What to Know About Cysts at the Base of the Spine

Medically Reviewed by Stephanie S. Gardner, MD on February 21, 2024
3 min read

Tarlov cysts are a condition where you develop cysts on the nerves of your spine. These pockets of fluid aren't life-threatening, but they can lead to symptoms like pain or muscle weakness. The cysts are treatable but may require spine surgery to remove them completely. 

Tarlov cysts, also called perineural or sacral cysts, are pockets of fluid that form around the nerves that make up your spinal cord. Most often, you will find cysts on your sacrum or lower back area. It's also possible to have more than one at a time, in different places along your spinal cord.

The cysts can be small and cause no symptoms at all. You may never know you have a Tarlov cyst unless you get an X-ray for an unrelated issue and your doctor happens to spot it. Other cysts, though, cause significant discomfort.

Women are more likely to get Tarlov cysts than men, though doctors aren't sure why that is the case. They occur most often when people are between ages 30 and 60. The true number of people who get Tarlov cysts is unknown since so many of them go undetected. As much as 5% to 9% of the population may have Tarlov cysts. 

Doctors aren't sure what causes Tarlov cysts. Some experts believe it's possible that some people are born with a higher risk of developing these cysts. Other evidence suggests that the cysts might form as a result of physical strain such as heavy lifting, automobile accidents, or childbirth.

Some Tarlov cysts affect the spinal nerves. This can lead to significant discomfort. Lower back Tarlov cyst symptoms include:

  • Bowel problems
  • Changes in bladder function
  • Discomfort or pain when sitting or standing
  • Difficulty with sexual function
  • Muscle weakness
  • Pain in the genitals
  • Pain in the buttocks‌

Cysts that are higher up on the spine can affect your upper back, neck, hands, and arms. Some people develop numbness in their skin. Others report a tingling or prickling sensation.

Many of these symptoms are also associated with different health issues, such as sciatica or a herniated disc. You may try a series of treatments that don't have an effect. You may not discover you have a Tarlov cyst unless you get an MRI to examine your spine for problems. 

If you have Tarlov cysts that don't cause symptoms, you don't need any treatment. Your doctor may advise you to have periodic follow-ups to monitor the situation, though. If the cyst starts growing or changing in a way that could cause discomfort, you can get treatment before it becomes a bigger problem.

If you have an asymptomatic Tarlov cyst, there are some treatment options, including:

  • Draining the fluid to relieve pressure
  • A combination of draining and filling the empty cyst with a fibrin glue to prevent a recurrence
  • Physical therapy to reduce symptoms
  • Medicine to manage pain
  • Steroid injections to manage pain

Some cysts require surgery. Your doctor will do an operation to drain the cyst. Once the fluid is removed, they will use a small muscle flap to fill in the space where the cyst occurred. This can help prevent a recurrence.

If the symptoms of Tarlov cysts go untreated, you may be at risk for permanent nerve damage. The pressure and irritation from the cysts can damage the nerves beyond repair, leaving you with lifelong health issues.

Tarlov cysts are persistent and don't always respond to non-surgical treatment. The cyst can fill back up with fluid, sometimes within hours of your doctor draining it. Other cysts fill more slowly, but you will eventually experience a return of your symptoms. 

Surgery can be more effective at preventing the recurrence of cysts. In some cases, nerve damage from the cyst is permanent, and even surgery won't reverse it.

If you are having symptoms that may be caused by a Tarlov cyst, discuss your treatment options with your doctor.