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SIR 2025

Pain Management/MSK

Educational Exhibit

Session: Educational Exhibit Presentations - Arterial Interventions

Percutaneous Intrathecal Plasmin Delivery for Proposed Treatment of Adhesive Arachnoiditis: A Minimally Invasive Fibrinolytic Approach

Monday, March 31, 2025
5:20 PM – 5:25 PM CT
Location: Music City Center, 205 BC
Learning Objectives:


  1. Understand the pathophysiology of adhesive arachnoiditis and its impact on cerebrospinal fluid flow and patient outcomes. 



  2. Describe the potential role of percutaneous intrathecal plasmin delivery in facilitating fibrinolysis as a minimally invasive alternative to surgical lysis of arachnoid adhesions. 



  3. Review the procedural details, potential risks, and benefits associated with this novel approach.




Background: Adhesive arachnoiditis is a rare form of myelopathy characterized by inflammation and subsequent fibrosis of the arachnoid mater, leading to severe back pain, neurological deficits, and impaired cerebrospinal fluid flow {1,2,3,4}. Current treatment options primarily include open surgery for lysis of arachnoid adhesions, which carries significant risks and complications {5}. Plasmin, a naturally occurring fibrinolytic enzyme, has been used successfully in other medical conditions, such as thrombolysis, to break down fibrin. Previous studies, such as Seifert et al.'s use of intrathecal recombinant tissue plasminogen activator for preventing cerebral vasospasm after subarachnoid hemorrhage provide precedent for the safe intrathecal delivery of fibrinolytic agents, albeit for a different clinical goal {6}. We propose percutaneous intrathecal delivery of plasmin as a minimally invasive alternative to surgery, targeting the fibrotic tissue in arachnoiditis to restore normal CSF flow.

Clinical Findings/Procedure Details: This educational exhibit will detail the theoretical basis and procedural steps involved in percutaneous intrathecal plasmin injection. We will review the role of plasmin in fibrinolysis and its application in breaking down fibrotic scar tissue in the spinal canal. The procedure involves careful placement of a spinal needle under image guidance into the intrathecal space, followed by injection of a plasmin solution. Potential procedural risks, including bleeding and neurotoxicity, will be discussed, along with strategies to mitigate these risks. Additionally, we will explore patient selection criteria and comparisons to traditional surgical methods in terms of invasiveness, recovery time, and potential for symptom improvement.

Conclusion and/or Teaching Points: Percutaneous intrathecal plasmin delivery presents a promising, minimally invasive alternative to surgical lysis of adhesions in patients with adhesive arachnoiditis. This technique has the potential to reduce fibrosis, restore cerebrospinal fluid flow, and alleviate clinical symptoms with fewer risks than open surgery. However, further preclinical and clinical studies are required to validate the approach.