Obliterative arachnoiditis complicating lumbar spinal stenosis

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Abstract
Five patients with spinal stenosis had a total myelographic block at the level of the obliterated subarachnoid space. Arachnoiditis was not considered as a primary diagnosis until laminectomy revealed a non-pulsating, thickened dural sac that conformed to the internal configuration of the involved spinal canal. Two patients had stenosis complicated by spondyloarthrosis over multiple lumbar levels, one had a previous spinal fusion, another had degenerative spondylolisthesis and the 5th had a large midline extruded disc at L2-3 that completely blocked the spinal canal. The dura was opened in 2 patients, confirming the lesion. Despite obliteration of the subarachnoid space, significant relief for approximately 1 yr followed decompressive laminectomy, foraminotomy and discectomy, with disappearance of neurogenic claudication in 3 patients. Postoperative erect films showed no caudad passage of contrast. While further observations are required, an awareness of this complication of spinal stenosis is important in the diagnosis and management of such patients and in evaluating their ultimate prognosis.