Post-Procedural Adhesive Arachnoiditis With Subsequent Incomplete Paraplegia

Research Objectives To describe a case of adhesive arachnoiditis in the setting of obstetric anesthesia. Design Case report. Setting Tertiary care academic hospital system. Participants This is a case report of one patient. Interventions This is a 36-year-old G3P3003 female with vaginal birth after cesarean complicated by pre-eclampsia with severe features who developed bilateral leg weakness and loss of sensation in the setting of obstetric anesthesia. The patient did not endorse any motor or sensory deficits after her delivery with epidural anesthesia. However, within hours after a same-day tubal ligation with spinal anesthesia, she developed incomplete paralysis (AIS D) in her lower extremities with loss of sensation. She had associated urinary retention and bowel incontinence since symptom onset. MRI displayed diffuse thickening and enhancement of the cauda equina nerve roots concerning for arachnoiditis. Few treatment options are available, with surgical interventions demonstrating poor outcomes. In this case, a conservative approach was pursued with a three day course of IV solumedrol. Main Outcome Measures This is a descriptive case report, there are no measured outcomes. Results The patient continues to experience paresthesias in the lower extremities, urinary retention managed by clean intermittent catheterization, and fecal incontinence with improved self-disimpaction using valsalva. Her motor function has shown significant recovery after only three weeks of acute inpatient rehabilitation, as she is walking short distances with partial assist using a rolling walker and bilateral knee ankle foot orthoses. Conclusions Progressive ascending weakness and sensory loss in the setting of procedures using spinal anesthesia should alert clinicians to the workup of adhesive arachnoiditis. Author(s) Disclosures None.