Tarlov Cyst Surgery

Tarlov cyst surgery is an operation to treat fluid‑filled sacs that form around nerve roots, usually in the lower spine (sacrum). Think of the nerve like a cable and the cyst like a balloon that has bulged out from its covering. If that balloon gets big or tense, it can press on nearby nerves and tissues, causing buttock or leg pain, numbness, or problems sitting for long.

A neurosurgeon plans the surgery using MRI and other tests to confirm the cyst is actually causing your symptoms. In the operating room, the goal is to reduce pressure and protect the nerve. Depending on the cyst and anatomy, the surgeon may carefully open the covering of bone to reach the cyst, drain the built‑up fluid, and then reinforce the area so it doesn’t immediately refill.

Techniques can include

• fenestration (creating a controlled opening),
• imbrication (folding and stitching the cyst wall),
• sealing small leaks with microsurgical sutures or special sealants, and
• adding a small patch to strengthen the nerve covering.

The idea is simple: decompress the irritated nerve and stabilize the cyst’s weak spot so signals travel normally and sitting, standing, and walking feel more comfortable.

Shorter wait times

• Public queues for consults, MRI, and OR time can be long. Private centres can coordinate assessment and surgery within weeks—reducing time spent with sit‑pain, leg symptoms, and sleep disruption.

Choice and control

• Choose a neurosurgeon who itemizes experience with Tarlov cysts (fenestration, imbrication, sealing, CSF management).
• Select clinic location (often out‑of‑province) and schedule around exams, work, caregiving, or sport seasons.
• Get a clear, personalized plan: imaging correlation, targeted cyst levels, and technique selection.

Peace of mind

• You know who will operate, the date, and the approach. Direct communication and predictable timelines make it easier to arrange travel, time off, and physiotherapy.

Preventing further decline

• Function: Ongoing nerve irritation can worsen pain, numbness/tingling, or sitting tolerance.
• Complexity: Long‑standing cyst pressure can contribute to more inflammation/scar tissue, sometimes making later surgery tougher.
• Performance: Earlier relief protects fitness, mood, and sleep.

Integrated care

• Access to advanced imaging and microsurgical tools in accredited facilities, with teams experienced in CSF leak prevention and repair.
• Coordinated pathways (anesthesia, pain, physio) and virtual follow‑ups if you live far away.

1. ‍Confirm the diagnosis. Most patients start with a family doctor or specialist who confirms that surgery is advisable, but your neurosurgeon can also confirm if needed.
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2. Research. Explore surgeons who specialize in Tarlov cyst surgery.
   
   • You can find surgeon in Vancouver, British Columbia; Calgary, Alberta; Toronto, Ontario; and Montréal, Québec on our app, and review qualifications, as well as pricing.
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3. ‍Schedule an initial consultation. Most neurosurgeons offer in-clinic and online consults.
   
   • Consultations are usually booked within days or a few weeks.
   • Note: expect a consultation fee between $150 - $350.
   • We recommend scheduling at least 2-4 consults with different surgeons.
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4. ‍Consultation. The surgeon will review your condition, symptoms, and any previous treatments or diagnostics, such as x-rays or MRIs.
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5. ‍Post consultation. The surgeon will then review your case and provide surgical options based on your needs; review the risks and expected outcomes; and present pricing and scheduling options.
   
   • Because the procedure is not covered by your provincial health plan when done privately, you’ll need to review the quoted cost and consider payment options (out-of-pocket, private insurance, or financing).
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6. ‍Schedule your surgery date. Once you confirm the procedure and payment, the clinic will schedule your surgery—generally within a few weeks.
   
   • Plan for travel and accommodation, since the surgery will likely take place outside your home province.
   • Expect pre-surgery preparation, and possibly some pre-surgery tests.

Typical single‑level Tarlov cyst surgery takes about 2–4 hours of operating time. Add extra hours at the centre for check‑in, anaesthesia, and recovery. Complex or multi‑cyst cases can take longer and may include an overnight stay.

Basic steps (what actually happens)

Check‑in and marking

• You meet the team, review the plan, and confirm the exact spinal level(s). The skin is marked.

