Empty thecal sac sign

Dr Craig Hacking and Dr Tom Millner et al.

The empty thecal sac sign or empty sac sign is when the thecal sac appears empty on MRI of the lumbar spine, best seen on T2-weighted images. If the empty thecal sac sign is present, a diagnosis of adhesive arachnoiditis can be made.​

Radiographic features


There is usually no gadolinium contrast enhancement. Delamarter et al. 1 described three categories of MRI appearances consistent with chronic adhesive arachnoiditis. Groups 1 and 2 were mild and group 3 severe.  Groups 1 and 2 were consistent with adhesions developing between nerve roots and the parietal arachnoid.

The adherent nerve roots were seen centrally within the CSF in group 1. Whilst in group 2 the nerve roots were adherent peripherally to the theca, which leads to the appearance of an empty thecal sac.

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Article information

rID: 14052
Section: Signs
Synonyms or Alternate Spellings:
  • Empty sac sign
  • Empty theca sign

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