Neuraxial Consideration with a Spinal Dorsal Arachnoid Web: A Case Report of a Rare Spinal Pathology
1Department of Anesthesiology, Oklahoma University Health Sciences Center, Oklahoma City, OK.
Background:
Dorsal arachnoid webs (DAW) are thickened spinal arachnoid tissue bands that impinge onto the subarachnoid space and may progressively cause localized cord compression with an associated syringomyelia.
Case Reports:
A 68-year-old woman with metastatic cancer had thoracic back pain a month after spinal fusion for bony spread. Though initially managed symptomatically, the pain progressively worsened without other neurological symptoms. Two years later, we discovered a thoracic DAW without associated syringomyelia during evaluation. Due to higher risk for spinal cord injury, we avoided epidural injection.
Conclusions:
Iatrogenic spinal cord compression is a concern when performing neuraxial intervention with a present DAW. The safety or efficacy of epidural or spinal anesthetic techniques in DAW is unknown. Given the rarity of DAW, variable presentation, and difficult radiographic identification, unwitting neuraxial performance in an undiagnosed DAW may occur. Awareness and careful evaluation are important for pain physicians and anesthesiologists performing neuraxial interventions.
