Perineural or Tarlov cysts

Posted by jenapower @jenapower, May 23, 2017

Hi, my name is Jennifer. I have commented on here before but I've never started a post. I have been told that I have fibromyalgia for a long time, I also have had a number of accidents with many broken bones and surgeries to put things back together. All of this has resulted in chronic pain, most of it is down my head/back/pelvis/spine and legs. In an effort to try to see more my doctor did a lumbar and pelvic MRI last week. Turns out I have a cyst on my spine called a perineural or Tarlov cyst. It's basically assistant starts at the nerve root and herniates out filling with spinal fluid. I guess there's like a leak from your spine to this cyst but the system itself is made up of nerves. It's the best of my understanding at this point. Mine is at the S2 location, and can cause pain from your back down your bottom and down your legs and includes some pretty severe headaches because it's upsetting the pressure of the spinal fluid around the brain. Again this is the best of my understanding of what I've been told. It certainly explains a lot of my symptoms that have been contributed to fibromyalgia and broken bones. Again they're not really sure what causes them but they think trauma in that area could be a contributor. I just wondered if anyone else had heard of this or experienced it. It is considered rare, i've come to find out there are only two doctors in the United States to do surgery on it. One of them that's all he does and he actually goes to other countries to help people that don't have access to a doctor that is experienced in this surgery. It's a long recovery and pretty scary surgery because they're messing with your new or nerve root I don't want to think about what the bad consequences could be although I know I have to. I think I've gotten to a point where I'm pretty much flat on my back every day and it's no life, so I'm actually happy to have an answer. If anybody else knows anything about this I would love to hear it or has any experience with the surgery.
Thank you, Jennifer

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@jenapower Hi, I don't know anything about your problem, but wanted to let you know I'm praying for you. I'm sad that you have been through so much. I can't imagine what it's like. I'm recovering from a 9 hr fusion back surgery, but that's nothing to what you are going through.
May God Bless you and be with you.

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My insurance co. finally approved my surgery thanks to Reta Honey Heiers from the Tarlov Cyst Disease Foundation http://www.tarlovcystfoundation.org She requested that a code specifically for Tarlov Cysts be added and has been fighting for it since 2016. On Oct. 1, 2020 it went into effect and that is the only reason my insurance co. approved my surgery. I had to call her directly and thank her for all her hard work. If anyone else is successful in getting their surgery approved due to the new ICD code please thank Reta at http://www.tarlovcystfoundation.org

I had the surgery on Dec. 8. 2020 by Dr. Frank Feigenbaum from Feigenbaum Neurosurgery - Tarlov Cyst Center in Dallas, TX. Dr. Feigenbaum is the leading expert in Tarlov Cysts/perineural cysts having done many more surgeries than anyone else. Anyone interested in this surgery must understand that the recovery period can be 2 years or more because nerves take a very long time to regenerate. Dr. Feigenbaum said it best in one of his videos I found on Youtube: He can treat the cysts but he cannot treat the nerves. You have to understand that recovery is different for all of us because we are all "wired" differently. If the cysts have been compressing your nerves for a long time like mine have you will need to accept that you may very well have permanent nerve damage to some extent. All I was able to do prior to surgery is lay on my couch 95% of every day because I was in so much pain.

Now, I have to admit that I'm still in a lot of pain and will have to take more pain medication for quite a while but knowing that the sacral nerves are no longer compressed making my symptoms worse gives me piece of mind. I had 5 cysts. They showed me on a model where each cysts was. There are 5 sacral nerves (10 bilaterally) and all of them either had a cyst or was being compressed by a cyst from the nerve next to it. I had no idea it was that bad! They told me that I am on the extreme end of the spectrum due to the extent of the nerve compression, the length of time I've had symptoms, and the toll they have already taken on my health. They also found a tethered cord (fatty filium) and release that. Although rare, they normally find this at birth but in my case I acquired it when I fell in 2003. All these years it has been pulling on my spinal cord causing severe pain.

This may be too much info. for some but others will want to know these details because they are having similar issues. I'll just mention the main ones. So far my vaginal and rectal areas are totally numb, which makes wiping very interesting, but when I do wipe I get some pretty bad nerve pain. They said this is normal right after surgery but should get better over time. The bladder issues are a bit worse right now because sometimes I can tell I have to go and then other times I have no idea and it just happens. Same with the bowel issues. The tailbone area has a deep, nagging pain and then it spreads down my butt cheeks and down both legs. I can say that my hip pain and lower back pain has already improved about 65% though. I'm only 11 days out of surgery so I will have to wait and see what the symptoms are like as time goes on.

