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

Ho-Seung Jeon; Seok-Ha Hwang; Seung-Pyo Suh; Jae-Nam Kim

doi:10.4055/jkoa.2019.54.4.361

Journal List > J Korean Orthop Assoc > v.54(4) > 1130643

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jeon, Hwang, Suh, and Kim: Cauda Equina Syndrome Occurred by Adhesive Arachnoiditis of the Lumbar Spine with an Unknown Cause

Case Report

Journal of the Korean Orthopaedic Association 2019; 54(4): 361-365.

Published online: 21 August 2019

DOI: https://doi.org/10.4055/jkoa.2019.54.4.361

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

Ho-Seung Jeon, M.D.

, Seok-Ha Hwang, M.D., Seung-Pyo Suh, M.D., Jae-Nam Kim, M.D.

Department of Orthopedic Surgery, Sung-Ae Hospital, Seoul, Korea.

Correspondence to: Ho-Seung Jeon, M.D. Department of Orthopedic Surgery, Sung-Ae Hospital, 22 Yeouidaebang-ro 53-gil, Yeongdeungpo-gu, Seoul 07354, Korea. TEL: +82-2-840-7231, FAX: +82-2-840-7755, j9422hs@hanmail.net

Received 27 June 2018 Revised 13 August 2018 Accepted 31 August 2018

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: lumbar spine, arachnoiditis, cauda equina syndrome, decompression

Figures and Tables

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).

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.

Figure 3

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

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).

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

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.

TOOLS

ORCID iDs: Ho-Seung Jeon
https://orcid.org/0000-0002-0172-9923
Similar articles