Tarlov Cyst Symptoms by Nerve Root: Understanding How Cyst Location Shapes Experience

Jul 20
3 min read

When it comes to understanding Tarlov Cyst Disease (TCD), one of the most critical—and frequently misunderstood—aspects is that symptoms vary depending on where along the spine the cysts develop. These fluid-filled sacs, also known as perineural cysts, form around the nerve roots and are most commonly found in the sacral spine (S1–S4), although they can appear at any level from the cervical to thoracic to lumbar regions.

Tarlov Cyst symptoms aren't random. They correspond to the specific nerve root being compressed or irritated. This means one patient may experience tailbone pain and pelvic dysfunction, while another may have leg weakness, numbness, or trouble walking. Understanding this connection is crucial for accurate diagnosis and effective care.

Below is a breakdown of Tarlov Cyst symptoms by nerve root, as supported by clinical literature and anatomical studies.

🔹 S2, S3, S4 – The Pelvic Zone

These nerve roots control pelvic organs, sexual function, bladder and bowel control, and perineal sensation.

Common symptoms include:

Pelvic pain, pressure, or instability
Pain in the vagina, penis, scrotum, or perineum
Pain during intercourse (dyspareunia)
Urinary symptoms: retention, urgency, frequency, hesitation, incontinence
Bowel dysfunction: constipation, diarrhea, cramps, urgency, incontinence
Genital paresthesias (burning, stabbing, or numbness)
Sexual dysfunction: erectile dysfunction, anorgasmia, retrograde ejaculation
Persistent Genital Arousal Disorder (PGAD), which has been associated with Tarlov cysts in some case reports

🧠 Why this happens: These nerve roots carry both motor and autonomic fibers, making them responsible for voluntary muscle control as well as involuntary organ functions.

🔹 S2 – Legs & Feet

S2 also contributes to sensory and motor control of the posteromedial thigh and plantar surface of the feet.

Symptoms may include:

Foot pain, tingling, or cramping
Atrophy of intrinsic foot muscles (if motor function is impaired)

🔹 L5 & S1 – Lower Back, Hips, Legs

These are major nerves for leg movement, sensation, and posture.

Common symptoms include:

Lower back and sacral pain
Pain or numbness in hips, legs, or feet (often sciatic-like)
Piriformis muscle pain
Leg weakness or cramping
Walking difficulty, especially uphill (neurogenic claudication)
Weakness in:
- Foot dorsiflexion (L5 – difficulty lifting toes; possible foot drop)
- Foot plantarflexion (S1 – difficulty pushing off with toes)

🔹 L1–L4 – Upper Legs & Hips

Involves hip flexors and knee extensors.

Symptoms may include:

Pain, tingling, or burning in the upper legs
Hip instability or knee weakness

🔹 Thoracic Nerves – Upper Back & Ribs

Less commonly affected, but when involved, can produce:

Symptoms:

Pain or burning in the upper back
Rib cage pain (intercostal neuralgia)

🔹 Cervical Nerves – Neck, Arms, Hands

Cysts in the cervical spine are rare but documented.

Symptoms include:

Pain in the neck, trapezius, or shoulders
Numbness or tingling in the arms or hands
Grip weakness or loss of fine motor control

🔹 Brain-Related Symptoms

Tarlov Cysts themselves do not form in the brain—but if they cause cerebrospinal fluid (CSF) pressure imbalances, patients may experience:

Symptoms:

Pressure headaches
Migraines that worsen when standing or sitting upright
Symptoms of intracranial hypertension or CSF leaks

How to Use This Information

If you’ve been diagnosed with Tarlov Cysts, or suspect your symptoms may be related to them, this kind of nerve-specific mapping can help you:

✅ Advocate for targeted imaging

✅ Push for a symptom-based diagnosis

✅ Understand which specialists might be most helpful

✅ Explain your symptoms with anatomical precision

🔍 Diagnostic Resource

Want to know how doctors determine if a cyst is symptomatic? Visit our Get Support section to download the Tarlov Cyst Disease Diagnostics Poster—an evidence-based visual tool to take to your medical appointments.

The location of your Tarlov cysts matters. The symptoms you feel aren’t “mysterious” or psychological—they’re neurological, anatomical, and real. At the Tarlov Cyst Society, we’re committed to simplifying the science, spreading accurate information, and helping patients speak the language of their own bodies.

Have these symptoms? 📩 Email us your story at: info@tarlovcystsociety.com

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