If anyone has any questions please PM me. I am not on here all the time but will check in here and there. Please give me time to respond to you.

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Profile picture for qball2019 @qball2019

My insurance co. finally approved my surgery thanks to Reta Honey Heiers from the Tarlov Cyst Disease Foundation http://www.tarlovcystfoundation.org She requested that a code specifically for Tarlov Cysts be added and has been fighting for it since 2016. On Oct. 1, 2020 it went into effect and that is the only reason my insurance co. approved my surgery. I had to call her directly and thank her for all her hard work. If anyone else is successful in getting their surgery approved due to the new ICD code please thank Reta at http://www.tarlovcystfoundation.org

I had the surgery on Dec. 8. 2020 by Dr. Frank Feigenbaum from Feigenbaum Neurosurgery - Tarlov Cyst Center in Dallas, TX. Dr. Feigenbaum is the leading expert in Tarlov Cysts/perineural cysts having done many more surgeries than anyone else. Anyone interested in this surgery must understand that the recovery period can be 2 years or more because nerves take a very long time to regenerate. Dr. Feigenbaum said it best in one of his videos I found on Youtube: He can treat the cysts but he cannot treat the nerves. You have to understand that recovery is different for all of us because we are all "wired" differently. If the cysts have been compressing your nerves for a long time like mine have you will need to accept that you may very well have permanent nerve damage to some extent. All I was able to do prior to surgery is lay on my couch 95% of every day because I was in so much pain.

Now, I have to admit that I'm still in a lot of pain and will have to take more pain medication for quite a while but knowing that the sacral nerves are no longer compressed making my symptoms worse gives me piece of mind. I had 5 cysts. They showed me on a model where each cysts was. There are 5 sacral nerves (10 bilaterally) and all of them either had a cyst or was being compressed by a cyst from the nerve next to it. I had no idea it was that bad! They told me that I am on the extreme end of the spectrum due to the extent of the nerve compression, the length of time I've had symptoms, and the toll they have already taken on my health. They also found a tethered cord (fatty filium) and release that. Although rare, they normally find this at birth but in my case I acquired it when I fell in 2003. All these years it has been pulling on my spinal cord causing severe pain.

This may be too much info. for some but others will want to know these details because they are having similar issues. I'll just mention the main ones. So far my vaginal and rectal areas are totally numb, which makes wiping very interesting, but when I do wipe I get some pretty bad nerve pain. They said this is normal right after surgery but should get better over time. The bladder issues are a bit worse right now because sometimes I can tell I have to go and then other times I have no idea and it just happens. Same with the bowel issues. The tailbone area has a deep, nagging pain and then it spreads down my butt cheeks and down both legs. I can say that my hip pain and lower back pain has already improved about 65% though. I'm only 11 days out of surgery so I will have to wait and see what the symptoms are like as time goes on.

If anyone has any questions please PM me. I am not on here all the time but will check in here and there. Please give me time to respond to you.

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Wow! Best of luck in your very involved recovery! I am glad you are getting pain meds to help you!

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Hi everyone. I posted back in 2019 re: my daughter's diagnosis of TC. She had surgery with Dr. Rudolph Schrot in July 2019 and seems to be doing well 1-1/2 years later. Feel free to contact me if you would like any information. It was a rather long odyssey, including a very deflating experience with a neurosurgeon at the Rochester Mayo (this doctor had successfully treated at least one TC patient maybe a decade ago at another well known medical institution). However, I understand from another TC mom that this doctor's colleague, Dr. Michelle Clarke, is sympathetic and willing to look into treatment options if you are headed to the Mayo in Minnesota. Also, in addition to the organization headed by Rita Honey Hiers, there are good Facebook support info where I found the bulk of the resources needed. I remain active on these sites and it's amazing how much has changed in just over two years... there are more and more doctors that recognize this condition... but you have to consult the right ones. And in our case, lots of prayer. I attribute my daughter's recovery to Jehovah God, Dr. Rudolph Schrot, and the good people on the FaceBook support sites. Best to you all as you navigate this tricky condition.

