European Spine Journal

, Volume 21, Supplement 4, pp 436–440 | Cite as

Arachnoid ossificans containing metaplastic hematopoietic marrow resulting in diffuse thoracic intrathecal cysts and severe myelopathy

  • Joshua AbramsEmail author
  • Gordon Li
  • Stefan A. Mindea
  • Claudia M. Haynes
  • Ivan Cheng
Case Report



To present a rare case of multiple compressive thoracic intradural cysts with pathologic arachnoid ossification, review the literature and present the surgical options.

Summary of background data

Few reports have identified the existence of arachnoid calcifications and intrathecal cysts causing progressive myelopathy. The literature regarding each of these pathologies is limited to case reports. Their clinical significance is not well studied, although known to cause neurologic sequelae.


An 81-year-old female clinically presents with rapidly progressive myelopathy. Pre-operative magnetic resonance imaging identified multiple compressive thoracic intrathecal cysts. Surgical exploration and decompression of these cysts identified calcified plaques within the arachnoid. Histopathologic examination revealed fibrocalcific tissue undergoing ossification with bone marrow elements.


Due to progressive myelopathy, the thoracic cysts were decompressed and calcified plaques were excised, once identified intra-operatively.


On last examination, the patient’s neurologic status had not improved, but had stabilized. The rate of neurologic improvement from excision and decompression is variable, but it may still be warranted in the face of progressive neurologic deficits.


Arachnoid ossification Intrathecal cysts Myelopathy Osseous metaplasia 


Conflict of interest

None of the authors has any potential conflict of interest.


  1. 1.
    Revilla TY, Ramos A, Gonzalez P, Alday R, Milla’n JM (1999) Arachnoiditis ossificans. Diagnosis with helical computed tomography. Clin Imaging 23:1–4PubMedCrossRefGoogle Scholar
  2. 2.
    Kitagawa H, Kanamori M, Tatezaki S, Itoh T, Tsuji H (1990) Multiple spinal ossified arachnoiditis. A case report. Spine 15:1236–1238PubMedCrossRefGoogle Scholar
  3. 3.
    Whittle IR, Dorsch NW, Segelov JN (1982) Symptomatic arachnoiditis ossificans. Report of two cases. Acta Neurochir 65:207–216CrossRefGoogle Scholar
  4. 4.
    Testworth KD, Ferguson RL (1986) Arachnoiditis ossificans of the cauda equine: a case report. Spine 11:765–766CrossRefGoogle Scholar
  5. 5.
    Sakai T, Sairyo K, Kashima M, Kosaka H, Katoh S, Yasui N (2009) Diffuse arachnoid ossification and multiple arachnoid cysts presenting with progressive thoracic myelopathy. Skeletal Radiol 39:299–304PubMedCrossRefGoogle Scholar
  6. 6.
    Papavlasopoulos F, Stranjalis G, Kouyialis AT et al (2007) Arachnoiditis ossificans with progressive syringomyelia and spinal arachnoid cyst. J Clin Neurosci 14:572–576PubMedCrossRefGoogle Scholar
  7. 7.
    Kaufman AB, Dunsmore RH (1971) Clinicopathological considerations in spinal meningeal calcifications and ossification. Neurology 21:1243–1248PubMedCrossRefGoogle Scholar
  8. 8.
    Jaspan T, Preston BJ, Mulholland RC, Webb JK (1990) The CT appearances of archnoiditis ossificans. Spine 15:148–151PubMedCrossRefGoogle Scholar
  9. 9.
    Perry NG, Lorentz I, Sun Soo Y (1996) Arachnoiditis ossificans of the cauda equina demonstrated on computed tomography scanogram. A case report. Spine 21:2504–2507CrossRefGoogle Scholar
  10. 10.
    Toribatake Y, Baba h, Maezawa Y, Umeda S, Tomita K (1995) Symptomatic arachnoiditis ossificans of the thoracic spine. Case report. Paraplegia 33:224–227PubMedCrossRefGoogle Scholar
  11. 11.
    Van Paesschen W, Van Den Kerchove M, Appel B, Klaes R, Neeens I, Lowenthal A (1990) Arachnoiditis ossificans with arachnoid cyst after cranial tuberculous meningitis. Neurology 40:714–716PubMedCrossRefGoogle Scholar
  12. 12.
    Barthelemy CR (1982) Arachnoiditis ossificans. Case report. J Comput Assist Tomogr 6:809–811PubMedCrossRefGoogle Scholar
  13. 13.
    Burton V (1978) Lumbosacral arachnoiditis. Spine 3:24–30PubMedCrossRefGoogle Scholar
  14. 14.
    Collins DH, Curran RC (1959) Pathological calcification and osseous metaplasia in man. In: Modern trends in pathology, 2nd edn. Butterworth, LondonGoogle Scholar
  15. 15.
    Nainkin L (1978) Arachnoiditis ossificans. Report of a case. Spine 3:83–86PubMedCrossRefGoogle Scholar
  16. 16.
    Wijdicks CA, Williams JM (2007) Spinal arachnoid calcifications. Clin Anat 20(5):521–523PubMedCrossRefGoogle Scholar
  17. 17.
    Slavin KV, Nixon RR, Nesbit GM et al (1999) Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature. Neurosurg Focus 6:E11CrossRefGoogle Scholar
  18. 18.
    Slager UT (1960) Arachnoiditis ossificans Report of a case and review of the subject. Arch Pathol 70:322–327PubMedGoogle Scholar
  19. 19.
    Lynch C, Moraes GP (1983) Spinal arachnoiditis ossificans: case report. Neurosurgery 12:321–324PubMedCrossRefGoogle Scholar
  20. 20.
    Tagaki T, Nomura T, Toh E, Watanabe M, Mochida J (2006) Multiple extradural arachnoid cysts at the spinal cord and cauda equina levels in the young. Spinal Cord 44:59–62CrossRefGoogle Scholar
  21. 21.
    Kahler RJ, Knuckey NW, Davis S (2000) Arachnoiditis ossificans and syringomyelia: a unique case report. J Clin Neurosci 7(1):66–68PubMedCrossRefGoogle Scholar
  22. 22.
    Hatashita S, Kondo A, Shimizu T, Kurosu A, Ueno H (2001) Spinal extradural arachnoid cyst. Neurol Med Chir (Tokyo) 41:318–321CrossRefGoogle Scholar
  23. 23.
    Andrews BT, Weinstein PR, Rosenblum ML et al (1988) Intradural arachnoid cysts of the spinal canal associated with intramedullary cysts. J Neurosurg 68:544–549PubMedCrossRefGoogle Scholar
  24. 24.
    Kendall BE, Valentine AR, Keis B (1982) Spinal arachnoid cysts: clinical and radiological correlation with prognosis. Neuroradiology 22:225–234PubMedCrossRefGoogle Scholar
  25. 25.
    McCormick P, Stein B (1990) Arachnoid cysts. Neurosurg Clin North Am 695:695–696Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Joshua Abrams
    • 1
    Email author
  • Gordon Li
    • 2
  • Stefan A. Mindea
    • 2
  • Claudia M. Haynes
    • 3
  • Ivan Cheng
    • 1
  1. 1.Department of OrthopedicsStanford University Medical CenterStanfordUSA
  2. 2.Department of NeurosurgeryStanford University Medical CenterStanfordUSA
  3. 3.Department of PathologyStanford University Medical CenterStanfordUSA

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