Ask a doctor on the topic of Neurology

Tarlov cysts?

January 24, 2017 | 25,00 EUR | answered by Dr. med. Frauke Gehring

I have back pain in the lumbar area, which started in early 2015. I have had countless sessions of physiotherapy and participated in rehabilitation sports. In July 2016, I underwent further diagnostic tests at Charite, ruling out rheumatic diseases. Everything came back negative. MRIs were conducted, and the final report stated:

"Extradural, T2w hyperintense lesion on the right S1 nerve root in the segment L5/S1 measuring 35 (cc) x 19 (ap) mm and on the right S2 nerve root in the segment L5/S2 measuring 22 (cc) x 9 (ap) mm. Lesion of the same morphology also present on the left S3 nerve root measuring 9 (cc) x 6 (ap) mm. Perineural cyst around S1 on the right with a maximum diameter of 20mm and length of 30mm, smaller cyst also around S2 on the right."

My orthopedist then referred me to a neurosurgeon and also tried acupuncture, which did not provide relief. The neurosurgeon dismissed me and suggested I do more sports or yoga. I work as a nurse in neurology. I now experience pain in the mornings after waking up, which worsens throughout the day. Prolonged standing and slow walking are particularly challenging for me. I have been taking Ibuprofen 600 for a long time, but my doctor wanted to switch me to Tramal 100, as the pain never completely goes away. It is very burdensome for me. I have been practicing yoga since November, now doing it at home three times a week for 30 minutes.

Should I seek another opinion from a different neurosurgeon or consider going to a clinic?

Dr. med. Frauke Gehring

Good day,

Tarlov cysts are very rarely symptomatic, and in your case, there is apparently no indication that the described cysts were causing your symptoms. However, the course of events makes me skeptical. Persistent pain that continues despite movement and even under Tramal 100 (I assume, 2x1) definitely warrants further investigation.

Given your profession, you are surely aware that spinal surgeries are rarely performed and only when conservative therapy is unsuccessful. Scarring can sometimes lead to worsening rather than improvement.

Nevertheless, considering your course of events, it is clear that conservative therapy has failed. Therefore, I would strongly recommend consulting a skilled neurosurgeon. You can find good clinics here: https://www.weisse-liste.de/de/ (sort search results by case numbers and also consider patient satisfaction).

All the best!

Warm regards, Dr. Höllering