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Profile picture for qball2019 @qball2019

My insurance co. finally approved my surgery thanks to Reta Honey Heiers from the Tarlov Cyst Disease Foundation http://www.tarlovcystfoundation.org She requested that a code specifically for Tarlov Cysts be added and has been fighting for it since 2016. On Oct. 1, 2020 it went into effect and that is the only reason my insurance co. approved my surgery. I had to call her directly and thank her for all her hard work. If anyone else is successful in getting their surgery approved due to the new ICD code please thank Reta at http://www.tarlovcystfoundation.org

I had the surgery on Dec. 8. 2020 by Dr. Frank Feigenbaum from Feigenbaum Neurosurgery - Tarlov Cyst Center in Dallas, TX. Dr. Feigenbaum is the leading expert in Tarlov Cysts/perineural cysts having done many more surgeries than anyone else. Anyone interested in this surgery must understand that the recovery period can be 2 years or more because nerves take a very long time to regenerate. Dr. Feigenbaum said it best in one of his videos I found on Youtube: He can treat the cysts but he cannot treat the nerves. You have to understand that recovery is different for all of us because we are all "wired" differently. If the cysts have been compressing your nerves for a long time like mine have you will need to accept that you may very well have permanent nerve damage to some extent. All I was able to do prior to surgery is lay on my couch 95% of every day because I was in so much pain.

Now, I have to admit that I'm still in a lot of pain and will have to take more pain medication for quite a while but knowing that the sacral nerves are no longer compressed making my symptoms worse gives me piece of mind. I had 5 cysts. They showed me on a model where each cysts was. There are 5 sacral nerves (10 bilaterally) and all of them either had a cyst or was being compressed by a cyst from the nerve next to it. I had no idea it was that bad! They told me that I am on the extreme end of the spectrum due to the extent of the nerve compression, the length of time I've had symptoms, and the toll they have already taken on my health. They also found a tethered cord (fatty filium) and release that. Although rare, they normally find this at birth but in my case I acquired it when I fell in 2003. All these years it has been pulling on my spinal cord causing severe pain.

This may be too much info. for some but others will want to know these details because they are having similar issues. I'll just mention the main ones. So far my vaginal and rectal areas are totally numb, which makes wiping very interesting, but when I do wipe I get some pretty bad nerve pain. They said this is normal right after surgery but should get better over time. The bladder issues are a bit worse right now because sometimes I can tell I have to go and then other times I have no idea and it just happens. Same with the bowel issues. The tailbone area has a deep, nagging pain and then it spreads down my butt cheeks and down both legs. I can say that my hip pain and lower back pain has already improved about 65% though. I'm only 11 days out of surgery so I will have to wait and see what the symptoms are like as time goes on.

If anyone has any questions please PM me. I am not on here all the time but will check in here and there. Please give me time to respond to you.

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Hey there. so glad rita did that. I just love that chick. She fights more for patients than most doctors do. I am hoping you might be able to help me out. Or anyone else who reads this, for that matter. I have a very unique situation, so please try to refrain from comments that might freak me out. This will makes sense when you read this. I have one TC, right, S2. I found it after I read my MRI image that was given to assess pelvic floor function after two GIs over prescribed laxatives for almost 2 years. As you can guess, this is all bowel related and it began after I witness the las Vegas shooting in 2017. I had moved to las Vegas 4 hours before the Mandalay bay shooting and had moved from an abusive situation so I was already a mess. This added stress led to constipation. I have a history of constipation when stressed and moving, plus my bowels were never clinically normal. Meaning, I would go every 2 days. I never had an issue and life was great. I went to a UC health facility that claimed to be #1. They were not. For two years now, daily, second to second I am suffering greatly. I don't have an urge to have a BM at all on my own. I was told to induce diarrhea daily, clean out my colon using fleet saline enemas and mirlalx preps (8 caps every three days to wash out) this is what led to the MRI pelvic assessment, which is where the TC was discovered. Like you, I went on YouTube, found Dr. Feigenbaum, and finally flew to Dallas the week you were having surgery. Due to my unique and complex case, its unclear if the cysts are the issue or not. To date, I suffer so much with discomfort and my main stepmoms are the lack of BM, the lack of urgency to go. What makes this complicated and hard to distinguish the pathology is the fact I have been dependent on cathartics to have a BM. In short, I have not had a solid stool in over a year. I was told to drink the preps until I force it out via fluid. This also increased daily vomiting and I gained 30 pounds in less than a year. However, I know bowel dysfunction is a symptom of S2 compression and is common with TC sufferers. I don't know if my issues are related to the cyst or what has occurred with my entire GI. As it was explained to me, the anal internal spinchters don't relax, therefore, you do not go OR you go and do not know it. Its clear that I have more issues going on here. He didn't say I need surgery ASAP. He did say that, of course, the cyst wont go away, that he can off pressure but not cure the nerves (if damage has occurred). I really like this Dr and love that is honest, to the point and consistent. With that said, my symptoms are day to day and each day I don't have a BM it causes anxiety and panic attacks, knowing in three days I have to another bottle of mirlalx. I hate this. When you, or others who might read this, say they also constipation issues, do my symptoms sound TC related? This seemed to get worse the more I was told to increase the laxatives and use more enemas. FYI, TC dilate in response to an increase in intra-abdominal pressure. This was the case with me.
1. lack or urgency to go (I use enemas daily so that might explain this in part. the rectum is absent of enough stool to activate the stretch receptors, which initiate the urge to go).
2. I have a ton of bloating and trapped gas on my descending colon. Again, the pelvic nerves S234, innervate the left side. with that said, I am not sure if the TC is responsible, even in part, for this.
3. When I do go by getting an urge, its still very very thin, but this could also be due to the lack of bulk or meals and the motegrity. Has anyone else experienced this (in a way, I hope not!). Thank you again! Hope you recover well. Its only been a month for you so hang in there.

