1486. Arachnoid Web of the Spine: A Systematic Literature Review
Authors: Peyton Lubbock Nisson; Ibrahim Hussain, MD; Roger Hardle, MD; Samuel Kim, MD; Ali Baaj, MD (Tucson, AZ)
Arachnoid webs of the spine (AWS) are a rare and often times challenging lesion to diagnose given its subtle radiographic finding. However, when left untreated these can have devastating effects on a patients’ neurologic function. To date, only limited case reports and series have been published on this topic.
A systematic literature search was performed in September 2018 querying several scientific databases, per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with AWS for which any relevant surgery types were considered and applied.
A total of 19 records and 2 patients treated by the senior authors were included in the systematic review, providing 43 patients with AWS. The mean age was 52 years (Range 28 – 77 years) and the majority of patients were male (72%, 31/43). A syrinx was present in 69% (29/42) of the cases. All AWS were located in the thoracic spine and all but 2 (95%) were located on the dorsally (1 ventrally and 1 circumferentially).
Weakness was the most frequently reported symptom (67%, 29/43), followed by numbness and or sensory loss (65% 28/43). The most commonly used surgical technique was a laminectomy with intradural excision of the arachnoid web (73%, 30/41). Following surgery, 91% (39/43) of patients had reported improvement in their neurologic symptoms. The mean follow-up was 7 months (Range 0-51).
AWS of the spine can be a debilitating disease of the spine with no more than an indentation of the spinal cord found on advanced imaging studies. We found this lesion more commonly occurred in males, was associated with a syrinx more than 2/3 of the time, to only have been reported in the thoracic spine, and over 90% of patients experienced improvement in their neurologic function following surgery.