Tarlov cysts—also called perineural or sacral cysts—are fluid-filled sacs that develop along the nerve roots of the spine, most commonly in the sacral region near the tailbone. While many Tarlov cysts are harmless and cause no symptoms, Tarlov cysts that are symptomatic can compress nerves and be very painful and lead to a wide range of problems.
At Excel Spine Center we collaboration with San Diego Sexual Medicine to evaluate and treat patients with complex spinal and pelvic nerve conditions, including rare but life-changing problems caused by Tarlov cysts.
What Are Tarlov Cysts?
Tarlov cysts form in the nerve root sheath, the protective covering around spinal nerves. They are filled with cerebrospinal fluid (CSF) and can vary greatly in size. When a cyst grows large enough, it can put pressure on nearby nerves and structures, causing pain and other symptoms.
Symptoms of Symptomatic Tarlov Cysts
The symptoms depend on which nerves are being compressed and can include:
- Lower back or tailbone pain
- Sciatica — radiating pain down one or both legs
- Numbness or tingling in the buttocks, legs, or feet
- Weakness in the lower extremities
- Pelvic pressure or pain
- Bowel or bladder dysfunction in severe cases
- Pain that worsens with sitting, standing, or straining, and improves when lying down
The Link Between Tarlov Cysts and PGAD
In some patients, Tarlov cysts in the sacral spine can press on the pudendal nerve or related nerve pathways that carry sensory signals from the pelvic region. This nerve irritation can lead to Persistent Genital Arousal Disorder (PGAD) — a neurological condition characterized by unwanted, ongoing sensations of genital arousal unrelated to sexual desire.
PGAD can be emotionally and physically distressing, making it critical to identify and address any underlying nerve compression, such as that caused by a Tarlov cyst.
How Dr. Kim Began Treating Tarlov Cysts — and the Partnership with Dr. Goldstein
Dr. Choll Kim’s work with Tarlov cyst patients began when Dr. Irwin Goldstein, a renowned sexual medicine specialist, began referring patients whose sexual health symptoms were suspected to have a neurological cause.
Many of these patients had undergone extensive evaluations and treatments without relief—until imaging revealed Tarlov cysts compressing sacral or pudendal nerves. By combining Dr. Goldstein’s expertise in sexual medicine with Dr. Kim’s advanced skills in minimally invasive spine surgery, the team developed a collaborative, multidisciplinary approach that:
- Pinpoints the cyst’s role in neurological and sexual health symptoms
- Offers targeted surgical or non-surgical solutions
- Provides patients with comprehensive care addressing both spine and pelvic nerve function
This collaboration has allowed patients—many of whom had suffered for years without a diagnosis—to finally understand the cause of their symptoms and receive treatments that address the root problem.
Causes and Risk Factors
Tarlov cysts may develop due to:
- Congenital factors (present from birth)
- Spinal trauma or injury
- Increased CSF pressure that enlarges existing cysts
- Inflammatory or degenerative spinal conditions
Diagnosis
Diagnosis typically involves:
- Detailed medical history and symptom review
- MRI imaging to identify cyst location and size
- In some cases, CT myelography or nerve conduction testing
- Targeted diagnostic injections (helps to target pain generator)
- Collaboration with sexual medicine specialists if PGAD or other pelvic nerve symptoms are present
Treatment Options
Treatment depends on severity and impact on quality of life:
Conservative options:
- Activity modification
- Pain management
- Physical therapy
- Pelvic floor therapy (especially in cases with PGAD)
Surgical options:
- Cyst drainage and sealing
- Cyst wall reduction or excision
- Microsurgical decompression of affected nerves
Because these surgeries are complex, it’s critical to choose a specialist experienced in both spinal nerve surgery and pelvic nerve disorders.
Take the First Step Toward Answers and Relief
If you have unexplained pelvic or genital sensations, persistent lower back pain, or sciatica, a Tarlov cyst could be the cause. Let’s find out what’s behind your symptoms, a free MRI review can help uncover whether a Tarlov cyst may be contributing to your pain.