Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

Abstract

Objective: The pathophysiology of arachnoiditis ossificans (AO) and its association with syringomyelia remains a rare and poorly understood phenomenon. Here, we present a case of AO associated with syringomyelia, a review of literature, and a discussion of current understanding of disease pathophysiology.Methods: A literature review was performed using MEDLINE (January 1900–May 2010) and Embase (January 1900–May 2010) to identify all English-language studies that described AO with syringomyelia. The current report was added to published cases.Results: Over 50 cases of AO are reported in literature, of which only eight are associated with syringomyelia. The various presumptive etiologies of syrinx formation include abnormalities in blood circulation, ischemia, hydrodynamic alternations in cerebrospinal fluid (CSF) flow, tissue damage, or incidental coexistence. Changing CSF dynamics related to decreased compliance of the subarachnoid space and subsequent paracentral dissection of the spinal cord may be implicated in the disease process. magnetic resonance imaging (MRI) scanning may identify the syrinx but fail to diagnose the calcified arachnoid. Five patients, including the current case, improved clinically following laminectomy and decompression.Conclusions: Syringomyelia in association in AO is a rare phenomenon. A high index of suspicion is required and both MRI and computed tomography (CT) are recommended for diagnosis. The pathophysiology of syringomyelia in AO remains an area of ongoing research.

Arachnoiditis ossificans with syringomyelia: a unique case of myelopathy

“…It has been postulated that mature bone cells arise from multipotent arachnoid cells secondary to insults mentioned above. 4,5 However; etiology in our case is not entirely clear. Though she has a history of pulmonary and abdominal tuberculosis twenty-two years back, there were no spinal complaints back then.…”

“…On T1WI C+ minimal or no nerve root enhancement is seen. 1,[4][5][6][7] AO was divided by Domenicucci M et al, in 2004 into three types based on computed tomography (CT) and magnetic resonance (MR) findings-type I ossifications are semicircular in appearance, type II is circumferential, and type III are a honeycomb like ossifications, which affect the cauda equina. 8 The management of arachnoiditis ossificans remains a dilemma between conservative and surgical treatment.…”

Spinal arachnoid web—a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population

“…It is a rare calcification of the arachnoid membrane with characteristic histopathological characteristics. It causessimilar to SAWspinal cord compression and is mostly located in the thoracic spine with corresponding clinical symptoms 31 . Associated syringomyelia is described in a subset of these cases, but is not the norm as in SAW 31 .…”

“…Diagnostic modalities such as conventional MRI and computed tomography (CT) show an intradural, extramedullary calcified lesion compressing the spinal cord 31,32 . Similar to SAW, a history of prior spinal procedures is frequently reported in patients with this pathology [33][34][35] .…”

“…Similar to SAW, a history of prior spinal procedures is frequently reported in patients with this pathology [33][34][35] . Surgical approaches rely mainly on decompressive laminectomy with or without intradural lesion excision, which usually leads to clinical improvement 31,33,36 .…”