Tarlov Cyst: Symptoms, Causes, Diagnosis, Treatment, and Outlook

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What is a Tarlov cyst?

A Tarlov cyst is a fluid-filled sac on a spinal nerve root, most often in the sacrum at the base of the spine, that can compress nearby nerves. Many cause no symptoms, but larger cysts may cause lower back pain, burning leg sensations, numbness or bladder changes. MRI or CT diagnoses it. Symptom-free cysts may only need monitoring. [4]

What the research says

• Tarlov cysts are not rare on spinal MRI. In a retrospective review of 384 patients who had spinal MRI for back pain, 25 (6.51%) had Tarlov cysts, most at the S2/S3 level, with no gender or age predilection. It was a single-center study (Shoyab, The British Journal of Radiology, 2021). [3]

• Finding a cyst does not automatically explain symptoms. Among 242 patients with pudendal neuralgia who had pelvic MRI, 39 (16.1%) had at least one sacral Tarlov cyst, but in 31 of the 38 with complete pain records (81.6%) the side of the symptoms did not match the side of the cyst (Lim et al., American Journal of Obstetrics and Gynecology, 2020). [2]

• Surgery relieved symptoms in most people studied, but not all. A systematic review of 31 case series (646 participants) found complete symptom resolution in 32%, partial resolution in 50%, no change in 16% and worsening in 0.4%; reported adverse events were temporary. All studies were case series, and the review also cites an estimate that 1.5% of people have at least one cyst, about 13% of them symptomatic (Dowsett et al., Clinical Spine Surgery, 2018). [1]

Where do Tarlov cysts form?

Tarlov cysts usually form at the base of the spine, in the lower back near the sacrum. They sit on nerve roots that extend from the spinal cord. The fluid inside is usually cerebrospinal fluid, which surrounds the brain and spinal cord. [4]

You may have more than one Tarlov cyst at a time. Healthcare providers may also call them meningeal cysts or perineural cysts. [4]

Are Tarlov cysts common?

Tarlov cysts are hard to count because many cause no symptoms, but one study estimates that just under 4% of people in the United States have one. One study estimates that just under 4% of people in the United States experience this type of cyst. Among people diagnosed with a Tarlov cyst, studies show that only about 5% to 8% experience symptoms. [4]

Larger cysts are more likely to cause symptoms. A cyst may also be discovered incidentally when imaging is performed for another issue, such as lower back pain. [4]

What the numbers describe	Estimate or meaning
People in the United States	One study estimates just under 4% experience this type of cyst.
People diagnosed with a Tarlov cyst	About 5% to 8% experience symptoms in studies.
Cyst size	Larger cysts are more likely to cause symptoms.

What are the symptoms of a Tarlov cyst?

Symptoms depend on the size and location of the cyst. Many people do not feel anything. When a cyst is symptomatic, possible symptoms include lower back pain, a shocking or burning sensation traveling from the lower back through the legs, and numbness, weakness, or loss of feeling in the legs. [4]

A Tarlov cyst may also affect bladder or bowel regulation. Symptoms can include incontinence or constipation. Headaches and sexual dysfunction are also possible. [4]

Symptom	What it may feel like or affect
Lower back pain	Pain in the lower back or sacral area.
Burning or shocking sensation	A sensation that travels from the lower back through the legs.
Numbness or weakness	Reduced feeling, weakness, or loss of feeling in the legs.
Bowel or bladder changes	Incontinence, loss of regulation, or constipation.
Headaches	Head pain may occur with a symptomatic cyst.
Sexual dysfunction	Sexual function may be affected.

What causes a Tarlov cyst?

Experts do not know exactly what causes Tarlov cysts. Research suggests that a cyst may form after a CSF leak, usually caused by a traumatic spinal injury, or after inflammation of the protective sheath around a nerve root. [4]

CSF pressure naturally fluctuates. When pressure increases, the cyst may become larger. Symptoms may become worse or noticeable during strenuous activities such as lifting weights. [4]

Possible factor	How it may relate
Spinal injury	Trauma may cause a CSF leak, which may contribute to cyst formation.
Nerve-root inflammation	Inflammation of the protective nerve-root sheath may play a role.
Changing CSF pressure	Increased pressure may enlarge the cyst and make symptoms more noticeable.
Strenuous activity	Activities such as lifting weights may coincide with pressure changes and worsening symptoms.

Who is at higher risk?

Anyone can develop a Tarlov cyst. Factors that may increase risk include a spine injury, a connective-tissue condition such as Marfan syndrome or Ehlers-Danlos syndrome, being female, and being between ages 30 and 60. [4]

Having a risk factor does not establish that a cyst is present or that it will cause symptoms. The cyst’s size, location, and relationship to nearby nerves help determine its significance.

