Neurosurgical Challenges in Recurrent Adhesive Arachnoiditis After Spinal Anesthesia for Cesarean Delivery: Case Report and Literature Review.

Adhesive arachnoiditis (AA) is a rare, chronic inflammatory condition affecting the pia-arachnoid layers, characterized by fibrosis and adhesion formation. It leads to nerve root adhesion and spinal cord compression, often resulting in severe neurological impairment. Commonly associated etiologies include prior spinal surgeries, infections, subarachnoid hemorrhage, epidural anesthesia, myelography, contrast agents, chemical irritation, and, occasionally, idiopathic factors. Following the literature review, 12 cases of AA related to anesthesia and obstetric procedures were identified.  We report the case of a 39-year-old woman presenting with lower limb weakness and thoracic paresthesia three months after receiving spinal anesthesia during a cesarean section. Magnetic resonance imaging (MRI) revealed extensive spinal cord edema and an expanding cystic lesion causing spinal cord compression. Despite initial corticosteroid treatment, the patient developed severe iatrogenic Cushing syndrome. She underwent two thoracic decompression surgeries, including microsurgical AA resection and cyst fenestration, which resulted in transient improvement but eventual symptom recurrence and persistent disability.  AA should be considered a potential complication in patients who develop neurological symptoms after spinal anesthesia. Early diagnosis via MRI and prompt initiation of corticosteroid therapy, surgical spinal cord decompression, and cyst drainage are critical for optimal outcomes, although recurrences are common.