Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York, USA.
Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.
Neurosurgery. 2022 May 1;90(5):581-587. doi: 10.1227/neu.0000000000001884.
Dorsal arachnoid webs (DAWs) are rare pathological abnormalities of the arachnoid layer of the spinal cord that can result in pain and myelopathy.
To present clinical, imaging, and pathological characteristics of patients diagnosed with DAW, case illustrations, and a review of the literature.
Seventeen cases of DAW between 2015 and 2019 at a tertiary medical center were retrospectively identified through a case log search. Patient characteristics, preoperative imaging, operative notes, and pathology reports were collected. Our main outcome assessed was postoperative resolution of symptoms. Odds ratios were used to determine associations between preoperative signs and symptoms with postoperative symptom resolution.
The mean age of the cohort was 50.5 years (IQR = 16) and presented primarily with back pain (64.7%). On imaging, all patients were found to have the "scalpel sign," and nearly half had a syrinx present (41.2%). All DAWs were located in the thoracic spine, with the most common location being the midthoracic (70.6%). The mean follow-up length for all patients was 4.3 months. There were no preoperative symptoms significantly associated with postoperative symptom resolution; however, a trend was noted with the presence of a preoperative syrinx. Pathology samples consistently demonstrated fibroconnective or collagenous tissue with no evidence of inflammation or neoplasm.
DAW is a rare pathology that can result in myelopathy or inappropriate interventions if misdiagnosed. Surgical intervention using laminectomy with intradural exploration should be considered in symptomatic patients with DAW because it is curative with a strong chance of preoperative symptom resolution with relatively low complication rates.
背侧蛛网膜 webs（DAWs）是脊髓蛛网膜层罕见的病理性异常，可导致疼痛和脊髓病。
介绍诊断为 DAW 的患者的临床、影像学和病理学特征、病例说明以及文献复习。
通过病例记录搜索，回顾性地确定了 2015 年至 2019 年在一家三级医疗中心的 17 例 DAW 病例。收集了患者特征、术前影像学、手术记录和病理报告。我们主要的评估结果是术后症状的缓解。使用比值比来确定术前症状与术后症状缓解之间的关联。
该队列的平均年龄为 50.5 岁（IQR=16），主要表现为背痛（64.7%）。在影像学上，所有患者均发现存在“手术刀征”，近一半患者存在脊髓空洞（41.2%）。所有 DAW 均位于胸椎，最常见的部位是中胸段（70.6%）。所有患者的平均随访时间为 4.3 个月。没有术前症状与术后症状缓解显著相关；然而，术前脊髓空洞的存在存在趋势。病理样本均显示纤维连接组织或胶原组织，无炎症或肿瘤证据。
DAW 是一种罕见的病理学疾病，如果误诊可能导致脊髓病或不适当的干预。对于有症状的 DAW 患者，应考虑采用椎板切除术伴硬脊膜内探查的手术干预，因为它是一种治愈性的方法，术前症状缓解的可能性很大，且并发症发生率相对较低。
