Prolotherapy: A Good Alternative Treatment for Patients Diagnosed with Tarlov Cysts
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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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