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Symptomatic Spinal Cord Kinking Due to Focal Adhesive Arachnoiditis, With Ossification of the Ligamentum Flavum: A Case Report

Miyazaki, Masashi MD, PhD; Yoshiiwa, Toyomi MD, PhD; Ishihara, Toshinobu MD; Kaku, Nobuhiro MD, PhD; Kawano, Masanori MD, PhD; Tsumura, Hiroshi MD, PhD

Spine:
doi: 10.1097/BRS.0000000000000225
Case Report
Abstract

Study Design. A case report.

Objective. To describe a rare case of symptomatic spinal cord kinking due to focal adhesive arachnoiditis, with ossification of the ligamentum flavum (OLF).

Summary of Background Data. Spinal cord kinking without spinal surgery is rare, and symptomatic spinal cord kinking due to focal adhesive arachnoiditis, with OLF is even rarer.

Methods. A 66-year-old female presented with numbness of the lower extremities and subsequently experienced gait disturbance due to motor weakness. Magnetic resonance imaging of the thoracic spine showed anterior displacement and kinking of the spinal cord from T11 to T12. Laminectomy and OLF resection were performed. The arachnoid membrane at the affected part was markedly thick and seemed cloudy. Adhesiolysis for arachnoid adhesion and release of spinal kinking were performed.

Results. She could walk with a cane 6 months postoperatively. One year postoperatively, thoracic computed tomography–myelography showed that the cord was repositioned in the dural sac, and that release of the spinal cord kink was maintained.

Conclusion. Symptomatic spinal cord kinking due to focal adhesive arachnoiditis, with OLF is a rare clinical condition. It was difficult to diagnose the precise pathology of the spinal cord before surgery. Microsurgical arachnoidolysis resolved the spinal cord kinking, and no recurrence was noted within the follow-up period.

Level of Evidence: N/A

In Brief

A 66-year-old female presented with spinal cord kinking due to focal adhesive arachnoiditis, with ossification of the ligamentum flavum (OLF). OLF resection and adhesiolysis were performed. She could walk with a cane after 6 months, and the release of the spinal cord kinking remained 1 year after the surgery.

Author Information

From the Department of Orthopaedic Surgery, Oita University, Oita, Japan.

Address correspondence and reprint requests to Masashi Miyazaki, MD, PhD, Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan; E-mail: masashim@oita-u.ac.jp

Acknowledgment date: November 21, 2013. First revision date: December 21, 2013. Acceptance date: January 9, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins