Arachnoiditis ossificans: Clinical series and

review of the literature.

Maulucci CM1, Ghobrial GM2, Oppenlander ME3, Flanders AE4, Vaccaro AR5, Harrop JS2.

Author information
1
 Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut
St., 3rd Floor, Philadelphia 19107, USA. Electronic address: cmaulucci@gmail.com.
2
 Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut
St., 3rd Floor, Philadelphia 19107, USA.
3
 Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut
St., 3rd Floor, Philadelphia 19107, USA; Division of Neurological Surgery, Barrow
Neurological Institute, St. Joseph Hospital and Medical Center, Phoenix 85003, USA.
4
 Division of Neuroradiology, Thomas Jefferson University Hospital, 1068 Main
Building, 132 South 10th Street, Philadelphia 19107, USA.
5
 Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University
Hospital, 925 Chestnut Street, Philadelphia 19107, USA.

Abstract

OBJECTIVE:

Ossification of the leptomeninges, or arachnoiditis ossificans (AO) of the spine resulting in

neurologic decline is a rarely reported disease. To date, there are 72 cases in the literature. The
natural history of the disease and the best management strategy for patients with this condition is
unknown. A series of five cases is presented adding to the relative paucity of knowledge of this
potentially debilitating disease.

METHODS:

A retrospective review of five cases of patients with arachnoiditis ossificans from 2009 to 2013
was conducted. All cases were obtained from a single institution. The diagnosis was based upon
computed tomography (CT) and magnetic resonance imaging (MRI) studies.

RESULTS:

All five patients in the series were found have a history of prior spinal procedures. Three of the
five patients had no history of intradural procedures or violation of the dura. Three of the patients
underwent surgery to address neurologic deficits related to AO. Surgical intervention mainly
consisted of decompression via laminectomy without resection of the intradural bony lesions. All
patients improved neurologically postoperatively.

CONCLUSIONS:
Arachnoiditis ossificans is a rare disease typically affecting the thoracolumbar spine. It may
result in devastating neurological deficits. There is no consensus as to the appropriate treatment
strategy and the surgical procedures can be technically demanding due to the tight adherence of
the abnormal bone to neural structures. For those patients who exhibit no symptoms referable to
the AO, close observation may be performed. However, once progressive neurologic deficits
occur due to AO, decompression via laminectomy can be a successful strategy.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS:

Arachnoid ossificans; Intradural; Laminectomy; Myelopathy