I had a MRI done on my back, and I need help to understand the impression reading.?

Question

Impression Reading is: Suspected small shallow free disc hernitation on the right at L-3-4 extending posterior to the L3 vertebral body causing mild right neural foraminal narrowing of uncertain clinical consequence. Disc desiccation most pronounced at L-2-3 and L5-S1. Tarlov cysts at the S1 and S2 levels of doubtful consequence. I am really disappointed in my Md because he did not go over any of this with me, his nurse just called and said I need to be referred to a back doctor. I am also a nurse and wonder if I need to see a neurosurgen instead? Please help me>

Answer 1

After reading the article given below on Tarlov cyst you might see a neurologist or neurosurgeon for a second opinion:

The etiology of perineural sacral cysts (Tarlov's cysts) is not well-understood. The best description is that they are a dilatation of arachnoid and dura of spinal posterior nerveroot sheath, containing nerve fibers. They are most commonly diagnosed on MRI. These lesions have been estimated to affect 4.6 percent to 9 percent of the adult population1 and are generally reported as incidental findings on CT or MR studies. It was originally thought that all Tarlov cysts were asymptomatic, but a small percentage can cause progressive painful radiculopathy. The statistical data are very inconsistent; I have seen reports of as high as one-fifth of Tarlov's cysts causing some symptoms.2

These cysts can occur anywhere in the spine, but the most common areas affected are the S-2 and S-3 nerve roots. Sacral cysts have been reported to cause sacral radiculopathy, hip, leg or foot pain, perineal pain, paresthesias, and bowel or bladder dysfunction. Symptoms can mimic a disc herniation.

There are many variations of Tarlov cysts. Some can become quite large - up to 6 cm. They can be multiple. As you might suspect, there is some confusion over the precise definition of Tarlov cysts and how they are different from other spinal cysts. The distinctive feature of the Tarlov perineurial cyst is the presence of spinal nerve root fibers within the cyst wall or cyst cavity itself.
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The nomenclature becomes daunting because the etiology of this lesion is still not agreed upon and unfortunately, there is no consensus on the optimal management of symptomatic Tarlov cysts. The good news is that most remain asymptomatic.

Treatment recommendations for symptomatic Tarlov cysts vary widely depending on the symptoms. They can be drained of CSF; in fact, draining the CSF also can be a useful diagnostic tool to determine if symptoms are indeed due to the Tarlov cyst. There are two ways of draining these cysts: one is via a lumboperitoneal shunt; the other is percutaneous drainage. Unfortunately, the cysts re-form over time with percutaneous aspiration.

Surgical treatment involves complete cyst removal and excision of the affected posterior root and ganglion. As you can imagine, there are several ways of doing this complete excision, which I will not describe here.

When I chose this topic to report upon, I didn't realize that there is an evolving specialty for treating these cysts. The classification and treatment procedures are evolving; therefore, I refer you to www.tarlovcyst.net for updated information.3

Unfortunately, there is no consensus yet as to the best way to manage these lesions. With improved imaging, these cystic lesions are becoming more apparent and most of the time they are considered incidental findings; the problem occurs when differentiating these cysts from other causes for the patient's symptoms, such as degenerative disc and joint disease.

It is interesting to note that even though the Tarlov cyst was described more than 60 years ago, we still have no agreement on the origin. They may be caused by inflammation, trauma or congenital weakness of the dura mater, combined with elevated CSF hydrostatic pressure. Regardless of the origin of the Tarlov cyst, treatment procedures are improving and most cases fortunately do not require any intervention.

Answer 2

I just saw my specialist last Wednesday about the same thing=he said that they cannot be operated on as you risk the chance of becoming paralyzed=I was told to do a lot of walking and exercises for the back