Tarlov cysts

[Anna D]

Dear colleagues

I have been recently diagnosed with Tarlov cysts in S1 and S3 and would really like to know what is the view held by physiotherapy professionals in this area. Is manipulation of the spine appropriate or could this irritate the cysts even more? Is it possible to 'deflate' them with massage or is neurosurgery the only alternative? Would I wast my monety by seeing an osteopath or physiotherapist? I know that surgery has a poor rate of success and can leave people in much worse pain. Am I condemned to age in horrible pain? I've read that they can grow and affect the bowels and bladder (in fact I think they have already in my case).
I have not yet been referred to a neurosurgeon but I just wanted your opinion.
The diagnosis has been a real shock for me. What would you recommend?

Many thanks for your advice?

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[thomas bibu]

hi anna,

from your post I understand that you are quite anxious, hence I am sure you must have read quite a lot on Tarlov cysts.

well, as far as physiotherapy is concerned electrotherapy for pain relief is an accepted treatment option, though in my experience i have had mixed results.

generally Tarlov cysts require no treatment. they are most often an incidental finding on MRI done for other reasons.

but if they tend to expand compressing or distending the affected nerve root they need to be treated. treatment options include - corticosteroid injections or other medications to relieve pain, innovative surgical methods such as draining the cysts, ligating (gluing) or resecting the affected nerve root.

regarding the option of massage/manipulation by an osteopath or trained physiotherapist, I have no comments as I have no documented evidence.

my advice to you would be to have symptomatic treatment and regular followups to rule out signs and symptoms of expanding/enlarging cysts in future.

all the best.

cheers,

thomas

[Anna D]

Thomas

Thank you so much for your answer, I really appreciate it and hope that other people like me find your information useful.
Do you know if exercise could do more harm than good? I do Pilates regularly and I find that any bending forward (like reaching my toes with my hands) triggers pain, just like sitting down. I take it I should avoid that flexions? I can't find any information on execise at all!

I will see a neurosurgeon as I am in pain, especially when I sit and walk so your suggestion to monitor the the cysts growth is greatly appreciated!

All the best

Anna

[thomas bibu]

hi anna,

there should be no doubt that full spinal flexion exercises are contraindicated, hence kindly avoid.

take care

cheers,

thomas

[Anna D]

Thomas

I'm really grateful for your reply. It is such great relief when someone appreciates your worries and gives you a precise and clear answer. However sad, I now know that it is better to avoid spinal flexion.

I'll now have to think of a good way of strengthening my rectus abdominis which I thought could only be achieved by doing the traditional 'abdominal curls'. Would it be safe if I still did this kind of exercise, laying on my back and squeezing the ribcage to the hips? This is not a full spinal flexion, is it?

Thank you so very much for your help!

Anna