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Prolotherapy:
A Good Alternative Treatment for
Patients Diagnosed with Tarlov Cysts
Ross Hauser, M.D.
What are Tarlov Cysts?
Tarlov cysts or perineural sacral cysts are described as fluid-filled
sacs that most often effect nerve roots at the lower end of the spine
(sacrum). Tarlov cysts were first identified in 1938, yet there is still
very limited scientific knowledge available. These lesions have been
estimated to affect four to nine percent of the adult population and are
generally reported as incidental findings on CT or MRI studies. This
condition affects women far more frequently than it affects men. These
cysts can occur anywhere in the spine, but the most common areas
affected are the S-2 and S-3 nerve roots. On average most Tarlov cysts
are small, but some can be as large as 6 cm (about 2.4 inches). There is
some confusion over the precise definition of Tarlov cysts and how they
are different from other spinal cysts. The distinctive feature of the
Tarlov perineurial cyst is the presence of spinal nerve root fibers
within the cyst wall or cyst cavity itself.
The exact cause of Tarlov cyst is unknown, but there are theories as to
what may cause an asymptomatic Tarlov cyst to produce symptoms. In
several documented cases, accidents or falls involving the tailbone area
of the spine caused previously undiagnosed Tarlov cysts to flare up.
Symptoms vary greatly by patient, and may flare up and then subside.
Any of the following signs and symptoms may be present in patients that
have symptomatic Tarlov cysts.
• Pain in the area of the nerves affected by the cysts, especially the
buttocks
• Weakness of muscles
• Difficulty sitting for prolonged periods of time
• Loss of sensation on the skin
• Loss of reflexes
• Changes in bowel function, such as constipation
• Changes in bladder function, including increased frequency or
incontinence
• Changes in sexual function
Traditional Treatment Options:
Non-surgical therapies include lumbar drainage of the cerebrospinal
fluid, CT scanning-guided cyst aspiration, and a newer technique
involving removing the CSF from inside the cyst and then filling the
space with a fibrin glue injection. Unfortunately, none of these
procedures prevent symptomatic cyst recurrence. Injections of
corticosteroids usually help. Other neurosurgical techniques for
symptomatic Tarlov cysts include simple decompressive laminectomy, cyst
and/or nerve root excision, and microsurgical cyst fenestration and
imbrication. The key to deciding about treatment of these cysts is to be
certain the cyst is the cause of the symptoms. Before deciding on
intervention the symptoms should be serious enough that their treatment
is indicated. This seems like a good place to talk about
Prolotherapy, what do you think?
Prolotherapy for Treating Tarlov Cysts:
Those of you who follow my writings know I am going to now talk about
when you will know that Prolotherapy will help your Tarlov cyst pain and
when it probably won’t help it. So what test does a person need? Yes,
they need the "my reproducibility instrument" - otherwise known as my
thumb. That is the best MRI test. Can someone press on the area of pain
and reproduce it? If the answer is “yes,” then there is a good chance
Prolotherapy can help get rid of the pain. The other test is? Don’t you
know? Yes, EMG/NCV tests of lower back and both extremities. If the EMG/NCV
test confirms that a nerve is getting injured and this is the nerve
where the cyst is located, then will Prolotherapy work? Probably not.
The person needs surgery to remove the cyst. If the EMG/NCV is normal or
does not correlate with where the Tarlov cyst is located, then the pain
is coming from something else besides the Tarlov cyst. In such a
situation, there is a good chance that Prolotherapy can give a lot of
symptom relief. If the pain, tingling, or numb feeling is coming from
ligament laxity or injury, (like in the sacroiliac joint), then
Prolotherapy is the treatment of choice. Typically treatment every month
for three to eight visits is necessary. The good news regarding these
cases is that Prolotherapy works great, often giving a complete
recovery. So if you or someone you know and care for have been diagnosed
with Tarlov Cysts, don’t despair, get a Prolotherapy evaluation.
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