medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2009, Number 4

<< Back Next >>

Acta Ortop Mex 2009; 23 (4)

Paraplegia due to adhesive arachnoiditis. A case report

Rodríguez LJG, Sandoval SV, Benavides RD, Olivares CJL, Taboada BJ

Language: Spanish
References: 21
Page: 232-236
PDF size: 172.15 Kb.


ABSTRACT

Various conditions of the spinal column occur at the lumbar level and new therapeutic surgical techniques have been applied to reduce the length of hospital stay, contribute to a quick return of patients to their activities of daily living, and reduce the postoperative limitations. However, a silent complication, adhesive arachnoiditis, has been reported with a frequency of 6-16% in cases undergoing lumbar surgery or with a history of revision surgery, and thus a second complication may occur, paraplegia, since the common symptom of arachnoiditis is persistent low back pain. The case of a 40-year-old patient is presented herein, who underwent lumbar spine surgery for herniated discs, and developed adhesive arachnoiditis involving the cauda equina, which was diagnosed with MRI. He had irreversible paraplegia with diffuse involvement of the cauda equina despite the mechanical lavage and surgical debridement performed due to the persistence of serous fluid discharge from the wound. The interbody implant placed during the first surgery was removed and the treatment was completed with posterior stabilization reinstrumentation; the patient had persistent neurologic impairment. There are few reports in the world literature of paraplegia due to non-infectious adhesive arachnoiditis. The remaining reports of paraplegia have been in patients with spinal infection, such as HIV-TB, mycosis, brucellosis or meningeal hemorrhage. It is not easy for patients to understand the very likely irreversible neurologic lesion of his complication. However, it is important for the spine surgeon to bear in mind the occurrence and frequency of adhesive arachnoiditis which could lead to irreversible neurologic deficit in patients undergoing lumbar spine surgery.


REFERENCES

  1. Ribeiro C, Reis FC: Adhesive lumbar arachnoiditis Servicio de Neurorradiología, Hospital de Santo Antonio dos Capuchos, Lisboa. Acta Med Port 1998; 11(1): 5965.

  2. Aldrete JA, Birmingham AL, USA: Chronic adhesive arachnoiditis. British J Anaesthesia 2004; 93(2): 301-3.

  3. Shaw MD, Russell JA, Grossart KW: The changing pattern of spinal arachnoiditis. J Neurol Neurosurg Psychiatry 1978; 41(2): 97-107.

  4. Hamilton D: Some experience with paraplegia in a small hospital in Nepal. Paraplegia 1978; 15(4): 293-301.

  5. Long D: Chronic adhesive spinal arachnoiditis: Pathogenesis, prognosis and treatment. Neurosurg Q 1992; 2: 296.

  6. Aldrete JA: Arachnoiditis: silent epidemia. 2° edition. Birmingham AL, USA, 2003: 56.

  7. Delamarter RB, Ross JS, Masaryc TJ, et al: Diagnosis of lumbar arachnoiditis by magnetic resonance imaging. Spine 1990; 15: 304-10.

  8. Seki T, Hida K, Yano S, Iwasaki Y: Expansive duralplasty and subarachnoid reconstruction for spinal adhesive arachnoiditis using Gore-Tex surgical membrane. 2004; 32(12): 1247-51.

  9. Orendacova J, Cizkova D, Kafka J: Cauda equina syndrome. Prog Neurobiol 2001; 64(6): 613-37.

  10. Houten JK, Errico TJ: Paraplegia after lumbosacral nerve root block: report of three cases. Spine J 2002; 2(1): 70-5.

  11. Terp A, Nord M: Paraplegia following lumbar anesthesia: five cases or chronic hypertrophic arachnoiditis spine. 1950;23; 43(25): 1026-9.

  12. Adriani J, Naragi M: Paraplegia associated with epidural anesthesia. South Med J 1986; 79(11): 1350-5.

  13. Paillas JE, Mouren P: Paraplegia of prolonged course caused by suppurative arachnoiditis and brucellosic myelitis. Rev Neurol (Paris) 1960; 102: 511-4.

  14. Lonchampt J, Vigouroux R: Paraplegia caused by melitococcic arachnoiditis, developing 14 years after the initial fever Presse Med. 1955; 63(1): 5.

  15. Jourdan C, Artru F, Convert J, Ottolese C, Chiara Y, Naous H: A rare and severe complication of meningeal hemorrhage: spinal arachnoiditis with paraplegia] [Article in French] Agressologie 1990; 31(6): 413-4.

  16. Bilgen IG, Yunten N, Ustun EE, Oksel F, Gumusdis G: Adhesive arachnoiditis causing cauda equina syndrome in ankylosing spondylitis: CT and MRI demonstration of dural calcification and a dorsal dural diverticulum. Neuroradiology 1999; 41(7): 508-11,

  17. Ramli N, Merican AM, Lim A, Kumar G: Post-traumatic arachnoiditis: an usual cause of Brown Sequard syndrome. Eur Radiol 2001; 11(10): 2011-4.

  18. Moghtaderi A, Alavi Naini R: Tuberculous radiculomielitis: review and presentation of five patients. Int J Tuberc Lung Dis 2003; 7(12): 1186-90.

  19. Nakano M, Matsui H, Miaki K, Tsuji H: Postlaminectomy adhesion of the cauda equina. Inhibitory effects of anti-inflammatory drugs on cauda equina adhesion in rats. Spine 1998;1; 23(3): 298-304.

  20. Guyer DW, Wiltse LL, Eskay ML, Guyer BH: The long-range prognosis of arachnoiditis. Spine 1990; 14: 1332-41.

  21. Aldrete JA, Birmingham AL, USA: Chronic adhesive arachnoiditis. British Anaesth 2004; 93(2): 301-3.




2020     |     www.medigraphic.com