Na Chuh-Hyoun, Ridwan Hani, Neuloh Georg, Schubert Gerrit Alexander, Nolte Kay, Prescher Andreas, Clusmann Hans, Blume Christian
Department of Neurosurgery, RWTH Aachen University Hospital, Germany.
Clinic for Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Germany.
Brain Spine. 2025 Jul 24;5:104336. doi: 10.1016/j.bas.2025.104336. eCollection 2025.
Dorsal arachnoid web (AW) is a rare cause of spinal cord compression, which is indicated on MRI by a dorsal indentation of the spinal cord (scalpel-sign). AW can be associated with a myelon lesion as a sign of secondary syringomyelia resulting from alterations of CSF flow-dynamics. The etiology of AW is unclear, and evidence-based treatment recommendations are still lacking.
A retrospective chart study was conducted on patients with the scalpel-sign, treated at a tertiary neurospine center between 2016 and 2024. Clinical presentation, imaging, and histopathological findings were evaluated, and treatment outcome was assessed using the thoracic Japanese Orthopedic Association (tJOA) score pre- and postoperatively, and anatomically and pathophysiologically contributing factors are discussed.
17 patients (mean age 55.5 ± 10.3 yrs, 9 males) were identified. Predilection site was the upper half of the thoracic spine, with additional syringomyelia in 9 patients (53 %). 10 patients (65 %) showed sensory deficits, 10 (59 %) motor symptoms, 10 (59 %) ataxia, 9 (53 %) back pain, and 7 (41 %) neuropathic pain. 10 (59 %) patients underwent surgery with web removal/adhesiolysis. Median follow-up was 176 days. Postoperatively, symptoms worsened in one patient, but improved in the majority of cases (mean tJOA pre-/postoperatively: 8 ± 1.1/9.2 ± 1.3; Wilcoxon signed-rank-test p < .02), with postoperative MRI showing regression of AW and syringomyelia.
Surgical intervention appeared beneficial in the majority of patients, even in those with longstanding symptoms and resulting in regression of spinal cord lesions. Awareness of AW should be raised, as it identifies a rare but effectively treatable cause of spinal cord compression and syringomyelia.
背侧蛛网膜网（AW）是脊髓压迫的罕见原因，在磁共振成像（MRI）上表现为脊髓背侧凹陷（手术刀征）。AW可与脊髓空洞症相关，作为脑脊液流动动力学改变导致继发性脊髓空洞症的体征。AW的病因尚不清楚，且仍缺乏基于证据的治疗建议。
对2016年至2024年在一家三级神经脊柱中心接受治疗的有手术刀征的患者进行回顾性病历研究。评估临床表现、影像学和组织病理学结果，并使用术前和术后的胸段日本骨科协会（tJOA）评分评估治疗结果，同时讨论解剖学和病理生理学方面的促成因素。
共确定17例患者（平均年龄55.5±10.3岁，男性9例）。好发部位为胸椎上半段，9例患者（53%）合并脊髓空洞症。10例患者（65%）出现感觉障碍，10例（59%）出现运动症状，10例（59%）出现共济失调，9例（53%）出现背痛，7例（41%）出现神经性疼痛。10例患者（59%）接受了蛛网膜网切除/粘连松解手术。中位随访时间为176天。术后，1例患者症状恶化，但大多数患者症状改善（术前/术后tJOA评分平均值：8±1.1/9.2±1.3；Wilcoxon符号秩检验p<0.02），术后MRI显示AW和脊髓空洞症消退。
手术干预对大多数患者似乎有益，即使是那些有长期症状的患者，且能使脊髓病变消退。应提高对AW的认识，因为它是一种罕见但可有效治疗的脊髓压迫和脊髓空洞症原因。
