Spinal arachnoid webs in adults: Clinical and imaging features in a multicenter study

Abstract

Background and Purpose Spinal arachnoid webs (SAWs) are rare and can present with myelopathic symptoms. This study aims to add 85 more cases of SAWs to the literature so we can continue to analyze clinical and imaging trends of SAWs to better understand this entity and its natural history. Methods An institutional review board‐approved retrospective review of SAW cases between 2016 and 2022 within a metropolitan, multihospital network was performed, searching for MR and CT reports that included “arachnoid web.” Of 108 identified reports, 85 patients had imaging and/or pathologically proven arachnoid webs. Demographic and clinical data were collected. Images were analyzed for SAW level, point of maximum kyphosis, presence of cord expansion, and signal intensity. The electronic medical record (EMR) was reviewed for age, sex, symptom presentation and duration, management, and outcomes. Results Of 85 cases, the most common presenting chief complaint was back pain and weakness. All (100%) SAWs were in the dorsal thoracic subarachnoid space, with 87% (74/85) located from thoracic (T) 2 to T6. Spinal cord expansion and signal abnormality were present in 54.1% and 23.5%, respectively. Twenty‐six underwent surgical resection with 20 showing improvement of at least one symptom. Conclusion We present 85 additional cases of SAWs to the existing literature. Our cases all occurred in the dorsal thoracic subarachnoid space, predominantly from T2 to T6. Patients present with symptoms like other causes of cord compression, and spinal MR studies should be evaluated routinely for the findings of SAWs. Further research could focus on understanding SAW prevalence, risk factors, and pathophysiology.

Resection of an incidentally discovered spinal arachnoid web: illustrative case

“…For example, the cohort of Elkadi et al. 12 included 59 patients who had been treated conservatively, but outcomes were only reported for 26 surgical patients. This may limit the ability to draw conclusions about the efficacy of a conservative SAW treatment approach, and future studies should explore outcomes for these patients.…”

“…Among patients who had been treated conservatively in our sample (n 5 77), there appeared to be lower rates of reporting on follow-up duration and neurological outcome. For example, the cohort of Elkadi et al 12 included 59 patients who had been treated conservatively, but outcomes were only reported for 26 surgical patients. This may limit the ability to draw conclusions about the efficacy of a conservative SAW treatment approach, and future studies should explore outcomes for these patients.…”