Spinal adhesive arachnoiditis

Dolan, R.A.

doi:10.1016/0090-3019(93)90035-y

Cited by 43 publications

(23 citation statements)

References 6 publications

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“…3,5,6,10 Epidural fibrosis still constitutes an important cause of recurrent symptoms after spinal surgery. [2][3][4][5]10 The Presence of a ruptured disc and operation for its removal are the contributing factors in initiating arachnoiditis. The incidence of arachnoiditis was reported between 10 and 40% after disc surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of arachnoiditis was reported between 10 and 40% after disc surgery. 3,5 Fibroblasts, originating from the overlying muscles and following extension of postoperative haematoma in to the vertebral canal, cause epidural fibrosis. [9][10][11] The migration of fibroblasts from the raw surface of the erector spinae musculature was stated as the source of postoperative scar tissue.…”

Section: Discussionmentioning

confidence: 99%

“…9 Furthermore, foreign body reaction from surgical swab debris, as well as a systemic fibrinolytic defect, has also been reported as possible aetiologies of postlaminectomy scar formation. 5,12 Prevention of postlaminectomy scarring has been attempted using different mechanical barriers, chemical regulation of scar formation and prevention of local Figure 1 Laminectomy site with thick, dense collageneous scar extending into the bone defect (thick arrow) and diffuse attachments to the dura (thin arrow) (H&E Â 40) Figure 2 Photomicrograph showing section of laminectomy site with moderate fibrous tissue presence in control rat (H&E Â 40) rt-PA in experimental epidural fibrosis S Kemaloǧlu et al haematomas. [1][2][3][4] Inflammation was reported to play a role in the occurrence of scar tissue.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] It is postulated that adhesive arachnoiditis may occur with any chemical or physical injury to the leptomeninges. 1,2 It is known that local haematoma has the potential to markedly alter the results [3][4][5][6] and increased epidural adhesion may develop because of local haematoma. 1 Platelet-derived growth factor is a mitogene from aggregating platelets responsible for the migration and proliferation of the myofibroblasts.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

gcaron

Özkan

et al. 2003

Spinal Cord

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Study design: A randomized-controlled experimental study was conducted to investigate the effectiveness of recombinant tissue plasminogen activator (rt-PA) on postlaminectomy epidural fibrosis in rats. Setting: Diyarbakir, Turkey. Methods: In a rat model, allowing objective histopathological quantification, the postoperative epidural scar formation was investigated and the potential of local rt-PA in preventing the production of epidural fibrosis was assessed. Rats were randomly allocated to local rt-PA (12 rats) or control (12 rats). Results: Findings suggest a beneficial effect of rt-PA in decreasing the epidural fibrosis following laminectomy when compared with control groups for all investigated parameters such as intermuscular scar (P ¼ 0.04), middle scar (P ¼ 0.001), deep scar (P ¼ 0.001) and dural adhesion (P ¼ 0.01) except new bone formation. The presence of arachnoiditis was less in treatment group (P ¼ 0.01). Conclusion: In rats, the topical thrombolysis with rt-PA is safe and efficacious in preventing postlaminectomy epidural fibrosis. This Thrombolytic therapy with rt-PA after spine surgery may come to play an important role in the prevention of epidural fibrosis and arachnoiditis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

gcaron

Özkan

et al. 2003

Spinal Cord

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“…The MRI findings (see Table 1) are highly characteristic and demonstrate good sensitivity (92%) and excellent specificity (100%) [4]. Presentations are highly variable in terms of severity and timing -there is a delay between the putative initial insult and the development of neurological signs and symptoms ranging from a week to more than a decade [5][6][7][8].…”

Section: Chronic Adhesive Arachnoiditismentioning

confidence: 99%

Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review

et al. 2012

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SummaryA 27-year-old woman developed severe adhesive arachnoiditis after an obstetric spinal anaesthetic with bupivacaine and fentanyl, complicated by back pain and headache. No other precipitating cause could be identified. She presented one week postpartum with communicating hydrocephalus and syringomyelia and underwent ventriculoperitoneal shunting and foramen magnum decompression. Two months later, she developed rapid, progressive paraplegia and sphincter dysfunction. Attempted treatments included exploratory laminectomy, external drainage of the syrinx and intravenous steroids, but these were unsuccessful and the patient remains significantly disabled 21 months later. We discuss the pathophysiology of adhesive arachnoiditis following central neuraxial anaesthesia and possible causative factors, including contamination of the injectate, intrathecal blood and local anaesthetic neurotoxicity, with reference to other published cases. In the absence of more conclusive data, practitioners of central neuraxial anaesthesia can only continue to ensure meticulous, aseptic, atraumatic technique and avoid all potential sources of contamination. It seems appropriate to discuss with patients the possibility of delayed, permanent neurological deficit while taking informed consent. Case reportA 27-year-old woman with no significant medical history and in her first pregnancy underwent spinal anaesthesia for caesarean section for fetal compromise at another hospital at 42 weeks' gestation, after going into spontaneous labour. With the patient sitting, the skin over the L4-5 interspace was cleaned once by a consultant anaesthetist using a SOLU-I.V.Ò MAXI swabstick (Solumed, Laval, Canada) impregnated with 2% chlorhexidine gluconate and 70% isopropyl alcohol. There was no delay between opening the swabstick packaging and its use on the patient's skin. It is not clear whether the swabstick and its packaging were disposed of immediately. The prepared area was allowed to air-dry for 3 min before a 24-G needle (Becton, Dickinson & Company, Franklin Lakes, NJ, USA) was placed at L4-5 on the first attempt by a consultant anaesthetist wearing a sterile surgical gown and gloves, mask and hat, using an aseptic technique. After aspiration of free-flowing, clear cerebrospinal fluid (CSF), 2.5 ml bupivacaine 0.5% with 12.5 lg fentanyl was administered over approximately 15 s. A few seconds after the end of the injection, the patient complained of severe, burning pain in the lower back radiating into the legs bilaterally, worse on the right than the left. The pain began to recede as the block took effect and this was formally assessed 10 min after the

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Syringomyelia Associated with Diseases of the Spinal Canal

Klekamp

Samii

2002

Syringomyelia

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Spinal adhesive arachnoiditis

Cited by 43 publications

References 6 publications

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review

Syringomyelia Associated with Diseases of the Spinal Canal

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