Tarlov Cysts: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Tarlov cysts?
A neurologist (brain and nerve doctor) usually evaluates Tarlov cysts first, since they are fluid-filled sacs that form on nerves near the base of the spine. Most cysts cause no symptoms, but a neurosurgeon may be involved if a cyst is large and causes pain, numbness or bladder problems that do not improve.
What are Tarlov cysts?
Tarlov cysts are fluid-filled sacs that are usually found at the bottom of the spine, called the sacrum. The cysts appear in the roots of the nerves that grow out of the spinal cord. They are also called perineural cysts or meningeal cysts. A person can have more than one cyst, and the cysts can be different sizes. Most Tarlov cysts cause no symptoms.
Symptoms
Many Tarlov cysts are never noticed. The larger a cyst is, the more likely it is to cause symptoms. Symptoms can start when a cyst presses on the roots of the nerves. They can include:
- Lower back pain.
- Sciatica, which is shock-like or burning pain in the lower back, buttocks, and down one leg.
- Loss of bladder control, also called urinary incontinence.
- Constipation.
- Sexual dysfunction, which means trouble with sexual function.
- Headaches caused by changes in spinal fluid pressure.
- Some loss of feeling or control of movement in the legs or feet.
- Burning or prickling feelings, or numbness, especially in the legs or feet.
Pain may be worse when walking, coughing, or sneezing. Long-term symptoms can also lead to depression in some people.
Causes and who gets it
The exact cause of Tarlov cysts is unknown. They may form because of a difference in how the nerve sheath, the covering around a nerve, develops. Shock or injury to the spine, or hard physical effort, can make spinal fluid build up in the cysts. Some people with no symptoms began to have them after an injury or after heavy lifting. Small cysts with no symptoms can slowly grow and later cause symptoms. Women are at a higher risk of getting Tarlov cysts than men. Some reports suggest that people with connective tissue disorders are at greater risk. One estimate is that 4.6 to 9 percent of adults have one, with or without symptoms.
How doctors diagnose it
Doctors may suspect Tarlov cysts after a careful exam, a detailed history, and a nerve exam. An MRI or a CT scan of the lower back can show the cysts. Sometimes a cyst is found by chance on an x-ray or MRI done for another reason. A myelogram, a test that uses dye and a CT scan, can show how the cyst connects to the spinal fluid space. Other cysts and tumors can cause similar symptoms, so doctors compare them.
Treatment
There is no specific, accepted therapy for people with symptomatic Tarlov cysts. Treatment is aimed at the symptoms each person has, and what helps one person may not help another. Cysts that cause no symptoms should be checked from time to time to see if they grow or start to cause symptoms.
Doctors may prescribe NSAIDs, which are anti-inflammatory pain medicines, to ease nerve irritation. A treatment called TENS sends small electrical pulses through the skin to help control nerve pain. Fluid can be drained from a cyst, but the results vary and the cyst usually fills up again. In a fibrin glue procedure, the cyst is drained and then sealed with a medical glue. This has helped some people.
Surgery may be used for people with symptoms who do not respond to other treatment. One operation opens the cyst, drains the fluid, and then closes or fills the space so it does not refill. Results may be disappointing if nerve damage has already happened and cannot be undone.
When to see a doctor
See a doctor if you have lasting lower back pain, leg pain, numbness, or changes in bladder, bowel, or sexual function. If the cysts are not treated, pressure on the nerve roots can cause permanent damage to the nervous system.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can start with a careful exam and a detailed history, order imaging, and refer you to a neurologist or neurosurgeon.
Common questions
Are Tarlov cysts serious?
Most Tarlov cysts cause no symptoms, so they are often found by accident on an imaging scan done for another reason. Some cysts press on nerves and cause pain, numbness or bladder or bowel changes, and the larger a cyst is, the more likely that is.
Can a direct primary care doctor manage Tarlov cysts?
A direct primary care doctor can order imaging if you have symptoms and refer you to a neurologist for further evaluation. If a cyst is causing significant nerve symptoms, the neurologist may refer you on to a neurosurgeon to discuss treatment options.
Do Tarlov cysts need surgery?
Most Tarlov cysts do not need surgery because they cause no symptoms. Surgery is only considered for cysts that are causing ongoing pain, numbness or bladder problems that have not improved with other care.
Sources
- National Institute of Neurological Disorders and Stroke - Tarlov Cysts
- National Organization for Rare Disorders - Tarlov Cysts
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
