• Takashi Hirai, Tsuyoshi Kato, Shigenori Kawabata, Mitsuhiro Enomoto, Shoji Tomizawa, Toshitaka Yoshii, Kyohei Sakaki, Kenichi Shinomiya, and Atsushi Okawa.
• Department of Orthopedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. hirai.orth@tmd.ac.jp
• Spine. 2012 Feb 1;37(3):E195-8.

Study DesignA case report of a patient with adhesive arachnoiditis after combined spinal and epidural anesthesia.ObjectiveTo report an extremely rare case of paraplegia due to adhesive arachnoiditis with extensive syringomyelia (ES) and a giant anterior arachnoid spinal cyst (AASC) after spinal and epidural anesthesia for obstetric surgery.Summary Of Background DataProgressive inflammation of the arachnoid mater due to trauma, infection, or hydrocortisone was reported as early as the 1970s. However, coexistence of ES and a giant AASC after spinal and epidural anesthesia is extremely rare.MethodsA 29-year-old woman suffered from sudden anuresis 5 months after spinal and epidural anesthesia for a cesarean section and subsequently experienced paraplegia and numbness below the chest. Magnetic resonance imaging showed an AASC compressing the spinal cord at T1-T6 and an adhesive lesion at T7. Posterior laminectomy at T6-T7 and adhesiolysis for arachnoid adhesion at T7 were performed. Although there was slight recovery of locomotive function postoperatively, it gradually worsened until 3 years after surgery. Magnetic resonance imaging at that time demonstrated a giant AASC and ES at the lower-thoracic cord. The cord compressed by the AASC became thinner sagittally. Secondary surgery involving posterior laminectomy at T5-T6 and insertion of a cyst-peritoneal shunt into the AASC was performed.ResultsThe patient could walk without a cane 3 years after the shunt operation, although numbness and motor weakness of the lower extremities remained. Magnetic resonance imaging 3 years after the shunt operation showed a reduction of the AASC and decompression of the cord despite no improvement in ES.ConclusionThis is the first report of a patient with a giant AASC and ES caused by spinal and epidural anesthesia. Although the optimal surgical treatment for these conditions remains unclear, shunting of the cyst effectively prevented the progression of symptoms.

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