Spinal Arachnoiditis Ossificans: Report of Quadruple-Triggered Case

World Neurosurg. 2019 Mar:123:1-6. doi: 10.1016/j.wneu.2018.11.203. Epub 2018 Dec 3.


Background: Arachnoiditis ossificans (AO) is a rare condition often associated with previous spine surgery. Here we describe a unique case of a patient affected by ankylosing spondylitis (AS), presenting with progressive neurologic deterioration due to AO. We also review the literature on evaluation and management of patients suffering from AO.

Case description: The 65-year-old patient had a history of previous spinal trauma and related thoracolumbar surgery. Magnetic resonance imaging revealed multiloculated intradural/extramedullary cysts on the posterior surface of the spinal cord at Th9-L1, with clustered nerve roots. Computed tomography, with 3-dimensional reconstruction, demonstrated a likely ossification of both the dura and arachnoid from Th9 to S1. Microsurgical debridement of scar tissue from previous surgery, drilling of posterior ossified plaques at Th11-Th12-L1, and marsupialization and drainage of arachnoid cysts at Th11-Th12 were performed.

Conclusions: We submit that AS, spinal trauma, epidural hematoma, and related surgery may be synergistic and independent factors in the etiopathogenesis of AO. This should be considered in patients with AS and/or a history of spinal surgery who present neurologic worsening.

Keywords: Ankylosing spondylitis; Arachnoid cysts; Arachnoiditis ossificans; Spinal surgery; Spinal trauma.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arachnoid Cysts / etiology
  • Arachnoid Cysts / pathology
  • Arachnoid Cysts / surgery
  • Arachnoiditis / congenital*
  • Arachnoiditis / etiology
  • Arachnoiditis / pathology
  • Arachnoiditis / surgery
  • Calcinosis / etiology
  • Calcinosis / pathology
  • Drainage / methods
  • Humans
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging
  • Male
  • Spinal Fusion / methods
  • Suture Techniques
  • Tomography, X-Ray Computed

Supplementary concepts

  • Familial spinal arachnoiditis