The incidence of Tarlov cysts is 5-9% and most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are believed to be extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. However, in the Tarlov community we have found that TCD is extremely under diagnosed because radiologists report them as incidental findings and doctors ignore them as a possible source of pain. Because of this patients may go years or even decades without a diagnosis or treatment leading to permanent nerve damage, opioid addiction and severe depression!