Minimally invasive tubular resection of spinal arachnoid webs.

Abstract

Introduction: Spinal arachnoid webs (SAWs) are rare intradural extramedullary lesions causing progressive myelopathy. For surgical resection, minimally invasive approaches, especially using tubular retractors, remain underreported.

Research question: This study presents a series of minimally invasive SAW resections performed through expandable and non-expandable tubular retractors.

Material and methods: This retrospective monocentric cohort study included patients with minimally invasive tubular resection of SAWs between July 2017 and December 2025. Preoperative and postoperative status was assessed using the modified McCormick grading scale, surgical details were descriptively analyzed.

Results: The cohort comprised 5 male and 7 female patients (mean age 61.1 ± 8.8 years). All patients presented with progressive myelopathy. All lesions were located in the upper thoracic spine, with T2-3 being most common. All patients demonstrated the pathognomonic scalpel sign on preoperative MRI, two patients (17%) had associated syringomyelia. Surgical technique involved expandable (3/12) and non-expandable tubular retractors (20 mm diameter, 9/12). Mean operative time was 110 ± 30 min with minimal blood loss in all cases. Two patients required revision surgery. No permanent neurological deficits occurred, and all patients maintained stable or improved neurological function postoperatively.

Discussion and conclusion: This series represents the largest experience with tubular resection of SAWs using non-expandable retractor systems with 20 mm diameter access corridors. The revision rate aligns with the published literature and reflects the technical challenges rather than a limitation of the approach. This truly minimally invasive approach is safe and effective in appropriately selected patients and in experienced centers.