Anaesthesia

• General anaesthesia (you’re fully asleep). Monitors are placed; imaging (X‑ray/fluoro) is set up to confirm the level.

Position and prep

• You’re positioned face‑down on padded supports. The back is cleaned and covered with sterile drapes.

Small incision and exposure

• A focused incision is made over the sacrum/lower spine. Muscles are gently moved aside to reach the bone.

Open a window in the bone

• The surgeon removes a small section of bone (laminotomy/laminectomy) to see the cyst and nearby nerve root.

Identify and protect the nerve

• Under the microscope, the nerve root and cyst are carefully separated. The goal is to decompress the nerve without injuring it.

Treat the cyst

• The cyst is opened and drained (fenestration). The wall may be folded and stitched (imbrication), and tiny leaks are sealed with fine sutures or sealants. A patch (dural graft) can reinforce the weak area if needed.

Rinse and check

• Everything is irrigated. The surgeon confirms the nerve is free and there’s no ongoing leak.

Close up

• Layers are closed with sutures; a dressing is applied. A small drain may be used in some cases.

Wake‑up and instructions

• You recover in post-anaesthesia care unit, review early walking and wound‑care instructions, and either go home the same day or stay overnight based on your case and your surgeon’s protocol.

Every spine is different—follow your surgeon’s plan. Steady, smart progress beats pushing too hard.

In general, what to expect

Week 1

• Reality check: soreness at the lower back/buttock, muscle spasms, tiredness. Sitting may be the hardest.
• Goals: control pain and swelling, protect the area, and walk safely.
• Activities: short, frequent walks in your home; keep the dressing clean/dry; log‑roll to get in/out of bed; avoid BLT (bending, lifting, twisting). A drain (if used) is removed per your team’s timing.

Weeks 2–4

• Still annoying but improving.
• Goals: build a walking habit and calm nerve irritation.
• Activities: daily walks increasing time/distance; gentle nerve‑calming positions; basic stretches for hips/hamstrings (as cleared). Stitches/staples removed if needed. Gradually test short, supported sits; change positions often.

Weeks 5–8

• The work phase.
• Goals: better endurance and posture without stressing the sacrum.
• Activities: longer walks; upright stationary bike if cleared; gentle hip/glute strengthening; core activation in neutral (no crunches). Keep objects close to your body; avoid heavy lifting or twisting.

Weeks 9–12

• Confidence building.
• Goals: near‑normal daily activity with fewer nerve symptoms.
• Activities: progress lower‑body and core work; light upper‑body exercises kept close; low‑impact cardio. Many people tolerate longer sits with planned breaks.

Months 3–6

• Back to most normal life.
• Goals: routine tasks at school/work; sport/work‑specific training if approved.
• Activities: add impact/rotation only with explicit clearance. Keep spine‑smart habits (hip hinge, neutral spine, frequent movement breaks).

Helpful tips

• Sit‑smart: start with short, cushioned sits; use a coccyx/sacral cut‑out cushion if recommended; stand/walk every 20–30 minutes.
• Walk often: safest way to boost circulation and reduce stiffness.
• Bowel plan: pain meds can constipate—hydrate, add fibre, and use stool softeners as advised.
• Brace: wear exactly as prescribed (if you were given one).

Red flags—call your care team

• Fever, spreading redness, or foul drainage from the incision
• New/worsening leg pain, numbness, or weakness
• Loss of bladder/bowel control
• Painful, swollen calf; chest pain or shortness of breath

Exact prices vary with cyst size/number, level(s), technique (fenestration, imbrication, graft/sealant), and whether you need an overnight stay. Always ask for a written, itemized quote.

In Canada, private clinics charge between: $25,000 to $80,000+.

In the United States, you can expect to pay CA$80,000+.

