Tarlov cysts (also known as meningeal or perineurial cysts) occur on weakened areas of spinal nerve roots. These cysts balloon out to form sac-like structures along the wall of the nerve. The pressure of a growing cyst on the spinal nerves can cause pain and a number of debilitating symptoms. Though Tarlov cysts most often occur in the sacral area — the group of bones above the tailbone — they can occur anywhere on the spine.

Not all Tarlov cysts are symptomatic, but when they are, the symptoms can be severe. The cysts can grow and compress nerves which can cause damage and affect the function of the nerves. People with symptoms may experience:

• A feeling similar to “sitting on a rock”
• Buttock pain
• Nausea
• Numbness or tingling in the legs or feet
• Pain in the rectal or genital area
• Painful lump in the sacrum
• Persistent genital arousal disorder (PGAD)
• Trouble emptying the bladder or the constant urge to empty the bladder

If the Tarlov cyst is leaking, you may experience:

• Headaches
• Increased pain
• Ringing in the ears

Many patients with Tarlov cysts have minimal or only mild symptoms. It’s not uncommon to have flare-ups where symptoms get worse for a period and then get better. For persistent, disabling symptoms, surgery is often required.

Tarlov Cyst Surgery

The Sutter Medical Foundation Tarlov Cyst Program, located at Sutter Medical Center, Sacramento, is the only program of its kind in the Sutter network and in California. Led by Rudolph Schrot, M.D., MAS, FAANS, the program has performed hundreds of Tarlov cyst surgeries on patients who travel to Sacramento from all over the country.

Surgery is done under general anesthesia while the patient is positioned face down. A cut is made over the sacrum, a piece of bone is removed and the cysts are drained. The cysts are then wrapped with a dural graft material which is sutured around the nerve root to strengthen it. Fibrin glue is used to seal the suture line. A graft of fat from a separate incision may be used to fill the space previously occupied by the cyst. After the cysts have been repaired, the piece of bone from the sacrum is put back in place.

Typically, surgery takes around two hours to complete but may go longer based on the number and complexity of the cysts.

Surgery Risks and Recovery

Complications are unlikely, but may include:

• General risks of surgery, such as blood clots, heart attack, pneumonia and urinary tract infection.
• New numbness and weakness.
• Spinal fluid leak.
• Worsened problems with bowel, bladder or sexual function.
• Wound infection.

After surgery, you’ll remain flat in bed for two days. This takes the pressure off the newly repaired nerve roots and helps to avoid the possibility of a spinal fluid leak. Most patients have a bladder catheter in place during this time. After 48 hours, the catheter is removed, and a physical therapist will work with you to get you back on your feet and moving around. On the third day after surgery, patients are typically discharged home.

Most patients don’t have significant pain after surgery. Your doctor will prescribe medication for pain control that can be taken as needed.

Mild exercise, such as walking, within the first six weeks after surgery is encouraged. You may also do gentle stretching and Kegel-type exercises to strengthen the pelvic floor. After six weeks, you may increase your activity gradually back to a normal level, including stretching and range of motion exercise. Listen to your body. A good rule of thumb is that if it causes pain, don’t do it, although mild pain is OK. 

Aggressive physical therapy is not recommended after Tarlov cyst surgery. Gentle physical modalities such as a TENS unit (transcutaneous electrical nerve stimulator), ultrasound therapy, and heat application may be beneficial during recovery.