Hypertrophic Spinal Luetic Pachymeningitis: Neurosurgical Treatment. Case Report and Review of the Literature

Case descriptions of hypertrophic spinal pachymeningitis with compressive myelopathy are relatively rare in the literature. In recent years their number tends to increase as a result of the wider application of magnetic resonance imaging, the gold diagnostic standard for spinal pathology. Meningeal hyperplasia with reduction of the spinal subdural space is usually related to infectious diseases or considered idiopathic. Neurosurgical interventions performed in similar cases not only have a decompressive therapeutic effect, but also contribute to the diagnostic process by providing material for neuropathological assessment. The optimal surgical technique should be determined according to the specific clinical case. Methods of choice include laminectomy with excision of adhesions, aiming at spinal and root decompression, microsurgical technique (adhesiolysis) under optic magnification, and endoscopic subarachnoepidurolysis. We present the case of a 45-year-old woman with hypertrophic spinal luetic pachymeningitis and compressive myelopathy at the thoracic level, who underwent neurosurgical treatment: laminectomy at levels C7 to Th4 with excision of subdural adhesions, decompression of the spinal cord, and plastic reconstruction of the dura mater. Very good recovery of bladder functions and gait was achieved. The beneficial effect persisted on follow-up after 6 and 12 months.