Thecoperitoneal shunt placement for extensive spinal adhesive arachnoiditis or lumbosacral outlet obstruction with syringomyelia

Purpose: The pathways of clearance of cerebrospinal fluid (CSF) in the spine remains incompletely understood. While our minimally invasive subarachnoid-subarachnoid bypass technique has demonstrated efficacy in Syringomyelia related to spinal subarachnoid obstruction, its therapeutic utility is significantly limited in extensive spinal adhesive arachnoiditis (ESAA; >5 spinal levels involvement) or Lumbosacral Outlet Obstruction with Syringomyelia. This study evaluates thecal-peritoneal shunting as a novel intervention for ESAA or Lumbosacral Outlet Obstruction with Syringomyelia. Methods: We prospectively evaluated 20 consecutive Extensive Spinal Adhesive Arachnoiditis or Lumbosacral Outlet Obstruction with Syringomyelia patients undergoing thecal-peritoneal shunting, with a mean follow-up of 14 months (range 12–20 months). Intraspinal pressure was measured intraoperatively at sites cranial to arachnoid adhesions and preoperatively caudal to adhesions during myelography. Twenty baseline-matched small spinal meningioma or schwannoma patients served as controls with intraoperative pressure measurements. Results: The procedure yielded clinical improvement in 16 patients (80%), with 4 (20%) maintaining stable symptoms. Radiological assessment demonstrated syrinx reduction in 10 patients (50%). Transient complications occurred in 4 cases (20%; headache [n = 3], fever [n = 1]), all resolving within two weeks. Pressure analysis revealed significantly elevated cranial versus caudal pressures relative to adhesions (P < 0.05), with effective cranial pressure wave normalization post-shunting (P < 0.05). Conclusions: The thecal-peritoneal shunt represents an effective treatment for Extensive Spinal Adhesive Arachnoiditis or Lumbosacral Outlet Obstruction with Syringomyelia patients, preserving spinal cord integrity while normalizing pathological CSF pressure gradients wave by diverting CSF to the peritoneal cavity and bypassing the impaired lumbosacral drainage buffering pathway.