Arachnoiditis ossificans of the cauda equina demonstrated on computed tomography scanogram - A case report

Study Design. This case report illustrates a patient with arachnoiditis ossificans of the cauda equina of sufficient severity to be demonstrable on a computed tomography scout view. Objectives. The diagnosis of extensive arachnoiditis ossificans by computed tomography does not necessitate surgical intervention. The authors' patient had only mild, chronic symptoms when treated expectantly. Summary of Background Data. The value of axial computed tomography in visualizing and characterizing the lesions of arachnoiditis ossificans has been well documented. Arachnoiditis ossificans involving the cauda equina is uncommon. To the authors' knowledge, this report represents the first case of arachnoiditis ossificans of the cauda equina in which the arachnoid calcifications were of sufficient density to be obvious on a computed tomography scan. Methods. The patient was reviewed by a neurologist for paraesthesia in his right foot, occasional backaches, and urinary frequency. Physical examination revealed only a mild loss of lumbar lordosis and an area of hypoesthesia in the right foot. He then was investigated with computed tomography, which showed extensive arachnoiditis ossificans. Because his symptoms were mild, surgery was not contemplated. Results. The patient's symptoms remained minimal despite being treated conservatively. Conclusions. The value of computed tomography in delineating the lesions of arachnoiditis ossificans and the outcome of surgery for resection of its compressive osseous plaques have been well described. Despite extensive arachnoid calcification caused by arachnoiditis ossificans involving the cauda equina that was visible on a computed tomography scan, this patient continued to have only low-grade symptoms when treated conservatively.