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Obliterative arachnoiditis complicating lumbar spinal stenosis.

J A Epstein, B S Epstein, L S Lavine

    Journal of Neurosurgery
    |February 1, 1978
    PubMed
    Summary

    Spinal stenosis can cause a blocked spinal canal due to obliterated subarachnoid space, mimicking arachnoiditis. Surgical decompression offered temporary relief for neurogenic claudication in these complex cases.

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    Area of Science:

    • Neurosurgery
    • Spinal Surgery
    • Radiology

    Background:

    • Spinal stenosis presents diagnostic challenges, particularly when the subarachnoid space is obliterated.
    • Arachnoiditis is often considered, but other causes of dural sac obliteration exist.

    Observation:

    • Five patients with spinal stenosis presented with a total myelographic block.
    • Laminectomy revealed a thickened, non-pulsating dural sac, indicating an obliterated subarachnoid space.
    • Underlying causes included spondyloarthrosis, prior fusion, spondylolisthesis, and a large extruded disc.

    Findings:

    • Decompressive laminectomy, foraminotomy, and discectomy provided significant, albeit temporary (approx. 1 year), relief of neurogenic claudication in three patients.
    • Postoperative imaging confirmed no contrast passage, consistent with the obliterated space.

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  • Surgical intervention was effective despite the unusual dural sac morphology.

    • Implications:

    • Obliterated subarachnoid space is a critical complication of spinal stenosis that must be recognized.
    • This condition impacts diagnostic accuracy and prognosis for spinal stenosis patients.
    • Awareness aids in appropriate surgical planning and patient management for spinal stenosis.