Delayed symptomatic spinal adhesive arachnoiditis after surgery for thoracolumbar flexion-distraction injury: A case report

Abstract

Highlights First description of delayed spinal adhesive arachnoiditis after spine trauma surgery. Titanium instrumentation produces less artifacts make MRI a useful to evaluate operated lesions. Gabapentin can be the treatment of good option for delayed adhesive arachnoiditis.

Delayed Symptomatic Entrapment and Herniation of Lumbar Nerve Root Due to a Prior Durotomy Defect Initially Misdiagnosed As Arachnoiditis: A Case Report

“…The initial MRI lumbar revealed an empty sac sign, a focal thickening of the meninges such that little to no nerve roots are visible within the subarachnoid space [14]. An empty sac sign is characteristic of spinal arachnoiditis, a rare disease most common in patients who have undergone multiple lumbar surgeries or myelograms and manifesting as leg and back pain at various presentations [15][16][17][18][19][20].…”

Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

“…Historically, infections [ 5 , 18 , [21] , [22] , [23] , [24] ], mostly tuberculous meningitis [ 5 , [25] , [26] , [27] , [28] , [29] ], or myelographies due to the application of an oil-based contrast agent [ 2 , [30] , [31] , [32] , [33] , [34] , [35] ] played a major role as the cause of CSAA. Spinal surgery [ 6 , 11 , 22 , [36] , [37] , [38] , [39] , [40] ] and subarachnoid hemorrhages [ 3 ] continue to play a key role in the development of CSAA. In these cases, CSAA often does not occur until years after the event, whereas after epidural blood patches [ 10 , 13 ] or injection of chemical substances [ 11 , 15 , 16 , 35 , 41 ], CSAA manifests earlier.…”

“…In many cases, the diagnosis was made during surgery [ 6 ]. Today, MRI scans are considered the gold standard when diagnosing arachnoiditis [ 3 , 11 , 37 , 48 ]. Anderson et al [ 49 ] described the great variety of MRI findings in 29 cases and CT myelography in seven cases.…”

Spinal Adhesive Arachnoiditis: A Literature Review

“…Several etiologies have been described in the literature, such as infection, including tuberculosis [ 5 , 13 ], syphilis [ 5 , 13 ], brucellosis [ 14 ], candida [ 13 ], mycosis [ 14 ], and HIV infection [ 2 ]; mechanical causes, including spinal surgery [ 15 ], trauma [ 8 ], and disc herniation [ 8 ]; previous spinal illness, including ankylosing spondylitis [ 5 , 6 ], autoimmune vasculitis [ 2 ], and Guillain-Barré syndrome [ 2 ]; and chemical causes, including morphine [ 16 ], myelograms with oil-based radiographic contrast agents [ 17 , 18 ], sulfite-containing preservatives [ 2 ], phenolic solutions [ 10 ], chlorhexidine [ 19 ], epidural injection of steroids and antibiotics [ 5 ], blood in subarachnoid hemorrhage [ 20 , 21 ] or epidural blood patch [ 22 ], and epidural anesthetics [ 14 , 23 ]. Nevertheless, epidural analgesia in obstetrics using preservative-free, low-concentration bupivacaine with opioids is still not established as a defined cause for AA [ 1 ].…”

“…Medical remedies such as nonsteroidal anti-inflammatory drugs [ 2 , 12 ] and pulse steroid therapy, most commonly methylprednisolone [ 8 , 10 , 12 ], have been described to treat inflammation, although only a few studies show its effectiveness in preventing scar tissue [ 30 ]. In cases of pain, the pharmacologic therapy may include naltrexone, gabapentin [ 1 , 3 , 18 ], pregabalin [ 2 , 12 ], tricyclic antidepressants [ 2 , 12 ], muscle relaxants such as baclofen [ 2 ], local anesthetics [ 12 ], opioid analgesics [ 2 , 10 ], non-opioids [ 10 ], and narcotics [ 8 ]. Furthermore, although epidural injections improve pain, their use is not recommended, as it may exacerbate AA [ 2 ].…”