Q: I am a 40 years old male weighing 90 kg. I have been diagnosed with a symptomatic Tarlov cyst measuring 1.5 x 1.3 cm at S2 displacing the thecal sac. I have low back pain and unable to climb stairs and lift weight. How can Tarlov cyst be managed? Is there treatment available in India?

A:Tarlov Cysts are sacs of collection of CSF (the fluid that surrounds spinal cord and brain) which usually occurs around nerves in the lowest part of your spine (the sacrum and coccyx). Quite often these are completely asymptomatic and nothing needs to be done. More often these are incidental findings when MRIs are done for some other purpose. The mere presence of a Tarlov cyst does not warrant an intervention. If you have backache and the MR shows a Tarlov cyst it is not necessary to be the cause of backache. A Tarlov cyst is implicated only if there are no other abnormal findings and the neurological level and distribution of pain corresponds to the nerve that is involved. So, the key to diagnosing a symptomatic Tarlov cyst is a careful neurological / neurosurgical examination. Occasionally the pressure in the cyst may increase causing nerve damage. The treatment is recommended only if the cyst is definitely symptomatic. Simple pain killers, anti-depressions, occasionally steroid injection have all been tried but they all provide temporary relief. Surgical drainage can be done but the cyst can still reoccur. Careful microsurgical excision is possibly be best solution in those who do not respond to simple conservative measures. This can be successfully done in any good neurosurgical department.