Frequently Asked Questions
From Tarlov Patients
1. What is a Tarlov cyst?
A Tarlov cyst is a dilation of the nerve root sheath or outer covering of the nerve. Cerebral spinal fluid gets trapped inside the sheath and forms a cyst. The fluid in the cyst can put pressure on the nerve inside and on the adjacent nerve roots and cause debilitating symptoms. They can occur anywhere along the spine where there are nerve roots. They are most prevalent in the sacrum or base of the spine. The cyst is the nerve and therefore cannot be cut out. Check out our YouTube page for more educational videos!
2. What symptoms do Tarlov or meningeal cyst patients have?
Symptoms can vary depending on the location of the cysts in the spine.
a) Lumbar and/or Sacral
- Low back pain
- Sacral or tail bone pain, pressure, and/or numbness
- Pain with sitting. May feel like you are sitting on a rock or an object
- Avoid sitting related activities
- Pain with standing
- Pain in the legs and/or feet especially in the back of the thighs
- Leg/thigh weakness or numbness
- Foot numbness
- Bowel and/or bladder dysfunction like constipation or urinary retention
- Privates/perineal, vaginal, rectal, pelvic and/or abdominal pain or numbness
- Pain with sexual intercourse
- Sexual dysfunction like erectile dysfunction, and/or PGAD (Persistent Genital Arousal Disorder)
- Pain and/or numbness in the buttocks and/or between the legs
- Symptoms made better by lying down, or alternating positions throughout the day from sitting, standing, to lying down
- Cervical or neck pain, pressure, and/or numbness
- Shoulder pain, pressure, and/or numbness
- Arm pain, pressure, and/or numbness
- Hand pain, pressure, and/or numbness
- Finger pain, pressure, and/or numbness
- Pain radiating between the neck and shoulder, between the neck and arm, and/or between the neck into hands/fingers
- Thoracic or upper back pain, pressure, and/or numbness
- Middle back pain, pressure, and/or numbness
- Middle low back pain, pressure, and/or numbness
- Upper chest/thoracic pain, pressure, and/or numbness
- Lower thoracic/abdomen pain, pressure, and/or numbness
- Anterior front of arm pain and/or pressure
3. Are headaches a symptom of Tarlov cysts?
No, but some patients state they have headaches, and that after surgery, it decreases. Some patients tighten their jaw because of pain which can lead to headaches. A previous surgical patient found it helpful to use a mouth guard during sleep to relieve symptoms.
4. How are the cysts removed?
These unique cysts are the nerves and therefore are not removed but rather opened, explored and treated under an operating microscope while the nerves are continuously monitored. For other types of cysts such as a meningeal diverticulum it is possible to resect the cyst as long as there are no nerves attached.
5. What is the plate made of that is placed over the area where bone was removed during surgery?
In your consultation, Dr. Feigenbaum may have mentioned a "man-hole" cover. This plate looks like a clear plastic mesh and is made of a polymer called poly L-lactide-co-glycolide. Over a few years it breaks down to water and your body will absorb it. Over time your body will form a tough scar where the plate used to be.
6. How many Tarlov/meningeal cyst surgeries has Dr. Feigenbaum done?
Dr. Feigenbaum has treated over 2000 Tarlov and meningeal cyst patients.
7. What additional tests can I expect will be needed before determining if I am a surgical candidate?
Some patients will need a dedicated MRI of the sacrum or flexion/extension x-rays of the lumbar spine to look for instability. Other patient's may need a better quality MRI of the area of the spine they are being evaluated for.
8. Do I have to notify my insurance company to get approval for my surgery?
Our office will initiate your surgical pre-authorization and will contact you if additional insurance information is required.
9. What is a typical scenario for those coming out of town for surgery?
For example, if your surgery is planned for a Wednesday, this is a typical day by day plan.
If you have not met Dr. Feigenbaum in person, you will need to travel to Texas no later than early Tuesday and meet Dr. Feigenbaum Tuesday afternoon. Any pre-admission items at the hospital that have not been completed may be done so after your meeting with Dr. Feigenbaum. Surgery would be the following day on Wednesday. You would remain in the hospital Thursday and Friday and be discharged to a local hotel on Friday afternoon or Saturday if needed. You will then be seen in our office on the following Tuesday or Thursday for a post-operative appointment. You can plan to travel home after your post-operative appointment or the day after your visit.
If you have already met Dr. Feigenbaum, you will need to travel to Texas on early Tuesday so that you can complete any pre-admission items with the hospital on Tuesday; these are walk-in appointments, but please arrive before 4 P.M.
10. At what facility will the procedure be performed?
Surgery is scheduled at Medical City Dallas or Medical City Spine Hospital in Dallas, Texas. Patient needs and insurance coverage will determine the location.
11. How many days will I be in the hospital?
Generally three to four days.
12. Can a family member stay with me in the hospital?
13. How long will I need to stay in town after my surgery once I've been discharged from the hospital?
Seven to ten days, unless you are a local patient.
14. What follow up is done after the surgery?
Local patients: are seen at 3 weeks, 3 and 6 months, and 1 & 2 years after surgery. The post-operative appointments are most commonly with the nurse. An MRI is done at 3 months after surgery. Post-operative surveys or questionnaires are filled out by patients at 3 and 6 months and one and two years after the surgery.
Out of town patients: are seen in the office approximately one week after surgery. An MRI is done at 3 months after surgery. Post-operative surveys or questionnaires are filled out by patients at 3 and 6 months and one and two years after the surgery. These items need to be mailed to our main office in Texas to be reviewed by Dr. Feigenbaum.
15. What can I do to enhance my recovery from surgery?
While the recovery can be a long one and very different than other types of surgery there are some things you can do to make it the best possible recovery.
- Follow all your post-operative instructions
- Do not smoke
- Maintain a good support system of family and friends
- Follow your restrictions
- Have a positive outlook and have a motivation to get better
- Eat a healthy balanced diet to obtain proper nutrition
- Maintain a healthy weight
- Don't spend too much time focusing or talking about your pain or symptoms
- Have realistic expectations and be patient with yourself and the recovery
- Walk daily as you tolerate