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Anton Sebastian in A Dictionary of the History of Medicine, 2018
Arachnoiditis [Greek: arachne, spider] Inflammation of the spinal canal. Described in a patient as ‘meningitis circumscripta spinalis’ by William Gibson Spiller (1863–1940), J.H. Musser and Edward Martin (1859–1938) in 1903. A description of a similar case as ‘meningitis serosa spinalis’ was given by K. Mendel and Saul Adler in 1908. Victor Horsley (1857–1916) described it as ‘chronic spinal meningitis’ in 1909. War injuries were thought to be responsible by T. Mauss and H. Krugger in 1918. Chronic arthritis of the spine was incriminated by C.Vincent in 1930.J.D. French in 1946 pointed out a protrusion of an intervertebral disc as a cause. A presently established cause, spinal anesthesia, was identified by W.G. Haynes and F.A. Smith in 1942. Lipiodol and other contrast media were noted as a cause by P. Bucy and I.J. Spigel in 1943.
Inflammatory diseases affecting the spinal cord
Milosh Perovitch in Radiological Evaluation of the Spinal Cord, 2019
It is often difficult to diagnose arachnoid adhesions on the basis of the clinical symptomatology. Symptoms, if apparent, are not constant and frequently have an insidious onset with an intermittent course. The appearance of multiple levels of segmental sensory disturbances favors the diagnosis of chronic arachnoiditis with adhesions. Root pains are of a diffuse type, and they are not localized to the cutaneous distribution of one or several spinal roots. The pain can be intensified by movements or coughing, sneezing, or straining. Paralysis, partial or complete loss of sphincter control, and muscular wasting may develop later. Patchy areas of dysesthesia or hyperesthesia were found, and they were similar to those encountered in intrinsic diseases of the spinal cord.69 In the domain of the cauda equina, the radicular disturbances are similar to those caused by disk herniation, and indeed, it is often impossible to exclude the coexistence of a disk prolaps. The variability of clinical symptoms and their appearance weeks, months, and often years following the causative pathologic process makes the clinical diagnosis of chronic arachnoiditis and adhesions rather indeterminate.
Transforaminal Lumbar Interbody Fusion: Technique, Complications, and Early Results *
Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson in 50 Landmark Papers, 2018
Low back pain dissipated completely in 16 patients following surgery. Five patients had moderately persistent low back pain requiring oral narcotics for pain management. Last, one patient’s preoperative pain level persisted postoperatively due to arachnoiditis. Fortunately, the index procedure resolved radicular symptoms in all 19 patients who presented with radiculopathy at the time of surgery. One unintentional intraoperative durotomy was noted. Primary closure was attempted at the time of durotomy, but a second more definitive operation was necessary to close the persistent CSF leak as the tear extended past the initial closure. Two postoperative wound infections were successfully treated with antibiotics and did not require revision surgery. Additional postoperative complications included transient postoperative brachial neuralgia secondary to intraoperative positioning, distal neuropathy in the arm due to prolonged blood pressure cuff inflation, and L5 motor weakness. The patient with distal arm neuropathy passed away 3 months following surgery from cardiomyopathy. The stated patient was still suffering from distal neuropathy at the time of death. The L5 motor weakness was discovered only when the patient attempted to resume jogging. Weakness resolved completely following a course of physical therapy. The authors conclude that TLIF is a safe and viable option for treatment of degenerative lumbosacral spine disease and for achieving circumferential fusion.
Spinal arachnoiditis leading to recurrent reversible myelopathy: A case report
Published in The Journal of Spinal Cord Medicine, 2022
Erol Jahja, Charles Sansur, Peter Howard Gorman
Arachnoiditis is a rare inflammatory condition leading to fibrosis and adhesions of the arachnoid membrane surrounding the spinal cord. It can be due to various conditions including infection, spinal interventions, subarachnoid hemorrhage, and trauma.1,2 The thickening of the membrane can lead to conglomeration of nerve roots within the thecal sac and clumped roots attaching to the meninges, presenting as soft tissue signaling in the thecal sac on magnetic resonance imaging (MRI).3 These changes can produce the characteristic symptoms of pain, spasms and sensorimotor changes. There have also been reports of urinary incontinence, frequency or urgency in 23% of chronic arachnoiditis cases.4 This condition usually causes permanent neurologic changes. Recurrent reversible cases of arachnoiditis have rarely been reported.5,6
Arachnoiditis ossificans associated with syringomyelia: a case report
Published in British Journal of Neurosurgery, 2019
Changbing Wang, Zhong Chen, Deyong Song, Tianhang Xuan
Calcification or ossification of the arachnoid membranes is a common phenomenon occurring during surgery and autopsy.1 However, spinal arachnoiditis ossificans is a rare chronic arachnoiditis, characteriszed by metaplastic ossification and/or calcification of the arachnoid membrane.2 The exact pathogenesis of arachnoiditis ossificans is still unknown. Nonetheless, a variety of causes such as previous trauma, surgery, subarachnoid haemorrhage or myelography leading to arachnoiditis are postulated.3 However, in many cases a specific precipitant cannot be identified, as in our case. According to Kaufman and Dunsmore’s theory,2 osseous metaplasia associated with chronic inflammation is probably the most likely cause, among mechanisms proposed for the development of the ossification. Because chronic fibroblastic proliferative change to the leptomeninges associated with the osseous metaplasia, were founded in all the cases they reviewed.2 Arachnoid cells have multipotential differentiation. When they are exposed to certain conditions, they undergo bony metaplasia and lead to the proliferation of osteoblasts, with increased activity and subsequent development of ossification.
Spinal cord atrophy following the resection of multiple intraspinal arachnoid cysts: case report and literature review
Published in British Journal of Neurosurgery, 2023
Wenyan Li, Chenghai Zuo, Hua Feng, Hui Meng
In our case, the reason for the spinal cord atrophy over 1 year after surgery is still unknown. The arachnoid cysts were located intradurally and adhered to the nerve roots and spinal cord. Removal of them could cause injury to axons and neuronal cells. Therefore atrophy could happen above or below the injury site because of disconnected axons.6 Scar adhesions can also lead to atrophy of spinal cord. Surgery may inflame the arachnoid, inducing arachnoiditis and progressively developing scar tissue could compress the spinal cord.7–9 Reperfusion injury is another explanation. An obscure hydrodynamic mechanism is also a possibility, as that could explain the lack of any detectable ongoing active pathological process.10,11 At present, the patient only complains of mild back pain and examinations is unremarkable, so we will watch closely what happens.