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Spinal arachnoiditis ossificans: report of a quadruple triggered case.
World Neurosurgery 2018 December 4
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 neurological 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 thoraco-lumbar surgery. Magnetic resonance imaging (MRI) revealed multiloculated intradural/extramedullary cysts on the posterior surface of the spinal cord at Th9-L1, with clustered nerve roots. Computed tomography (CT), with three-dimensional (3D) reconstruction, demonstrated a likely ossification of both the dura and the arachnoid from Th9 to S1. Microsurgical debridement of scar tissue from previous surgery, drilling of posterior ossified plaques at Th11-Th12-L1, as well as 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 neurological worsening.
CASE DESCRIPTION: The 65-year-old patient had a history of previous spinal trauma and related thoraco-lumbar surgery. Magnetic resonance imaging (MRI) revealed multiloculated intradural/extramedullary cysts on the posterior surface of the spinal cord at Th9-L1, with clustered nerve roots. Computed tomography (CT), with three-dimensional (3D) reconstruction, demonstrated a likely ossification of both the dura and the arachnoid from Th9 to S1. Microsurgical debridement of scar tissue from previous surgery, drilling of posterior ossified plaques at Th11-Th12-L1, as well as 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 neurological worsening.
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