Progressive arachnoiditis following spine surgery: a case report

• Spinal adhesive arachnoiditis in a 43-year-old female with multiple concurrent pathologies. • Varied physical examination and symptoms leading to complex case. • Supplemental imaging and multispecialty collaboration to aid diagnosis. • Additional tips for diagnosing post-surgical arachnoiditis. Spinal adhesive arachnoiditis is a rare condition with unclear etiology and limited treatment options. This case describes a patient who developed arachnoiditis after L4/L5 and L5-S1 decompression laminectomies with foraminotomies. Post-surgical MRI suggested a lesion within the spine initially thought to be an intrathecal pooling of blood, and later imaging revealed probable early onset adhesive arachnoiditis. The diagnosis was ultimately made using the imaging and the patient’s broad, evolving range of neurological symptoms. Despite the diagnostic complexity, the patient eventually made a full recovery following conservative management and careful monitoring. This case is significant in that it demonstrates how adhesive arachnoiditis can unfold progressively over time, presenting as a series of overlapping and misleading pathologies. This case also emphasizes the importance of how multidisciplinary collaboration plays a vital role in accurately identifying and managing such cases in current practice. Given the diagnostic complexity, further research is needed to clarify the pathophysiology and to define specific clinical and radiologic patterns that facilitate earlier recognition.