Spontaneous-Onset Delayed Spinal Arachnoiditis With Dorsal Cord Herniation in a 29-Year-Old Paraplegic Patient: A Case Report

Cureus, 2023 · DOI: 10.7759/cureus.51374 · Published: December 31, 2023

Simple Explanation

Spinal adhesive arachnoiditis is a rare condition causing inflammation of the arachnoid, leading to adhesion and fibrosis around nerve roots. This can disrupt cerebrospinal fluid and vascular flow, resulting in varying degrees of neurological deficits. Spontaneous spinal cord herniation occurs when the spinal cord is displaced through a dural or arachnoid defect. This case reports a patient with both spontaneous-onset delayed spinal arachnoiditis and dorsal cord herniation. The patient, a 29-year-old male paraplegic, experienced loss of truncal balance two years after surgery for an intradural extramedullary lesion. He was diagnosed with spinal arachnoiditis and dorsal cord herniation through a laminectomy window.

Study Duration

Not specified

Participants

One 29-year-old male paraplegic patient

Evidence Level

Level 4, Case Report

Key Findings

1
The patient presented with ascending sensory level changes, reaching T4, and a loss of truncal balance, indicating a new pathology at the cord level.
2
MRI revealed loculated fluid collection around the spinal canal, extending from T9 to T12, involving the distal cord, conus medullaris, and cauda equina nerve roots. Cord edema was also present up to the T6 level.
3
CSF analysis confirmed a methicillin-resistant Staphylococcus aureus (MRSA) infection, leading to treatment with vancomycin and intravenous steroids, resulting in clinical improvement and resolution of cord edema and herniation.

Research Summary

This case report describes a rare occurrence of spontaneous-onset delayed spinal arachnoiditis with dorsal cord herniation in a 29-year-old paraplegic patient two years after initial spine surgery. The patient presented with ascending sensory deficits and loss of truncal balance. MRI revealed arachnoiditis, cord herniation, and fluid collection. The patient was treated with antibiotics and steroids with a positive outcome. This case highlights the importance of considering spinal arachnoiditis in paraplegic patients presenting with new or worsening neurological deficits, and the potential for conservative treatment with steroids and antibiotics in early stages.

Practical Implications

Clinical Awareness

Clinicians should be aware of the possibility of delayed-onset spinal arachnoiditis in patients with SCI presenting with new or worsening neurological deficits, even years after the initial injury or surgery.

Diagnostic Vigilance

Clinicians should maintain a high index of suspicion for spinal arachnoiditis in patients with SCI and promptly investigate with MRI if new or progressive neurological signs and symptoms develop.

Therapeutic Considerations

Early conservative management with corticosteroids and antibiotics may be beneficial in treating spinal arachnoiditis, especially when initiated promptly after diagnosis.