the spinal cord; the outer most and the toughest layer would be the dura mater, followed by the arachnoid and the innermost layer is called the pia mater. Subarachnoid space is the space between the pia and arachnoid mater.
What are the Signs and Symptoms of a Perineural Cyst (Tarlov Cyst)?
The presence of a Perineural Cyst may or may not be accompanied by neurologic symptoms. However, living with a Tarlov cyst for years will start remodeling and erosions of the sacral bone. This, in turn, may lead to increased spinal fluid pressure causing the cyst to be filled with more CSF hence, growing bigger. If the cyst begins to compress the surrounding nerve fibers, patients may experience many symptoms including chronic pain. Any mechanism which may contribute to a hike in spinal fluid pressure such as traumatic accidents, infections, falls, childbirth or epidurals can lead an asymptomatic cyst to become symptomatic.
Symptoms of an enlarging Tarlov Cyst or Perineural Cyst would be similar to that of a neurologic pathology. Patients would experience either localized or radiating pain, numbness, paresthesia, and tingling. A patient with a Perineural Cyst, however, would also complain about soreness or pain at the sacral region, bowel/bladder changes and they might say they feel like they are sitting on a rock. Pain may increase with a cough or sneeze, and they may have headaches or dizziness.
What Should You Do if You Have Been Diagnosed with a Tarlov Cyst or Perineural Cyst?
As mentioned earlier, a Tarlov cyst is often not the cause of pain. Medical research has established the fact the 98% of Perineural Cyst cases is not the source of pain. In fact, in the majority of cases, patients who are diagnosed with a Tarlov cyst are those that suffer from spinal disc disorders such as a herniated disc (slip-disc or slipped disc). Therefore, clinical expertise and judgment are needed when it comes to treating patients that present with a Tarlov cyst. In our centers, we have treated thousands of patients with Tarlov cysts. In almost all cases, the source of their pain was not related to the cyst.
Tarlov cysts are often a complicating or aggravating factor. Much like when you cut your finger while cooking and not feeling the pain until you touch slat or an acidic liquid like lemon juice. Similarly, the Tarlov cyst is an aggravating factor, especially when you have a spinal disc disorder or a joint malfunction. In other words, the spinal disc or spinal joint is the source of pain rather than the cyst. Just like the pain, you feel when your cut finger comes in contact with salt or lemon juice.
Non-Invasive Therapy Options for the Tarlov Cyst or Perineural Cyst
The clinical teams of Chiropractic Specialty Center are experts in the spine and joint conditions. Our methods of treatment for the spine have improved the lives of thousands of our patients. In fact, we have helped many that others could not. Our successes in the area of the spine and joint care are due to our commitment to research and understanding of causes. If you have a Tarlov cyst, your best hope of recovering from pain through non-invasive manner is us. Our methods of integrative treatments coupled with advanced spine technology allow us to deliver for you a world-class level of care unmatched by others. Visit us today and discover your non-surgical treatment options for a Tarlov Cyst or Perineural Cyst today.