Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case.

BACKGROUND: Spontaneous spinal subarachnoid hemorrhage is a rare pathological entity with a variety of presentations depending on the underlying etiology, which often remains cryptogenic. The literature is sparse regarding the most efficacious treatment or management option, and there is no consensus on follow-up time or modalities. Additionally, there are very few reports that include operative videos, which is provided herein. OBSERVATIONS: The authors present a case of spontaneous spinal subarachnoid hemorrhage without an underlying etiology in a patient with progressive myelopathy, back pain, and lower-extremity paresthesias. She presented to our institution, and because of progressive worsening of her symptoms and the development of compressive arachnoid cysts, she underwent thoracic laminectomies for evacuation of subdural fluid, fenestration of the arachnoid cysts, and lysis of significant arachnoid adhesions. Her clinical course was further complicated by the recurrence of worsening myelopathy and the development of a large compressive arachnoid cyst with further arachnoiditis. The patient underwent repeat surgical intervention for cyst decompression with an improvement in symptoms. LESSONS: This case highlights the importance of long-term follow-up for these complicated cases with an emphasis on repeat magnetic resonance imaging. Unfortunately, surgical intervention is associated with short-term relief of the symptoms and no significant nonoperative management is available for these patients.

Using Finite Element Models to Assess Spinal Cord Biomechanics after Cervical Laminoplasty for Degenerative Cervical Myelopathy.

Cervical laminoplasty is an established motion-preserving procedure for degenerative cervical myelopathy (DCM). However, patients with pre-existing cervical kyphosis often experience inferior outcomes compared to those with straight or lordotic spines. Limited dorsal spinal cord shift in kyphotic spines post-decompression and increased spinal cord tension may contribute to poor neurological recovery and spinal cord injury. This study aims to quantify the biomechanical impact of cervical sagittal alignment on spinal cord stress and strain post-laminoplasty using a validated 3D finite element model of the C2-T1 spine. Three models were created based on the C2-C7 Cobb angle: lordosis (20 degrees), straight (0 degrees), and kyphosis (-9 degrees). Open-door laminoplasty was simulated at C4, C5, and C6 levels, followed by physiological neck flexion and extension. The results showed that spinal cord stress and strain were highest in kyphotic curvature compared to straight and lordotic curvatures across all cervical segments, despite similar segmental ROM. In flexion, kyphotic spines exhibited 103.3% higher stress and 128.9% higher strain than lordotic spines and 16.7% higher stress and 26.8% higher strain than straight spines. In extension, kyphotic spines showed 135.4% higher stress and 241.7% higher strain than lordotic spines and 21.5% higher stress and 43.2% higher strain than straight spines. The study shows that cervical kyphosis leads to increased spinal cord stress and strain post-laminoplasty, underscoring the need to address sagittal alignment in addition to decompression for optimal patient outcomes.