Spinal Adhesive Arachnoidopathy, the Disorder More Than Simply Adhesive Arachnoiditis: A Comprehensive Systematic Review of 510 Cases

IF 4.8 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2024-10-22 DOI:10.1111/cns.70084

Weikang Zhang, Zhenlei Liu, Kai Wang, Lei Zhang, Shaocheng Liu, Xiangyu Zhang, Yutian Wang, Kun He, Hao Wu

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Abstract

Background

Spinal adhesive arachnoidopathy (SAA) is a chronic pathology associated with persistent inflammatory responses in the arachnoid. Adhesive arachnoiditis (AA) is one of the major forms of SAA, with accompanying secondary complications. Therefore, we aimed to systematically review both clinical and animal model studies related to SAA to gain a deeper understanding of this unique pathology.

Methods

A literature search was conducted in PubMed, EMBASE, and Cochrane Library databases to retrieve relevant publications up to October 2022. Clinical manifestations, etiologies, imaging modalities, treatments, and prognosis in patients with SAA were collected. Data from animal experiments related to SAA were also extracted.

Results

A total of 176 studies, including 147 clinical and 29 animal model studies, with a total of 510 patients were enrolled in this study. Pain (37.5%), abnormal nerve sensations (39.58%), and abnormal motor function (78.75%) were the top three common symptoms of SAA. Major etiologies included trauma (22.7%), infection (17.73%), surgery (15.37%), and hemorrhage (13.48%). MRI was widely used to confirm the diagnosis. AA could be involved in cervical (96/606, 15.84%), thoracic (297/606, 49.01%), lumbar (174/606, 28.71%), and sacrococcygeal (39/606, 6.44%) vertebral segments. Patients with AA in cervical segments had a higher post-surgery recovery rate (p = 0.016) compared to that of other segments. The common pathological diagnoses of SAA were AA (80.82%), AA combined with arachnoid cyst (12.79%), arachnoid calcification/scars (3.43%), and arachnoid web/fibrosis (2.97%). Patients with AA were more likely to develop syringomyelia, compared with patients with other forms of SAA (p < 0.001). Animal studies mainly focused on new AA therapeutic agents (n = 14), the pathomechanism of AA (n = 14), and the development of new MRI sequences for improved diagnosis (n = 1).

Conclusions

The pathological consequences of SAA are more complex than AA and manifest in different forms, such as AA combined with arachnoid cyst, arachnoid calcification/scars, and arachnoid web/fibrosis. In many instances, AA was associated with secondary syringomyelia. Unspecific clinical manifestations of SAA may easily lead to misdiagnosis and missed diagnosis. Although SAA may result from multiple etiologies, including spinal trauma, meningitis, spinal surgery, and hemorrhage, the pathogenesis and treatment of SAA have still not been standardized.

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脊髓粘连性蛛网膜病，一种不仅仅是粘连性蛛网膜炎的疾病：510 个病例的全面系统回顾。

背景：脊髓粘连性蛛网膜病（SAA）是一种与蛛网膜持续炎症反应有关的慢性病变。粘连性蛛网膜炎（AA）是 SAA 的主要形式之一，并伴有继发性并发症。因此，我们旨在系统回顾与 SAA 相关的临床和动物模型研究，以深入了解这种独特的病理现象：方法：在 PubMed、EMBASE 和 Cochrane Library 数据库中进行文献检索，检索截至 2022 年 10 月的相关出版物。收集了 SAA 患者的临床表现、病因、影像学模式、治疗方法和预后。此外，还提取了与SAA相关的动物实验数据：本研究共纳入了 176 项研究，包括 147 项临床研究和 29 项动物模型研究，共计 510 名患者。疼痛（37.5%）、神经感觉异常（39.58%）和运动功能异常（78.75%）是 SAA 常见的三大症状。主要病因包括外伤（22.7%）、感染（17.73%）、手术（15.37%）和出血（13.48%）。核磁共振成像被广泛用于确诊。AA可累及颈椎（96/606，15.84%）、胸椎（297/606，49.01%）、腰椎（174/606，28.71%）和骶尾椎（39/606，6.44%）。与其他节段相比，颈椎节段 AA 患者的术后恢复率更高（P = 0.016）。SAA 常见的病理诊断为 AA（80.82%）、AA 合并蛛网膜囊肿（12.79%）、蛛网膜钙化/疤痕（3.43%）和蛛网膜网/纤维化（2.97%）。与其他形式的 SAA 患者相比，AA 患者更有可能患上鞘膜积液（P 结论）：SAA的病理后果比AA更复杂，表现形式也不同，如AA合并蛛网膜囊肿、蛛网膜钙化/疤痕和蛛网膜网/纤维化。在许多情况下，AA 与继发性鞘膜积液有关。SAA 的临床表现不明确，很容易导致误诊和漏诊。尽管 SAA 可能由多种病因引起，包括脊柱创伤、脑膜炎、脊柱手术和出血，但 SAA 的发病机制和治疗方法仍未统一。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.