MEDULLARY COMPRESSION FROM SPINAL ARACHNOID CYST: A CASE REPORT AND REVIEW OF LITERATURE

G. Giani¹, M. Berdini² , L. Meco³ , N. Specchia⁴ , M. Iacoangeli⁵ , A. P. Gigante⁴ , M. Martiniani⁴

¹ linic of Adult and Pediatric Orthopedics , Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
² Clinic of Adult and Pediatric Orthopedics , Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
³ Clinic of Adult and Pediatric Orthopedics, Ancona University Hospital, Ospedali Riuniti di Ancona, Ancona, Italy
⁴ Clinic of Adult and Pediatric Orthopedics, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
⁵ Clinic of Neuro-oncological Surgery and Urgency, Ancona University Hospital “Ospedali Riuniti di Ancona”, Ancona, Italy

Correspondence to:

Journal of Orthopedics 2023 Jan-Apr; 15(1): 48-56
https://doi.org/10.69149/orthopedics/2023v15iss1_77

Received: 13 March 2023 Accepted: 20 April 2023

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Abstract

Arachnoid cysts, extradural or intradural, represent a fairly rare cause of compression of the spinal cord. They are mainly intradural cysts, mainly located in the cervico-thoracic sector. The onset is frequently characterized by motor deficits (i.e. tetraparesis, paraparesis), dysesthesia and pain. Here we describe the case of a 51-year-old man who showed a sensory-motor deficit secondary to a spinal arachnoid cyst (SAC) diagnosed by MR investigation and surgically removed with clinical improvement. We also present a review of literature about terminology, presentation, recommended investigations, management and outcomes of patients with Spinal Arachnoid Cyst. The patient was clinically evaluated at the admission, after the surgical treatment and with one year follow-up. We recorded clinical scores such as Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire (RMDQ). The radiographic investigations for the definition of the pathology were X-ray and MRI of the spine, electrophysiological investigations was also performed. The evaluation and treatment of the patient was carried out with a combined approach between an orthopedic specialist and a neurosurgeon. For the review of the literature a PubMed, NCBI and Google Scholar search was performed with keywords ‘Spinal Arachnoid Cyst’ and ‘spinal arachnoid cyst with spinal cord compression’. After surgical treatment there was a positive progress with recovery. At three months follow-up the limitation of movements and weakness of the upper limbs were recovered. At one year follow-up the patient had already resumed normal daily activities without any reported limitations. For the review of the literature we found 7 articles about the arachnoid cyst of the dorsal spine, of which 6 are single case reports and only one collects two cases. SACs are rare lesions that can present with various neurological symptoms: paraesthesia, neuropathic pain, paresis, and gait disturbances. Conservative treatment with careful observation may be an acceptable option for asymptomatic patients. However, in patients with progressive or recurrent symptoms, surgery is the gold standard of treatment.

Keywords: arachnoid cyst adult, cord compression, decompression arachnoid cyst, dorsal arachnoid cyst, medullary compression, spinal arachnoid cyst