Arachnoiditis Ossificans of the Lumbar Spine: A Rare Cause of Progressive Cauda Equina Syndrome

Benyaich, Zakariae; Laghmari, Mehdi; Benali, S. Aït

doi:10.1016/j.wneu.2021.01.057

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…Pathologic calcification in cauda equina elements has also been rarely described, and in some extreme cases may present as arachnoiditis ossificans, in which the arachnoid and dura develop calcifications. This is thought to be the result of a chronic inflammatory process, resulting from infection, trauma, or subarachnoid hemorrhage, and is the result of the progression of ongoing arachnoiditis [ 43 , 44 ]. It is therefore possible that the FT may develop a similar reactive deposition of calcium when it is inflamed, which may cause patients to develop symptoms of TCS.…”

Section: Discussionmentioning

confidence: 99%

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome

Abdulrazeq,

Leary,

Tang

et al. 2023

JCM

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This study investigated the prevalence of embryonic and connective tissue elements in the filum terminale (FT) of patients with tethered cord syndrome (TCS), examining both typical and pathological histology. The FT specimens from 288 patients who underwent spinal cord detethering from 2013 to 2021 were analyzed. The histopathological examination involved routine hematoxylin and eosin staining and specific immunohistochemistry when needed. The patient details were extracted from electronic medical records. The study found that 97.6% of the FT specimens had peripheral nerves, and 70.8% had regular ependymal cell linings. Other findings included ependymal cysts and canals, ganglion cells, neuropil, and prominent vascular features. Notably, 41% showed fatty infiltration, and 7.6% had dystrophic calcification. Inflammatory infiltrates, an underreported finding, were observed in 3.8% of the specimens. The research highlights peripheral nerves and ganglion cells as natural components of the FT, with ependymal cell overgrowth and other tissues potentially linked to TCS. Enlarged vessels may suggest venous congestion due to altered FT mechanics. The presence of lymphocytic infiltrations and calcifications provides new insights into structural changes and mechanical stress in the FT, contributing to our understanding of TCS pathology.

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Section: Discussionmentioning

confidence: 99%

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome

Abdulrazeq,

Leary,

Tang

et al. 2023

JCM

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“…9, 2022 compressing the spinal cord and cauda equina or blocking the CSF flow. [1][2][3][6][7][8][9][10][11][12] There are limited small case series of AO, though some common characteristics have been reported. AO is related to chronic inflammation caused by trauma, surgical manipulation, or myelography.…”

Section: Discussionmentioning

confidence: 99%

“…The surgery is challenging in cases with the entire spinal cord or the nerve roots of the cauda equina covered by ossifications. 6 , 7 , 9 , 10 ) While it is unnecessary to remove all ossifications, those strongly compressing the spinal cord or obstructing CSF flow should be taken out by IOU. In cases that do not ensure adequate spinal fluid flow, insertion of a shunt into the syringomyelia associated with the AO could be another surgical option.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment Strategies for Arachnoiditis Ossificans Following Subarachnoid Hemorrhage: A Case Report

Nagashima

Nishimura

Itô

et al. 2022

NMC Case Report Journal

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Arachnoiditis ossificans (AO) is a rare disease, wherein ossified lesions in the subarachnoid space obstruct the flow of spinal fluid or compress the spinal cord, thereby causing myelopathy. Here we describe a rare case of AO and discuss the diagnosis and treatment strategies for this disease. A 66-yearold man with a history of subarachnoid hemorrhage presented with gait disturbance and dysuria for 7 months. Spinal magnetic resonance imaging and computed tomography (CT) myelography showed syringomyelia at the T5-T8 level and dorsally tethered spinal cord at the T8-T10 level. Preoperative noncontrast CT was not performed. The patient was diagnosed with adhesive arachnoiditis and underwent arachnoidolysis. However, intraoperative findings showed the presence of ossification lesions on the dorsal surface of the spinal cord, and intraoperative ultrasound (IOU) showed a hyperintense lesion with acoustic shadowing on the dorsal surface of the spinal cord, with limited visibility of the spinal cord. After removal of the lesions, IOU showed untethered and well-decompressed spinal cord and restoration of cerebrospinal fluid pulsation. Based on these findings, the patient was finally diagnosed with AO, which is an extremely rare disease, with an unknown frequency of occurrence. Therefore, all patients with adhesive spinal arachnoiditis require a preoperative noncontrast CT scan to evaluate for ossification lesions. In this case, we were fortunate to be able to treat AO with IOU, which demonstrated specific findings.

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