Symptomatic Tarlov cysts are often overlooked: ten reasons why—a narrative review

  • Mieke HulensEmail author
  • Ricky Rasschaert
  • Frans Bruyninckx
  • Wim Dankaerts
  • Ingeborg Stalmans
  • Peter De Mulder
  • Greet Vansant
Review Article



Tarlov cysts (TCs) are dilations of nerve roots arising from pathologically increased hydrostatic pressure (HP) in the spinal canal. There is much controversy regarding whether these cysts are a rare source of pain or often produce symptoms. The aim of this review was to identify the reasons that symptomatic TCs (STCs) are easily overlooked.


The literature was searched for data regarding pathogenesis and symptomatology.


TCs may be overlooked for the following reasons: (1) STCs are considered clinically irrelevant findings; (2) it is assumed that it is clinically difficult to ascertain that TCs are the cause of pain; (3) MRI or electromyography studies only focus on the L1 to S1 nerves; (4) TCs are usually not reported by radiologists; (5) degenerative alterations of the lumbosacral spine are almost always identified as the cause of a patient’s pain; (6) it is not generally known that small TCs can be symptomatic; (7) examinations and treatments usually focus on the cysts as an underlying mechanism; however, essentially, increased HP is the main underlying mechanism for producing symptoms. Consequently, STCs may relapse after surgery; (8) bladder, bowel and sphincter dysfunction are not inquired about during history taking. (9) Unexplained pain is often attributed to depression, whereas depression is more likely the consequence of debilitating neuropathic pain. (10) The recognition of STCs is subject to gender bias, confirmation bias and cognitive dissonance and unconscious bias in publishing.


There are several reasons STCs are underdiagnosed, mostly due to persistent misconceptions and biases.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Tarlov cysts Meningeal cysts Unexplained pain Chronic pain Intracranial hypertension 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_5996_MOESM1_ESM.pptx (138 kb)
Supplementary material 1 (PPTX 137 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesUniversity of LeuvenHeverleeBelgium
  2. 2.Department of NeurosurgeryAZ RivierenlandBornemBelgium
  3. 3.Clinical Electromyography LaboratoryUniversity Hospitals UZ LeuvenLeuvenBelgium
  4. 4.Ophthalmology Research Group, Department of NeurosciencesUniversity of Leuven3000 LeuvenBelgium
  5. 5.Department of OphthalmologyUniversity Hospitals UZ LeuvenLeuvenBelgium
  6. 6.Department of Anesthesiology and Pain TherapyImelda Hospital2820 BonheidenBelgium
  7. 7.Department of Social and Primary Health Care, Public Health NutritionUniversity of LeuvenLeuvenBelgium
  8. 8.Sint-Joris-WeertBelgium

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