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Updated: Oct 18, 2025

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Flexible thecoscopy for extensive spinal arachnoiditis.

Panagiotis Mastorakos1,2, I Jonathan Pomeraniec1,2, Jean-Paul Bryant1

  • 11Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.

Journal of Neurosurgery. Spine
|October 1, 2021
PubMed
Summary

Flexible endoscopy safely treats extensive spinal arachnoiditis beyond surgical margins. This minimally invasive approach improves access for lysis of adhesions, offering hope for patients with severe spinal cord conditions.

Keywords:
neuroendoscopyspinal arachnoiditisspinal endoscopysurgical techniquesyringomyeliathecoscopy

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Area of Science:

  • Neurosurgery
  • Minimally Invasive Surgery
  • Spinal Cord Disorders

Background:

  • Chronic adhesive spinal arachnoiditis (SA) causes spinal cord tethering and CSF flow blockage.
  • Extensive SA (beyond 4 segments) has a poor prognosis due to incomplete adhesion removal and retethering.
  • Flexible neuroendoscopy offers a minimally invasive way to expand the surgical field.

Purpose of the Study:

  • To evaluate the use of flexible endoscopy in treating extensive cervical and thoracic SA.
  • To assess the safety and efficacy of extending surgical lysis of adhesions beyond open laminectomy margins.
  • To inform future improvements in treating extensive SA.

Main Methods:

  • 10 patients with progressive myelopathy and extensive SA underwent 2-5 level thoracic laminectomy.
  • Microscopic and endoscopic lysis of adhesions were performed at adjacent spinal levels.
  • Follow-up included neurological assessment and MRI for syrinx resolution over a mean of 5 months.

Main Results:

  • Endoscopy expanded surgical exposure by an average of 2.4 additional segments (6.1 levels total).
  • Complex arachnoidal bands and membranes were safely dissected in the dorsal subarachnoid space.
  • The endoscope did not cause compression or injury to the spinal cord.

Conclusions:

  • Intrathecal endoscopy enables safe visual assessment and removal of adhesions beyond laminectomy sites.
  • Further development of endoscopic techniques can enhance subarachnoid space opening and spinal cord untethering.
  • This approach shows promise for managing extensive chronic adhesive SA.