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Abstract

Spinal adhesive arachnoiditis is a rare occurrence with a diverse etiology. The clinical picture is not universal, and varying degrees of neurodeficit have been mentioned. Spontaneous spinal cord herniation or idiopathic spinal cord herniation occurs due to displacement of the cord through a dural or arachnoid defect.

We report a case of a 29-year-old male paraplegic patient with a nontraumatic spinal cord injury (SCI) following surgery for an intradural extramedullary lesion at T10-T11 level who developed loss of truncal balance after two years of the index surgery. After a thorough clinical examination and MRI as well as other investigations, the patient was diagnosed as having spontaneous-onset delayed spinal arachnoiditis with dorsal cord herniation through the laminectomy window with effacement of neural tissue and ascending edema up to T6 level.

A new-onset weakness or the development of an ascending loss of sensory level with a loss of truncal balance should alarm the therapist about some new pathology happening at the cord level in patients with SCI. In this regard, spinal adhesive arachnoiditis with or without cord herniation should always be suspected in a paraplegic patient with delayed-onset deterioration of neurology. Differential diagnoses like arachnoid web and arachnoid cysts should also be kept in mind.

Introduction

Adhesive arachnoiditis of the spinal cord is a relatively rare entity but can cause a significant amount of distress to the patient. The understanding of its pathophysiology is still evolving, but the distinguishing features are the non-specific inflammation of the arachnoid, leading to adhesion and fibrosis around nerve roots and other neural elements [1]. Sequential aggregation of neural elements blocks the cerebrospinal fluid (CSF) and vascular flow, leading to clinical manifestations. The etiologies have been diverse, like idiopathic, iatrogenic, degenerative, infectious, traumatic, etc. [2, 3]. In the early literature, spinal arachnoiditis most commonly affected cervical and thoracic levels; most of them were post-infective (predominantly post-tubercular) [4]. Also, cases of contrast media used for myelography have been cited as a causative factor. Most recently, cases of lumbar arachnoiditis have been reported following epidural injections and lumbar spine surgery [4,5]. The clinical picture is not universal, and varying degrees of neurodeficit have been mentioned. An MRI with or without contrast is the gold standard imaging modality to detect arachnoiditis, but it lacks generalized, accepted consensus regarding the distinguishing features [6].

Spontaneous spinal cord herniation or idiopathic spinal cord herniation occurs due to displacement of the cord through a dural or arachnoid defect. Post-surgery cord herniation is a known occurrence, usually seen dorsally in the cervical spine after laminectomy. In the thoracic spine, the cord herniation is seen ventrally due to a dural defect that allows the communication of subarachnoid space with extradural space. Normal thoracic kyphosis allows very close contact of the thoracic cord with the ventral dura, allowing cord herniation ventrally [7].

We report a case of spontaneous-onset delayed spinal adhesive arachnoiditis with dorsal cord herniation through the laminectomy window in a 29-year-old male paraplegic patient in whom arachnoiditis developed two years after thoracic spine surgery.

Case Presentation

A 29-year-old male patient was operated on elsewhere for an intradural extramedullary lesion two years ago. Midline laminectomy from T9 to T12 was done as...(More)

For more info please read, Spontaneous-Onset Delayed Spinal Arachnoiditis With Dorsal Cord Herniation in a 29-Year-Old Paraplegic Patient: A Case Report, by Cureus