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. --- SYNPOSIS 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