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Case Reports
. 2010 Aug;1(2):46-51.
doi: 10.1055/s-0028-1100914.

Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

George M Ibrahim  1 , Tara Kamali-Nejad, Michael G Fehlings
Affiliations
Case Reports

Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy

George M Ibrahim et al. Evid Based Spine Care J. 2010 Aug.

Abstract

Objective: The pathophysiology of arachnoiditis ossificans (AO) and its association with syringomyelia remains a rare and poorly understood phenomenon. Here, we present a case of AO associated with syringomyelia, a review of literature, and a discussion of current understanding of disease pathophysiology.

Methods: A literature review was performed using MEDLINE (January 1900-May 2010) and Embase (January 1900-May 2010) to identify all English-language studies that described AO with syringomyelia. The current report was added to published cases.

Results: Over 50 cases of AO are reported in literature, of which only eight are associated with syringomyelia. The various presumptive etiologies of syrinx formation include abnormalities in blood circulation, ischemia, hydrodynamic alternations in cerebrospinal fluid (CSF) flow, tissue damage, or incidental coexistence. Changing CSF dynamics related to decreased compliance of the subarachnoid space and subsequent paracentral dissection of the spinal cord may be implicated in the disease process. magnetic resonance imaging (MRI) scanning may identify the syrinx but fail to diagnose the calcified arachnoid. Five patients, including the current case, improved clinically following laminectomy and decompression.

Conclusions: Syringomyelia in association in AO is a rare phenomenon. A high index of suspicion is required and both MRI and computed tomography (CT) are recommended for diagnosis. The pathophysiology of syringomyelia in AO remains an area of ongoing research.

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Conflict of interest statement

This report has received no financial support.

Figures

Figure 1
Figure 1
Preoperative T2-weighted MRI scan a mid-sagittal view demonstrating a thoracic syrinx at the T3 level as well as an intradural extramedullary lesion displacing the spinal cord at the T4–5 levels b axial view at the level of T3 showing the large syrinx c axial view at the level of T4 demonstrating cord compression by the intradural extramedullary lesion. Abnormal cord signal is evident
Figure 2
Figure 2
Intraoperative ultrasonography demonstrating the syrinx as well as the hyerechoic calcified arachnoid
Figure 3
Figure 3
a Intraoperative image showing dissection and elevation of the calcified arachnoid plaque from the spinal cord. The calcified arachnoid is firmly adhered to the dorsal surface of the spinal cord b pathological specimen of calcified arachnoid plaque measuring 38 × 18 mm
Figure 4
Figure 4
Postoperative T2-weighted MRI scan a mid-sagittal view demonstrates interval decompression of the spinal cord at the T4–5 level. The persistent syrinx has decreased substantially in size b axial view at the level of T3 showing interval decrease in syrinx size c axial view at the T4 level showing re-expansion of the thoracic cord following laminectomy and resection of calcified arachnoid
See this image and copyright information in PMC

References

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