What problems can Tarlov cysts cause?

Complications are rare but may include chronic pain, bone deterioration, permanent nerve damage, movement difficulties, and cyst rupture with hemorrhage. Long-term symptoms can also affect mental health, including depression. [4]

Daily routines may need to change when complications affect movement or cause persistent pain. A healthcare provider can help assess symptoms and discuss support when chronic symptoms affect quality of life.

How is a Tarlov cyst diagnosed?

Diagnosis begins with a complete medical history, a physical examination, and a neurological examination. A provider may ask when symptoms began, whether activity makes them worse, and how they affect movement, sensation, or bowel and bladder function. [4]

MRI or CT imaging confirms the diagnosis by showing the cyst and the nerves it targets. A Tarlov cyst may be found incidentally during imaging for another problem, such as lower back pain. [4]

Diagnostic step	What it may show
Medical history	When symptoms started and whether activity affects them.
Physical exam	General signs that may help the provider evaluate the problem.
Neurological exam	Changes in strength, sensation, or nerve function.
MRI or CT scan	The cyst and the spinal nerves it may affect.

Do asymptomatic Tarlov cysts need treatment?

Usually, a Tarlov cyst that does not cause symptoms does not need treatment. A healthcare provider may recommend regular examinations to monitor the cyst’s size and whether symptoms appear over time. [4]

An incidental finding is not automatically the explanation for every symptom. The provider considers the cyst’s location, size, the nerves involved, and the person’s symptoms when deciding whether observation is appropriate.

How are symptomatic Tarlov cysts treated?

Treatment depends on the symptoms and the person’s situation. Possible options include pain medicines such as paracetamol, gabapentin, nonsteroidal anti-inflammatory drugs, or opiates; steroid injections in the lower back; TENS for nerve pain; and draining the cyst before filling it with fibrin glue, fat, or muscle. [4]

A provider weighs the possible benefits and risks of each option. None of the listed treatment options prevents the cyst from recurring.

Treatment option	What it may involve
Pain medication	Paracetamol, gabapentin, NSAIDs, or opiates may be used for pain.
Steroid injection	An injection in the lower back may reduce pain and inflammation.
TENS	Transcutaneous electrical nerve stimulation may be used for nerve pain.
Aspiration and filling	Fluid is drained from the cyst, which may then be filled with fibrin glue, fat, or muscle.
Monitoring	Regular exams may be used when a cyst causes no symptoms or during treatment.

What are the side effects and limitations of treatment?

Every treatment can have side effects. Pain medicines may cause drowsiness, nausea, or physical dependence. Ask the prescribing healthcare provider about the possible effects of a specific medicine.

After CSF is drained from a cyst, it may fill again. In some cases, this can happen within an hour. Providers may fill the cyst with another substance to reduce the chance that CSF returns and places pressure on the nerves. [4]

Symptom relief can occur immediately or soon after a medicine or procedure, but it may also take weeks. Some people do not find relief even after cyst decompression. Regular checkups during treatment can monitor side effects and the cyst’s size and location. [4]

How long does it take to feel better?

The timing of relief varies. Some people feel better immediately or shortly after treatment. For others, improvement takes weeks. Some people may not find relief even after cyst decompression.

Follow-up appointments can help monitor symptoms, possible side effects, and changes in the cyst.

Can a Tarlov cyst come back?

Yes. None of the listed treatment options prevents a Tarlov cyst from recurring. Fluid can also return after drainage, sometimes within an hour. [4]

Ask the care team how recurrence will be monitored and which symptoms should prompt a call.

Can Tarlov cysts be prevented?

Tarlov cysts have no known prevention because their cause is not well understood, though protecting yourself from physical injury may help reduce risk. Protecting yourself from physical injury may help reduce risk. [4]

Prevention steps cannot guarantee that a cyst will not form. They are general ways to reduce the chance of spinal injury rather than a treatment for an existing cyst.

When should you see a healthcare provider?

Seek medical evaluation for lower back pain without a known cause, incontinence or constipation, or numbness or weakness in the legs.

If you are receiving treatment, let your provider know about possible infection signs such as swelling or skin discoloration, or severe or worsening pain.

Situation	What to do
Unexplained lower back pain	Schedule an evaluation.
Incontinence or constipation	Contact a healthcare provider.
Leg numbness or weakness	Seek medical evaluation.
Swelling or skin discoloration during treatment	Report possible infection signs to the provider.
Severe or worsening pain during treatment	Contact the treating provider promptly.