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@cookiegirl

Just wondering if you have gotten any help and where you're sitting with your Tarlov cyst right now. I got help and am willing to share the info. I have if you are interested.

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@cookiegirl

I am not on here all the time. I check in periodically so I may not get back to you right away.

If anyone else still needs help or would like some info. please feel free to contact me via PM

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Hi Jennifer. I realize this is an old post. I too Have Tarlov Cyst at S2 and S3. Have you had surgery yet? I am Awaiting consult with Dr F out of Dallas. I dont Think anyone at Mayo truly acknowledges them as symptomatic or operates on them. I have Ruled out every possible thing leaving only the Tarlov Cyst. The vaginal pain is debilitating.

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Profile picture for rkbunn @rkbunn

Hi Jennifer. I realize this is an old post. I too Have Tarlov Cyst at S2 and S3. Have you had surgery yet? I am Awaiting consult with Dr F out of Dallas. I dont Think anyone at Mayo truly acknowledges them as symptomatic or operates on them. I have Ruled out every possible thing leaving only the Tarlov Cyst. The vaginal pain is debilitating.

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@rkbunn hello! I see that you have interest in connecting with Jennifer, so wanted to show you a tip for flagging that member of your interest. If you use their handle, in Jennifer's case it is @jenapower. If you use that and if that member is receiving alerts, they will be sent an alert to flag them. I hope that helps bring Jennifer back in to continue your discussion.

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Profile picture for qball2019 @qball2019

@cookiegirl
I have been fighting these symptoms for 15 years and it wasn't until June 2018 when something triggered the cysts to compress nerves and kick into high gear. I researched for the best neurosurgeon that specializes in Tarlov cysts and went to see him. Looking back he could see that the cysts appeared on the very first MRI after my accident. They were ignored all these years because they are an "incidental finding". After having to learn about the healthcare system the hard way over the years I have a few pointers for you. I hope that you don't have to go through what I've been through!

Make sure you tell the radiology tech more about the cysts and what kind of symptoms you are experiencing. Tell them that you want ALL findings, including the incidental ones documented on the report. It's a crap shoot as to whether they decide to note the cysts. Some do & some don't. Giving them all the info. you can will definitely help in the outcome of most testing. This goes for all tests you are sent for.

You are your own best advocate. Don't settle for unanswered or ignored questions, concerns, symptoms, etc. Don't settle for doctors that refuse to acknowledge the cysts (most of them won't). I've read that Tarlov cysts are merely just mentioned in medical school and skipped over so most doctors don't know anything about them. They figure if the cysts could cause issues they would have learned about them. Don't just see doctors, also see physical therapists, and integrative/holistic providers as well. Explore all your options.

The most helpful website is https://www.tarlovcystfoundation.org/. The best neurosurgeon that specializes in Tarlov cysts is Dr. Frank Feigenbaum in Dallas,TX. It's worth the trip, trust me! I wish you the best of luck and if have any questions I'll answer to the best of my ability.

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Did you have surgery for your TCs? I have them, and was going to get a consult with Dr. F before the COVID shutdown, but have delayed starting with him due to pandemic.

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