J Korean Orthop Assoc.  2019 Aug;54(4):361-365. 10.4055/jkoa.2019.54.4.361.

Cauda Equina Syndrome Occurred by Adhesive Arachnoiditis of the Lumbar Spine with an Unknown Cause

• Jeon HS
• Hwang SH
• Suh SP
• Kim JN

• KMID: 2455505
• DOI: http://doi.org/10.4055/jkoa.2019.54.4.361

Abstract

Spinal adhesive arachnoiditis is an inflammation and fibrosis of the subarachnoid space and pia mater caused by infection, trauma, spinal vascular anomalies, and iatrogenic (surgery and/or puncture). Adhesive arachnoiditis develops various symptoms and signs (gait disturbances, radiating pain, paralysis, and incontinence). On the other hand, adhesive arachnoiditis associated with cauda equina syndrome has not been reported in Korea until now. The authors experienced cauda equina syndrome caused by adhesive arachnoiditis of the lumbar spine with satisfactory results following decompression. We report this case with a review of the relevant literature.

Keyword

lumbar spine; arachnoiditis; cauda equina syndrome; decompression

MeSH Terms

Adhesives*
Arachnoid*
Arachnoiditis*
Cauda Equina*
Decompression
Fibrosis
Hand
Inflammation
Korea
Paralysis
Pia Mater
Polyradiculopathy*
Spine*
Subarachnoid Space
Adhesives

Figure

• 

  Figure 1 Preoperative magnetic resonance imagings (MRIs) show adhesive arachnoiditis. (A) Gadolinium-enhanced T1-weighted sagittal MRI shows dural enhancement from the L4–5 disc space level to the S2 level (arrow). (B) T2-weighted axial MRIs show clumping of the nerve roots (arrows).

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  Figure 2 Intraoperative photographs. (A) Fibrous tissue fragments removed from adhesive arachnoiditis. (B) Severe adhesion of the soft tissue and pale dura were resolved after decompression and laminectomy at the L5/S1/2 level.

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  Figure 3 Microscopic examination of dense fibrous tissue from adhesive arachnoiditis shows mild chronic inflammation with calcification (H&E, ×40).

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  Figure 4 One month later, follow-up magnetic resonance imagings (MRIs). (A) Gadolinium-enhanced T1-weighted sagittal MRI shows no more dural enhancement (arrows). (B) T2-weighted axial MRIs show resolved clumping nerve roots (arrows).

Reference

1. Whetstone KE, Crane DA. Cauda equina syndrome resulting from lumbar arachnoiditis after intracranial subarachnoid hemorrhage: a case report. PM R. 2013; 5:539–541.

2. Augustijn P, Vanneste J, Davies G. Chronic spinal arachnoiditis following intracranial subarachnoid haemorrhage. Clin Neurol Neurosurg. 1989; 91:347–350.

3. Faure A, Khalfallah M, Perrouin-Verbe B, et al. Arachnoiditis ossificans of the cauda equina. Case report and review of the literature. J Neurosurg. 2002; 97:239–243.

4. Quiles M, Marchisello PJ, Tsairis P. Lumbar adhesive arachnoiditis. Etiologic and pathologic aspects. Spine (Phila Pa 1976). 1978; 3:45–50.

5. Bourne IH. Lumbo-sacral adhesive arachnoiditis: a review. J R Soc Med. 1990; 83:262–265.

6. Bilgen IG, Yunten N, Ustun EE, Oksel F, Gumusdis G. Adhesive arachnoiditis causing cauda equina syndrome in ankylosing spondylitis: CT and MRI demonstration of dural calcification and a dorsal dural diverticulum. Neuroradiology. 1999; 41:508–511.

7. Delamarter RB, Ross JS, Masaryk TJ, Modic MT, Bohlman HH. Diagnosis of lumbar arachnoiditis by magnetic resonance imaging. Spine (Phila Pa 1976). 1990; 15:304–310.

8. Petty PG, Hudgson P, Hare WS. Symptomatic lumbar spinal arachnoiditis: fact or fallacy? J Clin Neurosci. 2000; 7:395–399.