What’s usually included

• Surgeon fee and anaesthesia services
• Accredited facility/OR time, nursing, and standard disposables
• Basic intra‑op imaging (fluoroscopy) and routine microsurgical instruments
• Immediate recovery room (PACU) care
• Early follow‑up visit(s) within the clinic’s “global” period

What’s often not included

• Initial consults and pre‑op imaging/labs done outside the clinic (MRI/CT, X‑rays, bloodwork)
• Advanced add‑ons: microsurgical dural grafts/patches, sealants, fibrin glue, extensive neuromonitoring, or navigation—unless explicitly bundled
• Extra OR time for additional cysts/levels or unexpected findings
• Overnight admission or extra hospital days if same‑day discharge isn’t possible
• Prescription medications after discharge (pain, nausea, stool softeners)
• Post‑op physiotherapy beyond the first visit(s); special cushions/braces if recommended
• Travel and accommodation if surgery is out‑of‑province/state

Tip to compare quotes

• Ask if the price is a “global” bundle and request line items: surgeon, facility, anaesthesia, imaging, neuromonitoring/navigation, grafts/sealants, follow‑ups, and what triggers extra charges (e.g., treating an additional cyst).

Choosing your surgeon is a major benefit of pursuing private surgery, here's how to choose wisely.

What to look for

Experience and volume

• Ask how many Tarlov (perineural) cyst surgeries they perform per year and their case mix (fenestration, imbrication, cyst wall repair, fibrin‑glue sealing, CSF‑leak repair). Higher volume and standardized pathways usually mean smoother care.

Credentials and training

• Verify licensure with your provincial college (CPSO Ontario, CPSBC BC, CPSA Alberta, CMQ Québec, etc.).
• Prefer FRCSC‑certified neurosurgeons with fellowship training in spine/peripheral nerve and specific Tarlov cyst experience.

Outcomes and safety

• Request recent data: infection rate, CSF‑leak/dural tear rate, unplanned return to the OR (30–90 days), readmissions, new/worsened nerve symptoms, and re‑operation for recurrence.
• Ask for patient‑reported outcomes (pain sitting, leg pain, disability scores) at 3, 6, and 12 months.

Indications and alternatives

• Ensure your symptoms match imaging and that non‑operative options were considered (guided injections/blocks, activity modification, meds/physio). Clear indications = better expectations.

Surgical plan and techniques

• Which cyst(s) and level(s) will be treated? Plan for fenestration vs imbrication vs patching; how they handle fragile nerve rootlets inside the cyst.
• How they minimize bone removal, protect nerve roots, and manage CSF pressure (intra‑op sealing strategies, grafts/patches).

Imaging and planning

• MRI with and without contrast; sometimes CT myelogram to confirm CSF connection. Ask how imaging guides the exact approach.

Facility accreditation

• Choose an accredited centre (Accreditation Canada/CAAASF) with microsurgical tools, neuromonitoring if used, and a clear hospital transfer agreement.

Rehab integration

• Written, phased recovery plan (walking, sitting limits, return to desk/manual work).
• Coordination with a local physiotherapist; direct post‑op contact and clear red‑flag instructions.

Transparent pricing

• Ask for an itemized quote: surgeon, facility, anaesthesia, imaging, grafts/patches/sealants, neuromonitoring, and follow‑ups. Clarify what triggers extra charges.

Questions to ask at your Tarlov cyst consultation

Surgeon and plan

• How many Tarlov cyst surgeries do you perform yearly, and how many like mine (level/size/number)?
• What are your last 12–24 month rates for CSF leak, infection, nerve complications, readmission, and re‑operation?

Technique and safety

• Will you do fenestration, imbrication, sealing, and/or a dural patch? Why that choice for me?
• How do you protect nerve rootlets inside the cyst? Do you use a microscope and neuromonitoring?
• How do you confirm the correct level and ensure a durable seal?

Recovery and after‑care

• What are my early sitting/walking limits? When can I return to desk vs manual work?
• Do you provide a written recovery plan and coordinate with my local physio?
• Who is my post‑op contact? How many follow‑ups are included? Can some be virtual?

Costs and logistics (if private)

• What exactly is included in my quote (surgeon, facility, anaesthesia, grafts/sealants, neuromonitoring, imaging, follow‑ups)?
• What could add cost (treating more cysts/levels, longer OR time, overnight stay)?
• Do you have a hospital transfer pathway if needed?

Signals of a high‑quality program

• Shares outcomes and complication rates openly.
• Provides an itemized, transparent quote with what’s included/excluded.
• Operates in accredited facilities with modern microscopes and microsurgical instruments.
• Gives a clear, written recovery plan, coordinates with local physio, and offers responsive communication with direct contact details.