Tarlov Cysts: Symptoms, Risks, and Treatment Options

2 cm Tarlov cyst

Hello, I fell while skiing in Korea on February 26, landing on my buttocks.
An X-ray taken in Korea indicated a coccygeal fracture.
After returning home, I visited an orthopedic specialist and underwent an MRI.
The MRI report stated: "Bone marrow edema-like signal is seen at the first segment of the coccyx.
Considering the recent buttock contusion, it could be a bone contusion or a non-displaced fracture.
There is no anterior cortical breakage.
A 1.04 x 0.71 x 1.94 cm Tarlov cyst is seen on the right side at the S1/2 level." I researched Tarlov cysts online and found that they can severely affect bowel and bladder function, and that surgery is recommended for cysts larger than 1.5 cm.
However, mine is almost 2 cm at 1.94 cm.
Currently, the injured coccyx area is no longer painful, but I am still experiencing constipation and reduced bowel movement, with little sensation of needing to defecate.
If I do not consume high-fiber foods like dragon fruit for a day, I struggle to have a bowel movement.
Although I do not experience incontinence, I sometimes feel that my urgency to urinate is not as strong as before.
On the day of the injury, I also experienced headaches and intense cramping pain in my uterus.
Occasionally, I feel numbness in one leg and the perineum, but it is not frequent.
I consulted two neurosurgeons, both of whom stated that, given my size, it should not affect my bowel and bladder function.
They suggested that the constipation may be due to injury to the pelvic floor muscles and ligaments from landing on my buttocks.
They mentioned that many people have Tarlov cysts, which are often congenital, and I may have had it all along, only discovering it due to this injury, advising me not to worry about it.
However, one doctor mentioned that the Tarlov cyst would only grow larger and suggested waiting until it reaches 3 cm before considering surgery.
I am concerned that the Tarlov cyst may be compressing nerve pathways and could gradually affect my bowel and bladder function.
Q1: If the constipation is due to injury to the pelvic floor muscles and ligaments, how long will it take to improve?
Q2: Do Tarlov cysts really only grow larger? What can be done to prevent them from growing?
Q3: Given my current situation, am I beginning to experience neurological damage? Must I wait for it to grow larger before surgery can be performed? Why not operate while it is still small?
Q4: If surgery is necessary, what does the procedure involve? Is it minimally invasive?
Q5: After surgery, is there a high chance of recurrence?
Q6: If I choose to monitor the situation without surgery, how will I know if my condition is worsening and when I should return for follow-up?
I apologize for the lengthy questions, and I greatly appreciate your assistance!

Hui, 20~29 year old female. Ask Date: 2019/04/12

Dr. Zhang Junwei reply Neurosurgery

Doctors base their recommendations on past experiences.
Tarlov cysts may grow larger, but the rate is usually slow, and they may not grow at all.
My suggestion is to have regular follow-ups.
If the cyst does increase in size or if neurological symptoms worsen, then further intervention may be necessary, as surgery does carry its own risks.

Reply Date: 2019/04/12

More Info

Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form on the nerve roots in the spine, particularly in the sacral region. They can vary in size and may or may not cause symptoms. Your concerns regarding the cyst, especially in relation to your recent injury and symptoms, are valid. Let’s address your questions one by one.

Q1: If the constipation is due to pelvic floor muscle and ligament injury, how long will it take to improve?
The recovery time for pelvic floor muscle injuries can vary significantly from person to person. Generally, with appropriate treatment, including pelvic floor physical therapy, dietary changes, and possibly medications, you may start to see improvement in a few weeks to several months. It’s essential to engage in exercises that strengthen the pelvic floor and improve bowel function. Consulting with a physical therapist specialized in pelvic health can provide tailored strategies to expedite recovery.

Q2: Do Tarlov cysts really only get bigger? What can be done to prevent them from growing?
Tarlov cysts can indeed grow larger over time, but not all cysts will necessarily increase in size. Factors influencing their growth are not entirely understood. While there is no definitive method to prevent their growth, maintaining a healthy lifestyle, including regular exercise and avoiding activities that put excessive strain on the lower back, may help manage symptoms and potentially slow progression. Regular monitoring through imaging studies can help track any changes in size.

Q3: Given my current situation, am I starting to experience neurological damage? Should I wait until the cyst grows larger for surgery? Why not operate now while it’s still small?
Your symptoms, such as constipation and changes in urinary urgency, could indicate some degree of nerve involvement, but they may also stem from the injury to the pelvic floor rather than direct compression from the cyst. The decision to operate on a Tarlov cyst typically depends on the severity of symptoms and the degree of neurological impairment. If a cyst is asymptomatic or only mildly symptomatic, many surgeons prefer to monitor it rather than perform surgery, as surgery carries its own risks. However, if symptoms worsen or neurological deficits become apparent, surgery may be warranted sooner rather than later. It’s crucial to have ongoing discussions with your healthcare providers about your symptoms and concerns.

Q4: If surgery is necessary, what does it entail? Is it minimally invasive?
Surgical options for Tarlov cysts typically involve decompression of the cyst and may include excision if necessary. The procedure can be performed using minimally invasive techniques, which involve smaller incisions and potentially quicker recovery times. However, the specific approach will depend on the cyst's size, location, and the surgeon's expertise. Discussing the surgical options with a neurosurgeon who specializes in spinal conditions will provide clarity on what to expect.

Q5: Is there a high chance of recurrence after surgery?
Recurrence rates for Tarlov cysts after surgical intervention can vary. Some studies suggest that while cysts can recur, many patients experience significant symptom relief post-surgery. The likelihood of recurrence may depend on factors such as the cyst's characteristics and the completeness of the surgical excision. Your surgeon can provide more personalized information based on your specific case.

Q6: If I choose to monitor the cyst, how will I know if my condition is worsening and when to return for evaluation?
Monitoring your symptoms is crucial. You should return for evaluation if you experience new or worsening symptoms, such as increased pain, significant changes in bowel or bladder function, or new neurological symptoms like numbness or weakness in the legs. Regular follow-ups with your healthcare provider, along with periodic imaging studies, can help assess any changes in the cyst's size or your symptoms.

In conclusion, while Tarlov cysts can be concerning, many individuals live with them without significant issues. Your symptoms warrant careful evaluation and management, and maintaining open communication with your healthcare team will be essential in navigating your treatment options.

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