Devoted to diagnostic and interventional spine imaging and therapeutics

Library

Radiological Features Of Severe Adhesive Arachnoiditis 2013

Category General Spine Yasmin Koohi, M.D.
Sugoto Mukherjee, M.D.
Purpose To describe imaging findings on MRI of severe adhesive arachnoiditis, utilizing a case from our institution. Etiology in this case was premumed to be post-traumatic. Materials & Methods Utilizing the electronic medical record, the patient's clinical history was reviewed. Additionally, all of the available imaging studies, including MRI cervical, thoracic and lumbar spine, were reviewed on PACS. Results The patient is a middle-aged female with reported history of lumbar surgery in 1998 and 1999. She did well after surgery, until she was involved in a motor vehicle accident 2005. She complains of worsening balance problems as well as progressive sensory changes of her bilateral lower extremities. The patient states her symptoms began after the motor vehicle accident and have progressively worsened. MRI of the entire spine was performed. Cervical spine MRI demonstrates multilevel degenerative changes without other significant abnormality. MRI of the thoracic spine shows multilevel adhesions within the thecal sac, with resultant extensive intraspinal cystic loculations and distortion of the spinal cord. This process extends to the lumbar spine, where an "empty" thecal sac is present with posterior displacement and clumping of nerve roots of the cauda equina. No suspicious contrast enhancement was present. Conclusion Arachnoiditis represents postinflammatory changes involving the spinal cord, cauda equina, and thecal sac. These changes may be as a result of prior trauma, infection, or spinal surgery. Typical imaging findings on MRI include clumping and thickening of nerve roots in the cauda equina, with an "empty sac" sign. Intradural cysts representing loculated CSF formed by adhesions may also be present. Treatment is usually conservative. Laminectomy with microlysis of adhesions is reserved for patients with progressive neurologic deficits. References 1. Ginanneschi F et al. Arachnoid cyst and arachnoiditis following idiopathic spinal subarachnoid haemorrhage. Br J Neurosurg. 22(4):578-9, 2008 2. Killeen T et al. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia. 2012 Dec;67(12):1386-94