• Mychael Delgardo, Dominique Higgins, Kyle L McCormick, Patrick Reid, Peter Canoll, and Paul C McCormick.
• Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York, USA.
• Neurosurgery. 2022 May 1; 90 (5): 581-587.

BackgroundDorsal arachnoid webs (DAWs) are rare pathological abnormalities of the arachnoid layer of the spinal cord that can result in pain and myelopathy.ObjectiveTo present clinical, imaging, and pathological characteristics of patients diagnosed with DAW, case illustrations, and a review of the literature.MethodsSeventeen cases of DAW between 2015 and 2019 at a tertiary medical center were retrospectively identified through a case log search. Patient characteristics, preoperative imaging, operative notes, and pathology reports were collected. Our main outcome assessed was postoperative resolution of symptoms. Odds ratios were used to determine associations between preoperative signs and symptoms with postoperative symptom resolution.ResultsThe mean age of the cohort was 50.5 years (IQR = 16) and presented primarily with back pain (64.7%). On imaging, all patients were found to have the "scalpel sign," and nearly half had a syrinx present (41.2%). All DAWs were located in the thoracic spine, with the most common location being the midthoracic (70.6%). The mean follow-up length for all patients was 4.3 months. There were no preoperative symptoms significantly associated with postoperative symptom resolution; however, a trend was noted with the presence of a preoperative syrinx. Pathology samples consistently demonstrated fibroconnective or collagenous tissue with no evidence of inflammation or neoplasm.ConclusionDAW is a rare pathology that can result in myelopathy or inappropriate interventions if misdiagnosed. Surgical intervention using laminectomy with intradural exploration should be considered in symptomatic patients with DAW because it is curative with a strong chance of preoperative symptom resolution with relatively low complication rates.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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