Symptomatic Tarlov cysts: A case series and effectiveness of multimodal rehabilitation plus pharmacological treatment

Abstract

BackgroundTarlov cysts, or perineural cysts, are nerve root lesions most frequently found in the sacral region, and are generally asymptomatic. They are usually detected incidentally and their association with sexual, bladder, or bowel dysfunction is frequently ruled out. AimsWe describe the management of a series of patients with symptomatic Tarlov cysts using a protocol that combines multimodal rehabilitation (biofeedback+posterior tibial nerve stimulation+INDIBA® radiofrequency) and pharmacological treatment (Tiobec Dol® dietary supplement and/or acetazolamide) and evaluate the effect of this programme on pain and pelvic floor muscle strength. Material and methodsRetrospective study of 5 patients with urinary or faecal incontinence and pelvic pain or dyspareunia, who presented Tarlov cysts.The outcome variables were: (1) pain as measured with the visual analogue scale (0–10) and (2) maximal and mean pelvic floor muscle strength (in mm Hg) at baseline and after treatment completion. ResultsTreatment improved mean pelvic floor muscle contraction from 9.2±6.01mmHg to 10.6±5.2mmHg (P=.3111) and maximal pelvic floor muscle contraction from 41.2±21.98mmHg to 45.8±17.51mmHg (P=.4430), and decreased pain from 8±1.26 points to 4.6±2.65 points (P=.0343). ConclusionsTarlov cysts may cause pain and radiculopathy, although they are usually asymptomatic and, consequently, underdiagnosed. More rarely, they cause urinary, bowel, and sexual dysfunction. We describe the cases of 5 patients with Tarlov cysts presenting with incontinence and pain who were managed with multimodal rehabilitation plus pharmacological treatment. Cases of Tarlov cysts should be reported and studied; this will help to expand our understanding of their pathophysiology and to standardise effective multimodal treatment.