Spinal adhesive arachnoiditis: three case reports and review of literature
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REVIEW ARTICLE
Spinal adhesive arachnoiditis: three case reports and review of literature Szymon Jurga1 · Olga Szymańska‑Adamcewicz1 · Wojciech Wierzchołowski2 · Emilia Pilchowska‑Ujma1 · Łukasz Urbaniak1 Received: 8 September 2019 / Accepted: 3 July 2020 © The Author(s) 2020
Abstract Spinal adhesive arachnoiditis is a rare pathology involving pia mater of the spinal cord and nerve roots. It can potentially lead to disability—many patients end up wheelchair-bound due to subsequent paraparesis. It is an infrequent but possible cause of lower extremities weakness in patients with a history of spinal surgery, epidural anaesthesia, myelography or spinal tumors. Three patients, one male and two females, admitted to our unit due to paraparesis presented at least one of the above mentioned risk factors. Each of them had a severe course of illness—progressive paresis of lower extremities. All above cases were diagnosed with spinal adhesive arachnoiditis confirmed with Magnetic Resonance Imaging (MRI) scan—the most sensitive and specific diagnostic tool. Despite conservative treatment and intensive rehabilitation none of the presented patients preserved the ability to mobilise independently. Considering spinal adhesive arachnoiditis in patients with paraparesis and history of typical risk factors should be included in clinical diagnostic procedure. Keywords Paraparesis · Adhesive arachnoiditis · Spine MRI · Spine imaging
Introduction
Case reports
Adhesive arachnoiditis is a rare entity caused by an inflammatory process of pia mater. The symptomatology varies significantly between cases—from asymptomatic, through painful radicular syndromes to severe disability caused by paraplegia. Just like its natural history, aetiology of the disease is also heterogeneous including infections, trauma and spinal tumours. One of the important risk factors of adhesive arachnoiditis is iatrogenic damage caused by neurosurgical interventions, injections of oil-based contrast agents or epidural anaesthesia to name a few. We would like to present three cases of spinal adhesive arachnoiditis admitted to our unit—each of different aetiology and all presenting severe course of disease.
B.S., female, 50 years old, treated at outpatient department (OPD) due to a painful radiculopathy caused by a lumbosacral discopathy (diagnosed with MRI done in February 2017) was subsequently transmitted to Neurology Department in February 2017 due to bilateral lower limb weakness, bladder incontinence and shooting pains radiating to lower extremities—the symptoms worsening over several weeks. She had a history of orthopaedic surgery—bimalleolar fracture and luxation of the right ankle treated with ORIF (open reduction internal fixation). In May 2015 under spinal block (L3–L4) anaesthesia, surgery and early postoperative recovery were all uneventful. Neurological examination on admission showed spastic paraparesis with the muscle strength of 2–3 on Lovett scale and decreased superficial sensation at T4–T5 level. The MRI of the thoracic and cervical spine s
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