The rising root sign: the magnetic resonance appearances of post-operative spinal subdural extra-arachnoid collections

Abstract

We present a case series of symptomatic post-operative spinal subdural extra-arachnoid collections that displace the cauda equina roots anteriorly. This is described as the "rising root sign".

Spinal subdural, extra‐arachnoid hygroma following lumbar decompression: a rare case following cauda equina syndrome

“…It also demonstrates successful non‐operative management, representing an important addition to the current literature. Whilst other case reports and case series focus on spinal subarachnoid haematomas with devastating neurological deterioration following lumbar spinal surgery necessitating further intervention,7 few describe their non‐operative management 9…”

“…Interpretation by a specialist musculoskeletal radiologist should be considered. The spinal cord is typically displaced anteriorly, and has been referred to as a ‘rising root sign’, owing to its ability to extend up the spinal canal between the dural layers 9. Although spinal subdural haematoma has been described in the absence of a dural tear,8 dural tear can contribute to cerebrospinal fluid leak, therefore vigilance in the identification and management of these lesions intraoperatively is highlighted.…”

“…Whilst other case reports and case series focus on spinal subarachnoid haematomas with devastating neurological deterioration following lumbar spinal surgery necessitating further intervention, [5][6][7] few describe their non-operative management. 8,9 Risk factors for spinal subdural haematoma following lumbar spine surgery are multilevel procedures, preoperative anticoagulant therapy and hypertension. 1 Use of gadolinium contrast may be useful in differentiating between hygroma, effusion and subdural haematoma.…”

“…The spinal cord is typically displaced anteriorly, and has been referred to as a 'rising root sign', owing to its ability to extend up the spinal canal between the dural layers. 9 Although spinal subdural haematoma has been described in the absence of a dural tear, 8 dural tear can contribute to cerebrospinal fluid leak, therefore vigilance in the identification and management of these lesions intraoperatively is highlighted. Haematoma formation in the subdural space can also potentially be produced by trauma to the thin extra-arachnoid capillaries even in instances where a dural tear is not noted.…”

A Case of Dural Herniation of the Cauda Equina Caused by Enlarged Spinal Subdural Extra-arachnoid Hygroma Following Lumbar Microsurgical Decompression: Case Report

“…Spinal subdural extra-arachnoid hygroma (SSEH) can occasionally develop even in spinal surgeries that do not include operations in the dura. [1][2][3][4] Involvement of intraoperative damage to the arachnoid membrane is suggested as the cause of onset. 1,4,5) SSEH presents diverse symptoms such as lower back pain, leg pain, and bladder and rectal dysfunctions.…”