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Spine and Back Health

Tarlov Cyst Removal

12/15/2008

Question:

Why do doctors not want to remove these cysts when they are in an uncomfortable place to begin with? My doctor said it won`t cause any harm to leave it there, but it is causing me pain... Can Tarlov Cysts turn into cancer?

Answer:

Anthony Guanciale, MD

A Tarlov cyst is very similar to dural ectasia which is a term that describes dilation of normal neural structures. There is no evidence that these structures cause pain since they are developmental and have been present for a person`s entire life. Since this is only a dilation of normal nerve tissue, removing such would result in possible permanent loss of function of that nerve root and would only worsen a person`s symptoms. Therefore, it is better to treat any symptoms felt to be associated with such dilation non-operatively such as with epidural steroid injections.

David Hart, MD

Most surgeons never operate on Tarlov cysts. There have been a couple of scientifically very weak studies suggesting that surgical treatment of them can help certain selected patients, but most other studies have refuted that idea, and it is well known that the success rates are extremely poor, with high complication rates (including nerve damage and big problems with spinal fluid leakage after surgery). This is why most surgeons (myself included) won't touch them, and usually don't believe that they can be a cause of pain. To answer your last question, Tarlov cysts are completely benign and do not turn into cancer.

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Response by:

Anthony Guanciale, MD
Associate Professor and Director, Division of Spine Surgery
College of Medicine
University of Cincinnati

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University