Tarlov Cyst Research Library
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Clinical overview

How Tarlov Cysts Affect Your Nerves: Sensory and Motor Symptoms Explained

Spinal nerves are made up of two primary parts: a dorsal (posterior) root which carries sensory information from the body to the brain, and a ventral (anterior) root, which transmits motor signals to the muscles to enable movement. The two roots merge to form a mixed spinal nerve that facilitates both sensory input and motor output, allowing communication between the body and the central nervous system.

Tarlov Cysts (TCs) develop specifically within the protective sheath of the posterior nerve root, most frequently near the dorsal root ganglion (DRG). Because these cysts arise on the sensory root, the earliest and most common symptoms are sensory, such as debilitating pain, numbness, or tingling. Sensory fibers are particularly vulnerable to pressure because they are smaller and have a lower degree of myelination compared to motor fibers. Tarlov Cysts may compress the adjacent ventral (motor) root causing motor dysfunction such as muscle weakness, reflex loss, or involuntary loss of bowel and bladder control.

Tarlov Cysts of any size are capable of becoming symptomatic. Modern, specialized research now indicates that physical size is not the primary factor in determining symptoms. Intracystic pressure is a more critical driver of the nerve damage than the diameter of the cyst. This increased hydrostatic pressure within the cyst compresses and stretches the delicate nerve fibers within it, leading to nerve damage. Specialized neurophysiological testing (electromyography & nerve conduction studies) have documented that cysts as small as 6mm can cause significant nerve damage & debilitating symptoms.

Reported Tarlov Cyst Symptoms According To The Involved Nerve Roots

What are the symptoms of a Tarlov cyst on the S2, S3, and S4 nerve roots?

Nerve supply

  • Sensory: perineum, clitoris, penis, vagina, scrotum
  • Autonomic: detrusor muscle of the bladder, descending colon, transverse colon, rectum, internal urinary sphincter, internal anal sphincter
  • Motor: external urinary sphincter, external anal sphincter

Symptoms

  • Pelvic pain
  • Perineal pain and paresthesia
  • Vaginal pain; dyspareunia
  • Testicular or penile pain; prostate pain
  • Pelvic instability symptoms (in pregnancy)
  • Neurogenic bladder symptoms: urine retention, hesitation, Valsalva voiding, urinary frequency, urgency, painful bladder, urge incontinence, stress incontinence
  • Neurogenic bowel symptoms: constipation, alternating with diarrhea; intestinal cramps; defecation frequency; urgency; bloating; false defecation urge, fecal incontinence; stabbing pain; pressure or cramps in the anal sphincter
  • Erectile dysfunction; retrograde ejaculation
  • Female anorgasmia; persistent genital arousal disorder

What are the symptoms of a Tarlov cyst on the S2 nerve root?

Nerve supply

  • Sensory: perineum, posteromedial side of the legs, plantar region of the feet
  • Motor: intrinsic foot muscles

Symptoms

  • Pain, cramps and paresthesia in the feet
  • Atrophy of the intrinsic foot muscles due to compression of nerve root S2

What are the symptoms of a Tarlov cyst on the L5 and S1 nerve roots?

Nerve supply

  • Sensory: posterior side of the legs (S1), lateral side of the leg, first and fifth toe (L5), dorsal side of the feet
  • Motor: gluteus maximus muscle and calf muscles (S1), gluteus medius muscle and extensor muscles of the feet and toes (L5)

Symptoms

  • Lumbar and sacral pain
  • Pain in the piriformis muscle and trochanter region
  • Pain and/or paresthesia in the legs and feet
  • Leg cramps
  • Leg weakness
  • Neurogenic claudication: pain while walking, a significantly slower walking pace than before onset, increased pain when walking uphill
  • Weakness of dorsiflexion of the feet; rarely, foot drop (L5)
  • Weakness of plantar flexion of the feet (S1)

What are the symptoms of a Tarlov cyst on the L1 to L4 nerve roots?

Symptoms

  • Paresthesia and pain in the legs
  • Weakness of knee or hip extension

What are the symptoms of a Tarlov cyst on the dorsal nerves?

Symptoms

  • Paresthesia and pain in the upper back
  • Intercostal neuralgia

What are the symptoms of a cervical Tarlov cyst?

Symptoms

  • Cervical pain and pain in the trapezius muscles
  • Pain and paresthesia in the arms and hands

Can a Tarlov cyst cause headaches?

Symptoms

  • Headaches

Hulens M, Rasschaert R, Bruyninckx F, Dankaerts W, Stalmans I, De Mulder P, Vansant G. "Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review." Eur Spine J. 2019 Oct;28(10):2237-2248.