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A 29-year-old man developed paraparesis with bladder and rectal dysfunction after a minor traffic accident. CT showed no fractures, and MRI demonstrated no intramedullary signal change, with only mild cord indentation and anterior deviation at T7–8. Microsurgical resection revealed thickened arachnoid tissue compressing and tethering the spinal cord. Postoperatively, cord pulsation restored and motor function improved, and histopathology confirmed AW.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/arachnoid-web-presenting-with-acute-myelopathy-after-minor-trauma-and-subtle-imaging-findings-illustrative-case/440269/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/arachnoid-web-presenting-with-acute-myelopathy-after-minor-trauma-and-subtle-imaging-findings-illustrative-case/440269.png","ImageObject",300,407,{"name":92,"@type":93},"Blue Pony","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was the diagnosis challenging in this case?","Question",{"text":112,"@type":113},"Imaging showed no fractures or intramedullary signal changes, with only subtle anterior deviation and indentation at T7–8, which can make AW difficult to recognize.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What intraoperative finding confirmed the presence of arachnoid web?",{"text":117,"@type":113},"Surgery revealed thickened arachnoid tissue compressing and tethering the spinal cord, and complete resection restored spinal cord pulsation.",{"name":119,"@type":110,"acceptedAnswer":120},"What was the patient’s postoperative outcome?",{"text":121,"@type":113},"Motor function recovered to MMT grade 5/5 in all lower-extremity muscle groups, sensory disturbance improved, and follow-up MRI showed resolution of cord indentation and deviation at T7–8.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},440269,1790742640,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},962090760266,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","JOURNAL OF NEUROSURGERY:  \nCase Lessons  \nJ Neurosurg Case Lessons 11(1): CASE25734, 2026  \nDOI: 10.3171/CASE25734  \nArachnoid web presenting with acute myelopathy after minor trauma and subtle imaging findings: illustrative case  \n*Shinichiro Tsukamoto, MD,1,2 Gaku Hidaka, MD,1 Masashi Uchida, MD,1 Yuichiro Kushiro, MD,1 Sora Yazaki, MD,1 Risa Sakuyama, MD,1,2 Hiroshi Takasuna, MD, PhD,1 Hidemichi Itoh, MD, PhD,1 Takashi Matsumori, MD, PhD,1 Ichiro Takumi, MD, PhD,1 Toshihiro Ueda, MD, PhD,1 and Hidetoshi Murata, MD, PhD1  \n1Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki; and 2Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan  \nBACKGROUND Arachnoid web (AW) is a rare entity characterized by a thickened band of arachnoid membrane on the dorsal surface of the spinal cord, often producing compressive myelopathy. The diagnosis is sometimes challenging, as imaging findings may be subtle.  \nOBSERVATIONS The authors report the case of a 29-year-old man who developed paraparesis with bladder and rectal dysfunction following a minor traffic accident. Imaging showed no fractures or intramedullary signal changes, with only subtle spinal cord anterior deviation at T7–8 . Surgical exploration revealed a thickened arachnoid band compressing and tethering the spinal cord. Resection of the AW restored cord pulsation, and motor function improved postoperatively. Histopathology confirmed arachnoid tissue with collagen fibers, consistent with AW.  \nLESSONS Even with subtle imaging findings, AW should be suspected in trauma-related myelopathy, and timely surgical intervention can provide recovery.  \n[https://thejns.org/doi/abs/10.3171/CASE25734](https://thejns.org/doi/abs/10.3171/CASE25734)  \nKEYWORDS arachnoid web; spinal cord compression; thoracic spine; minor trauma; myelopathy; microsurgical resection  \nArachnoid web (AW) is a band-like thickening of the arachnoid membrane located on the dorsal spinal cord, most frequently in the thoracic region.1 Although rare, AW can cause myelopathy through cord compression, tethering, or CSF flow obstruction.2 The “scalpel sign” on MRI is considered characteristic,3,4 but it is not always present, and some cases show only subtle radiological changes.2,5 Reports of AW have been increasing in recent years, yet much remains unknown regarding its etiology and natural history.6 Proposed causes include congenital anomalies,7 arachnoiditis,8 trauma,6,9 prior surgery,6 or subarachnoid hemorrhage.6 Although most cases present with insidious onset, trauma may act as a trigger for symptom manifestation, making early recognition crucial.  \nWe present an instructive case of a young man in whom AW became symptomatic after minor trauma, highlighting the diagnostic  \nchallenges, intraoperative findings, and histopathological confirmation, and discuss the clinical significance in the context of previously reported trauma-related cases.  \nIllustrative Case  \nA 29-year-old man was involved in a traffic accident and developed bilateral lower limb weakness and bladder-rectal dysfunction. He had no preexisting neurological symptoms.  \nClinical Findings  \nNeurological examination revealed paraparesis (manual muscle testing [MMT]: iliopsoas grade 4/5 bilaterally, quadriceps grade 4/5, tibialis anterior grade 3/5) and sensory loss distal to the ankles. He  \nABBREVIATIONS AW = arachnoid web; MMT = manual muscle testing.  \nINCLUDE WHEN CITING Published January 5, 2026; DOI: 10.3171/CASE25734 .  \nSUBMITTED September 19, 2025. ACCEPTED November 20, 2025.  \n* S.T. and G. H. contributed equally to this work.  \n© 2026 The authors, CC BY-NC-ND 4.0 ([http://creativecommons.org/l](http://creativecommons.org/l)icenses/by-nc-nd/4 .0/)  \nJ Neurosurg Case Lessons | Vol 11 | Issue 1 | January 5, 2026 | 1  \nalso reported numbness in both feet and impaired bladder-rectal sensation, although spontaneous voiding was preserved.  \nImaging  \nThoracic CT showed no fract","cbCair5JQ33Td8j7","https://ap.wps.com/l/cbCair5JQ33Td8j7","pdf",3239242,"English","# Case Lessons\n## Background\n## Observations\n## Lessons\n## Illustrative Case\n## Clinical Findings\n## Imaging\n## Management\n## Pathology\n## Outcome","[{\"question\":\"Why was the diagnosis challenging in this case?\",\"answer\":\"Imaging showed no fractures or intramedullary signal changes, with only subtle anterior deviation and indentation at T7–8, which can make AW difficult to recognize.\"},{\"question\":\"What intraoperative finding confirmed the presence of arachnoid web?\",\"answer\":\"Surgery revealed thickened arachnoid tissue compressing and tethering the spinal cord, and complete resection restored spinal cord pulsation.\"},{\"question\":\"What was the patient’s postoperative outcome?\",\"answer\":\"Motor function recovered to MMT grade 5/5 in all lower-extremity muscle groups, sensory disturbance improved, and follow-up MRI showed resolution of cord indentation and deviation at T7–8.\"}]","Arachnoid web presenting with acute myelopathy after minor trauma and subtle imaging findings - illustrative case | PDF",1790691680,13]