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    Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography

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    Author
    Schultz, R., Jr.
    Steven, A.
    Wessell, A.
    Date
    2017
    Journal
    Journal of Neurosurgery: Spine
    Publisher
    American Association of Neurological Surgeons
    Type
    Article
    
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    See at
    https://www.doi.org/10.3171/2016.11.SPINE16696
    Abstract
    OBJECTIVE: Dorsal arachnoid webs (DAWs) and spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. Differentiating these 2 entities on the basis of clinical presentation and radiological findings remains challenging but is of vital importance in planning a surgical approach. The authors examined the differences between DAWs and idiopathic SCH on MRI and CT myelography to improve diagnostic confidence prior to surgery. METHODS: Review of the picture archiving and communication system (PACS) database between 2005 and 2015 identified 6 patients with DAW and 5 with SCH. Clinical data including demographic information, presenting symptoms and neurological signs, and surgical reports were collected from the electronic medical records. Ten of the 11 patients underwent MRI. CT myelography was performed in 3 patients with DAW and in 1 patient with SCH. Imaging studies were analyzed by 2 board-certified neuroradiologists for the following features: 1) location of the deformity; 2) presence or absence of cord signal abnormality or syringomyelia; 3) visible arachnoid web; 4) presence of a dural defect; 5) nature of dorsal cord indentation (abrupt "scalpel sign" vs "C"-shaped); 6) focal ventral cord kink; 7) presence of the nuclear trail sign (endplate irregularity, sclerosis, and/or disc-space calcification that could suggest a migratory path of a herniated disc); and 8) visualization of a complete plane of CSF ventral to the deformity. RESULTS: The scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified. CONCLUSIONS: DAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of the ventral subarachnoid space at the level of the cord deformity. Copyright AANS, 2017.
    Keyword
    Arachnoid web
    Congenital
    Cord herniation
    CT myelography
    MRI
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85020176922&doi=10.3171%2f2016.11.SPINE16696&partnerID=40&md5=8723652662f05b2fb6f55af735d80f75; http://hdl.handle.net/10713/10025
    ae974a485f413a2113503eed53cd6c53
    10.3171/2016.11.SPINE16696
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    UMB Open Access Articles 2017

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