Clinical Features and Surgical Treatment of Adhesive Spinal Arachnoiditis

This is the authors' abstract. We don't add key points for this paper.

Effective surgical treatment of adhesive spinal arachnoiditis has not been established because of its complex clinical manifestations. In the present study, we retrospectively analyzed the clinical courses of 17 patients with adhesive spinal arachnoiditis who underwent surgical treatment in our institute between 1982 and 1996. The purpose of this study was to determine how to manage this disorder. CT-myelography and MRI revealed syringomyelia in 15 patients and cystic dilatation of the anterior subarachnoid space in 3 patients. All 17 cases presented paraparesis on admission. Two cases with hydrocephalus were treated with V-P shunt. Twelve cases underwent syringo-peritoneal shunt (S-P shunt, 10 cases) or syringo-subarachnoid shunt (S-S shunt, 2 cases). Three cases with cystic dilatation of the anterior subarachnoid space underwent laminectomy and opening of the cyst. Follow-up periods ranged from 1 month to 12 years (mean 4.6 years). Seven cases underwent additional operations for syringomyelia (S-P shunt 5, S-S shunt 2, lumbo-peritoneal shunt 2). In 3 cases, S-S shunt performed rostral to the site of adhesion was effective in long-term collapse of the syrinx. Alleviation of the symptoms was obtained in 10 cases (59%), while 3 cases (18%) showed progressive deterioration. Microcirculatory disturbance of the pial and subarachoid vessels and cystic changes around or in the spinal cord due to blockage of the cerebrospinal fluid are considered to be responsible for the pathogenesis of myelopathy. Drainage or shunting of the cerebrospinal fluid is essential in the treatment of this condition. S-S shunt can be an effective treatment in selected cases.