Spontaneous-Onset Delayed Spinal Arachnoiditis With Dorsal Cord Herniation in a 29-Year-Old Paraplegic Patient: A Case Report

Spinal adhesive arachnoiditis is a rare condition causing inflammation of the arachnoid, leading to adhesion and fibrosis around nerve roots. This can disrupt cerebrospinal fluid and vascular flow, resulting in varying degrees of neurological deficits. Spontaneous spinal cord herniation occurs when the spinal cord is displaced through a dural or arachnoid defect. This case reports a patient with both spontaneous-onset delayed spinal arachnoiditis and dorsal cord herniation. The patient, a 29-year-old male paraplegic, experienced loss of truncal balance two years after surgery for an intradural extramedullary lesion. He was diagnosed with spinal arachnoiditis and dorsal cord herniation through a laminectomy window.

• 1
  The patient presented with ascending sensory level changes, reaching T4, and a loss of truncal balance, indicating a new pathology at the cord level.
• 2
  MRI revealed loculated fluid collection around the spinal canal, extending from T9 to T12, involving the distal cord, conus medullaris, and cauda equina nerve roots. Cord edema was also present up to the T6 level.
• 3
  CSF analysis confirmed a methicillin-resistant Staphylococcus aureus (MRSA) infection, leading to treatment with vancomycin and intravenous steroids, resulting in clinical improvement and resolution of cord edema and herniation.