Review of mychrio.com and AI Summary

I want to begin by saying thank you to the creators of the mychiro Tarlov Cyst information page, from myself and from the community. I appreciate the efforts of the staff at mychiro.com to educate patients and colleagues on Tarlov Cyst Disease. And overall, I found this to be a very informative website.

My most critical warning to readers would be to focus on the medical information and ignore the under-reporting error that the first paragraph of their website perpetuates. This is what I have called I have called "The 1% Error", and it is so common, that I will be creating a full page dedicated to this "1% Error" Very soon. As this is one of my first blog posts after creating TarlovCyst.org, I'm going to cover it pretty extensively here.

But I do not want to discourage readers from visiting mychiro's Tarlov Cyst page for it's educational value, so I'm going to include a link here to jump to the part of this review more specific to mychiro.

The "1% Error"

This is a common error of data misinterpretation that came from the Lucantoni, et. Al study "Tarlov cysts: a controversial lesion of the sacral spine." Journal of Neurosurgery (Lucantoni C, Than KD, Wang AC, et al: Neurosurgical Focus 31 (6):E14, December 2011).

It was addressed in a Letter to the Editor by Dr. Anne-Louise Oaklander, in which two of the authors confirmed that according to the data used in their study, 15.6% of cysts were found to be symptomatic. The "1% Error" came about from people reading the two statistics incorrectly. 4% to 9% of people in the study group had Tarlov Cysts, and 1% were symptomatic. That was 1% of the group...not 1% of the patients with cysts.

As Dr. Than and Dr. Park wrote in response to Dr. Oaklander's Letter to the Editor:

• "Dr. Oaklander also asserts that we “err in reporting the proportion of TCs that are symptomatic as approximately 1%,” perhaps because we “used the number of patients undergoing lumbosacral MRI as the comparator rather than the total number of patients with TCs.” This was not an error. It is clear from Table 3 how the value was obtained. In our paper we state that “the reported incidence of symptomatic TCs is approximately 1% or less.” We intended this to refer to the likely incidence of symptomatic TC in the general population (Column 4 in Table 3 of our paper), and we apologize for any confusion our wording may have caused. We agree that the percentage of TCs that are symptomatic is > 1%, which can be determined in Table 3. Based on the studies that mentioned the number of symptomatic versus asymptomatic TCs, out of 77 patients with TCs, 12 (15.6%) were symptomatic.2,3"

This error has none-the-less persisted for more than a decade...that only 1% of the cysts are symptomatic, when in fact the data shows that 1% of the population likely has symptomatic Tarlov Cysts.

This is the difference between 3.4 million people with symptomatic Tarlov Cysts, or only 138,910 at 1% of 4% of cysts. And Globally, this is the difference between 80 million people with symptomatic Tarlov Cysts or only 3.2 million. Either way, the personal suffering is intolerable. But educating health care providers must begin with eliminating this prejudice that Tarlov Cysts are rarely symptomatic. The actual measured prevalence in more recent studies is between 15% to 20% of Tarlov Cysts are symptomatic, with 1% of the population predicted to be symptomatic overall.

mychiro.com's Tarlov Cyst Information page:

"Research suggests that up to 98% of Tarlov cysts remain asymptomatic and do not directly cause discomfort. However, in cases where they expand and exert pressure on surrounding structures, they may contribute to neurological symptoms such as:

• Numbness or tingling in the lower body

• Discomfort that worsens with prolonged sitting or standing

• Weakness in the legs or pelvic region"

For the letter and response from Dr. Park and Dr. Than, you can find the original with links to the original article here: Letter to the Editor: Tarlov cysts in: Neurosurgical Focus Volume 32 Issue 4 (2012) Journals

Aside from perpetuating the 1% error, mychiro then goes into agood overall explanation of Tarlov Cyst Disease, with an excellent sampling of images that would make a solid introduction for medical professionals as a starting point to learn about Tarlov Cyst Disease, how to identify it on patients' MRIs (especially when it is not often included in MRI written reports.)

The MRI portion shows some very clear imaging of large cysts, but could benefit from more clear imaging of small to mid-sized Tarlov Cysts impacting adjacent nerve roots. These smaller cysts are often overlooked, but frequently more symptomatic even compared to much larger cysts because they put higher pressure on a small section of the nerve root, thus frequently causing symptoms. The principle is simple but often overlooked in diagnostics...smaller, harder cysts may exert more pressure per square centimeter on a particular point of a nerve root; while larger, softer cysts distribute the pressure more evenly, resulting in some cases in lesser symptoms for larger cysts. This seems counter-intuitive, but is increasingly being confirmed with more recent studies.

The Coronal Sacral imaging that is usually encoded as a "Pelvic MRI" are also good for training...particularly with because nerve compression can be more clearly seen for nerve roots inside the sacrum where a smaller to mid-sized cyst is directly compressing adjacent nerve roots.

While the page shows that it has been updated as recently as 2025, the bibliography does not include much research within the last ten years. Perhaps a quick review and update by the authors could correct these few misconceptions. But otherwise, I greatly appreciate the time and effort that they have put into creating what is otherwise a very nice introduction to Tarlov Cyst Disease, and a well-appreciated plea to other health care providers to acknowledge the very real and unique needs of patients with Tarlov Cyst Disease in all fields of medical practice.

Just being acknowledged by our chiropractors, physical therapists, and other health care professionals is a critical step towards our recovery; and chirophractic care has been a benefit to many Tarlov Cyst patients. But there are also unique risk factors that must be taken into consideration when manipulating our spines.

It is good to see the chiropractic community engaging in the process of education, advocacy and support for people with Tarlov Cyst Disease.

My heartfelt thanks for your efforts to help both your patients and your colleagues better understand our disease.

Bibliography of sources from mychiro.com:
"Yama Zafer, D.C. – Tarlov Cyst: Causes, Types & Non-Invasive Care." Yama Zafer, D.C., with an educational background in physiotherapy and chiropractic from Cleveland Chiropractic University in Kansas City, has spent nearly three decades in physiotherapy and chiropractic; read more about Y. Zafer on his official bio page.

Peer-Reviewed Medical Citations (5–7, for footnote/reference section)

1. Paulsen RD, Call GA, Murtagh FR. Prevalence and percutaneous drainage of Tarlov cysts. AJNR Am J Neuroradiol. 1994.

2. Voyadzis JM, Bhargava P, Henderson FC. Tarlov cysts: a study of 10 cases. J Neurosurg Spine. 2001.

3. Langdown AJ, Grundy JR, Birch NC. The clinical relevance of Tarlov cysts. J Spinal Disord Tech. 2005.

4. Acosta FL, Quinones-Hinojosa A, Schmidt MH, et al. Diagnosis and management of sacral Tarlov cysts. Neurosurg Focus. 2003.

5. Kumar N, Sharma R, Tandon V, et al. Symptomatic sacral perineural cysts: fibrin glue therapy. Indian J Radiol Imaging. 2014.

6. Schreiber JJ, Hughes AP, Cammisa FP, et al. Symptomatic Tarlov cysts: pathogenesis and treatment. Neurosurg Focus. 2011.

7. Nabors MW, et al. Updated assessment and classification of spinal meningeal cysts. J Neurosurg. 1988.

Last Updated

Last updated on May 22, 2025: Tarlov Cyst Overview: Causes and Care Options

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