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Adhesive arachnoiditis - empty thecal sac sign

Case contributed by Roberto Schubert
Diagnosis certain

Presentation

Recurrent bilateral sciatica. History of lumbar spine surgery.

Patient Data

Age: 65 years
Gender: Female

The prior operation was obviously performed at the L5/S1 level. Here and caudally, the thecal sac appears devoid of its cauda roots.

Case Discussion

This is considered as a sign of (prior) adhesive arachnoiditis with adhesions developing between nerve roots and the parietal arachnoid.

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