Thoracic spine arachnoid ossification with and without cord cavitation

Abstract

<jats:p content-type="fine-print">✓ Thoracic spine arachnoid ossification is a relatively rare disease that affects mainly women and causes sensory, motor, and sphinctal symptoms associated with inferior limb pain. Based on three cases, the authors comment on pathogenic and surgery-related aspects of the disease. The patient in Case 1 was followed over the course of 23 years. Spinal cavitation is highlighted in Case 2, and yellow, gross, half-ring ossification is described in Case 3. Calcium deposits usually occur in the middle and lower thoracic spine where the majority of trabeculated arachnoid cells are located. Operative treatment does not interrupt the ossification process, which continues over time, causing progressive deterioration in the patient. Spinal cavitation can occur due to spinal cord tethering, stretching, and central cord edema formation, accompanied by cerebrospinal fluid blockage and pulse pressure changes. The results of surgical intervention are poor, offering short-term recovery with later deterioration. Multiple pathogenic factors are involved in this clinical syndrome including metabolic changes.</jats:p>

Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

“…Arachnoiditis calcificans (or “ossificans”) remains poorly understood and is a rare condition 1,2. With the advent of MRI, chances for its diagnosis have improved and the development of microsurgical treatment increases prospects for safe surgical intervention.…”

Spinal arachnoid calcifications

“…Mello et al reported a predisposition toward women, but other studies were not able to corroborate this association (Mello et al, 2001;Faure et al, 2002;Domenicucci et al, 2004). It has been suggested that trabeculated arachnoid cell clusters are more abundant at the thoracic level and that could explain the proclivity of these deposits in the thoracic cord.…”

“…In fact, a report of histopathology in one case with multiple areas of spinal ossified arachnoiditis convincingly showed bone present in a meningothelial cell cluster (Kitagawa et al, 1990). These calcifications are infrequently found in the cervical or cauda equina region, but can involve the filum terminale (Kitagawa et al, 1990;Mello et al, 2001;Faure et al, 2002).…”

A Case of Cauda Equina Arachnoiditis Ossificans and Review the Literature

“…The treatment of arachnoiditis ossificans is still a difficult problem. The rare nature of this disease makes it difficult to determine the standard treatment regimen, and the clinical outcomes of conservative treatment and surgical treatment regimens are uneven [10][11][12]. Changbing Wang and others believe that patients with mild symptoms should be observed and treated, while patients with severe or deteriorating symptoms should be treated by surgery, and the main purpose of surgery is to decompress [13,14].…”