What questions should you ask the care team about a Tarlov cyst?

Useful questions for the care team about a Tarlov cyst include where it is, whether it causes symptoms, which treatment fits and whether it can come back.

• Where is the cyst located? Location helps explain which nerves may be affected.

• Is the cyst causing my symptoms? Many cysts are found incidentally and do not cause symptoms.

• Do I need treatment or monitoring? Asymptomatic cysts may not need treatment.

• Which treatment do you recommend? Options vary according to symptoms and individual circumstances.

• What side effects should I watch for? Medicines and procedures have possible side effects.

• Can the cyst come back? Recurrence is possible after listed treatments.

• When should I contact you? A plan can clarify what to do if pain worsens or new symptoms appear.

Conclusion

A Tarlov cyst is a fluid-filled sac on a spinal nerve root, usually near the sacrum. Most cysts do not cause symptoms, but larger cysts may compress nerves and contribute to lower back pain, burning or shocking sensations, numbness, weakness, bowel or bladder changes, headaches, or sexual dysfunction. [4]

The cause is not fully understood. Diagnosis typically combines medical history, physical and neurological examinations, and MRI or CT imaging. A cyst without symptoms may be monitored, while symptomatic care may include medication, steroid injections, TENS, or procedures that drain and fill the cyst. [4]

There is no known way to prevent Tarlov cysts, and none of the listed treatment options prevents recurrence. Seek care for unexplained lower back pain, incontinence or constipation, leg numbness or weakness, or severe or worsening symptoms during treatment. [4]

Want a clearer next step for spinal nerve questions? Read more about spine and nerve health and talk with a healthcare provider about any symptoms before making decisions. [4]

Frequently Asked Questions

What is a Tarlov cyst?

A Tarlov cyst is a fluid-filled sac on a spinal nerve root, usually near the base of the spine. The fluid inside is usually cerebrospinal fluid.

Are Tarlov cysts dangerous?

Most Tarlov cysts do not cause symptoms. Rare complications can include chronic pain, permanent nerve damage, movement difficulties, bone deterioration, and rupture with hemorrhage.

What are common Tarlov cyst symptoms?

Symptoms may include lower back pain, burning or shocking sensations through the legs, numbness or weakness in the legs, bowel or bladder changes, constipation, headaches, and sexual dysfunction.

How is a Tarlov cyst diagnosed?

A provider may use a complete medical history, physical and neurological examinations, and MRI or CT imaging.

Do all Tarlov cysts need treatment?

No. A cyst that does not cause symptoms may only need regular exams to monitor its size and whether symptoms develop.

What is the first treatment for a symptomatic Tarlov cyst?

Treatment varies, but medication is usually the first step for symptomatic cysts. Other options may include steroid injections, TENS, or drainage and filling procedures.

Can Tarlov cysts come back after treatment?

Yes. None of the listed treatment options prevents recurrence, and fluid may return after drainage.

Can Tarlov cysts be prevented?

There is no known way to prevent them because the cause is not well understood. Protecting against physical injury may reduce risk.

When should I seek care?

Seek evaluation for unexplained lower back pain, incontinence or constipation, or leg numbness or weakness. During treatment, report swelling, skin discoloration, or severe or worsening pain.

References

1. Dowsett LE, Clement F, Coward S, et al. Effectiveness of surgical treatment for Tarlov cysts: a systematic review of published literature. Clin Spine Surg. 2018;31(9):377-384. PMID 28902742. https://doi.org/10.1097/BSD.0000000000000582

2. Lim VM, Khanna R, Kalinkin O, et al. Evaluating the discordant relationship between Tarlov cysts and symptoms of pudendal neuralgia. Am J Obstet Gynecol. 2020;222(1):70.e1-70.e6. PMID 31319080. https://doi.org/10.1016/j.ajog.2019.07.021

3. Shoyab M. Tarlov cysts in back pain patients: prevalence, measurement method and reporting points. Br J Radiol. 2021;94(1127):20210505. PMID 34538080. https://doi.org/10.1259/bjr.20210505

4. Cleveland Clinic. Tarlov Cyst: What It Is, Causes, Symptoms & Treatment. Cleveland Clinic. Last updated November 5, 2023. https://my.clevelandclinic.org/health/diseases/tarlov-cyst

Disclaimer

This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.

It explains what a Tarlov cyst is, where it forms, symptoms, possible causes, diagnosis, treatment options and recurrence. It does not diagnose a Tarlov cyst or provide a personal treatment plan. Tarlov cysts vary in size, location and symptoms, so imaging findings, treatment choices, recurrence and new or worsening symptoms should be discussed with a qualified healthcare provider.