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BackTable / MSK / Podcast / Episode #74
Diagnosis & Treatment of Tarlov Cysts
with Dr. Kieran Murphy
Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine.
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BackTable, LLC (Producer). (2025, April 8). Ep. 74 – Diagnosis & Treatment of Tarlov Cysts [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Kieran Murphy
Dr. Kieran Murphy is a physician author and interventional neuroradiologist at Toronto Western Hospital in Toronto, Canada.
Dr. Jacob Fleming
Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.
Synopsis
Dr. Murphy highlights the high risk of depression and suicide among patients, who are often misdiagnosed and overprescribed ineffective pain medications. He explains how to identify and treat Tarlov cysts through aspiration and fibrin sealing, addresses the historical dismissal of their significance, and underscores the need for a better understanding of CSF leaks. Additionally, Dr. Murphy emphasizes the importance of institutional responsibility in occupational radiation safety for interventionalists, advocating for improved lead protection and antioxidant use to mitigate radiation damage. The episode concludes with a humbling reminder of the implicit biases present in medical practice and the ongoing need for more inclusive and attentive patient care.
Timestamps
00:00 - Introduction
01:24 - Challenges in Diagnosing and Treating Tarlov Cysts
04:05 - Patient Experiences and Misdiagnoses
06:06 - Cyst Aspiration Techniques
15:12 - Improved Diagnosis of CSF Abnormalities
22:10 - Allergic Reactions to Fibrin
25:30 - Implicit Bias in Medicine
34:50 - Radiation Safety in Radiology
43:47 - Final Thoughts and Reflections
Transcript Preview
Yes. I agree, and it can be difficult, especially in our position. Often we're being referred patients who've been seen by a lot of other physicians. For some reason, and I call it the black pearl, it's that, "Oh, this patient has fibromyalgia." They've been told that. We take whatever that proclamation is as the truth. We continue running with it. We have to have a discerning eye and think, "Is that really true? Is that the source of the problems?" I feel that these patients often end up in that situation, "Oh, yes, they have fibromyalgia. They have a Tarlov cyst, and it all relates to that." They need someone with the diagnostic acumen and ability to say, "Does this make sense?"
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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