Summary
Forty patients with lumbar arachnoiditis, following previous operations, were classified into 4 myelographic types. Most patients with type I images had herniated disc symptoms with unilateral leg pain and limited straight-leg raising. Patients with types II and III myelographic appearances had bilateral leg pain, absent ankle jerks, weakness, cramps and signs of diffuse sensory deficit; some also had neurogenic claudication and urinary sphincter dysfunction. All patients with type IV had dysaesthesia. Twenty-three of the 40 patients underwent reoperation and those with types I and II had acceptable results, but poor results occurred in those with types III and IV myelograms.
Résumé
Quarante patients atteints d'arachnoïdite lombaire ont été classés selon les images myélographiques en quatre groupes. La plupart des patients avec une image de type I présentent des signes de hernie discale avec sciatalgies unilatérales et limitation de l'extension de la jambe. Chez les patients présentant des caractéristiques myélographiques de type II et III prédominent des sciatalgies bilatérales, des spasmes musculaires, de la faiblesse, des crampes et des troubles sensitifs diffus. Quelques patients présentent un syndrome neurologique déficitaire et une atteinte sphinctérienne. Tous les malades avec des images myélographiques de type IV ont des dysesthésies. Vingt-trois patients sur quarante ont été réopérés. L'intervention a obtenu un résultat satisfaisant (bon et moyen) chez les patients avec des images myélographiques de type I et II. Chez ceux qui avaient des myélographies de type III et IV les mauvais résultats ont été beaucoup plus fréquents.
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References
Benoist M, Ficat C, Baraf P, Cauchoix J (1980) Postoperative lumbar epiduro-arachnoiditis: diagnostic and therapeutic aspects. Spine 5: 432–436
Benner B, Ehni G (1978) Spinal arachnoiditis: the postoperative variety in particular. Spine 3: 40–44
Bertrand G (1975) The “battered” root problem. Orthop Clin North Am 6: 305–310
Brodsky AE (1976) Post-laminectomy and post-fusion stenosis of the lumbar spine. Clin Orthop 115: 130–139
Brodsky AE (1978) Cauda equina arachnoiditis: a correlative clinical and roentgenologic study. Spine 3: 51–60
Burton CV (1978) Lumbosacral arachnoiditis. Spine 3: 24–30
Cauchoix J, Ficat C, Girard B (1978) Repeat surgery after disc excision. Spine 3: 256–259
Crock HV (1976) Observations on the management of failed spinal operations. J Bone Joint Surg [Br] 58: 193–199
Delamarter RB, Ross JS, Masaryk TJ, Modic MT, Bohlman HH (1990) Diagnosis of lumbar arachnoiditis by magnetic resonance imaging. Spine 15: 304–310
De Villiers PD, Boysen EL (1976) Fibrous spinal stenosis. Clin Orthop 115: 139–144
Elkington JStC (1951) Arachnoiditis. Mod Trends Neurol 1: 149–152
Epstein JA (1978) Obliterative arachnoiditis: a complication of spinal stenosis. Spine 3: 87
Finnegan WJ, Fenlinm JM, Marvel JP, Nardini RJ, Rothman RH (1979) Results of surgical intervention in the symptomatic multiply-operated back patient: analysis of sixty-seven cases followed for three to seven years. J Bone Joint Surg [Am] 61: 1077–1082
Frymoyer JW, Matteri RE, Hanley EN, Kuhlmann D, Howe J (1978) Failed lumbar disc surgery requiring second operation. Spine 3: 7–11
Haughton WM, Eldewick DP, Larson SJ, Unger OE (1978) Arachnoiditis from experimental myelography with aqueous contrast media. Spine 3: 65–69
Johnston JDH, Matheny JB (1978) Microscopic lysis of lumbar adhesive arachnoiditis. Spine 3: 36–39
Jorgensen J, Hansen PN, Steenskov V, Ovensen N (1975) A clinical and radiological study of chronic lower spinal arachnoiditis. Neuroradiology 9: 139–144
LaRocca H, Macnab I (1974) The laminectomy membrane: Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg [Br] 56: 545–550
Lerat JL, Perrier JP (1986) Les résultats de l'arthrodèse lombaire intersomatique postérieure pour les échecs de la chirurgie discale. Rev Chir Orthop 72 (Suppl II): 95–102
Pheasant HC (1975) Sources of failure in laminectomies. Orthop Clin North Am 6: 319–329
Puiles M, Marchisello PJ, Tsaires P (1978) Lumbar adhesive arachnoiditis: etiology and pathology aspects. Spine 3: 45–50
Quencer RM, Tenner M, Rothman L (1977) The postoperative myelogram. Radiology 123: 667–669
Skalpe IO (1978) Adhesive arachnoiditis following lumbar myelography. Spine 3: 61–64
Spangfort EV (1972) The lumbar disc herniation: a computer-aided analysis of 2,504 operations. Acta Orthop Scand (Suppl) 142: 1
Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H (1979) Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg [Am] 61: 201–207
Wilkinson HA (1983) The failed back syndrome. Harper & Row, Philadelphia
Wiltse LL (1979) Problems of the multi-operated back patient. AAOS Instructional Course Lectures, vol 28. Mosby, St Louis, pp 207–236
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Roca, J., Moreta, D., Ubierna, M.T. et al. The results of surgical treatment of lumbar arachnoiditis. International Orthopaedics 17, 77–81 (1993). https://doi.org/10.1007/BF00183546
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DOI: https://doi.org/10.1007/BF00183546