An integrated classification to guide the management of spinal meninges pathologies

The terminology used for spinal meningeal pathologies is often inconsistent, with multiple terms referring to similar or related anatomical anomalies. This lack of standardization leads to variability in the management of these lesions, with differing diagnostic and therapeutic approaches for similar conditions. Our aim was to revise the classification of spinal meningeal pathologies by integrating pathogenesis, diagnostic criteria, and therapeutic strategies.

We first conducted a descriptive cohort study over a ten-year period at a single neurosurgical reference center. Clinical and radiological data were collected, and spinal meningeal pathologies were categorized according to a revised classification system. Next, we administered an online survey featuring selected cases to spine surgeons and neuroradiologists, comparing their responses to our proposed classification.

A total of 264 patients with 273 lesions were included. The lesions were categorized into dural pathologies (n = 192), comprising diverticula (n = 129), dissections (n = 46), and ectasia (n = 17); and arachnoid pathologies (n = 81), including cysts (n = 20), webs (n = 32), and arachnoiditis (n = 29). For each diagnosis, we identified specific clinical and radiological features and selected illustrative cases. A total of 93 physicians participated in the online survey (51.7% spine surgeons). We found that conventional diagnostic terms were still widely used and that misdiagnoses were common, even between duropathies and arachnoidopathies.

We propose an integrated classification of spinal meningeal pathologies to standardize terminology and guide management. This framework can be adopted by spine surgeons, radiologists, and neurologists to ensure a more consistent approach to diagnosing and treating these conditions.