胸腰椎粘连性脊髓蛛网膜炎的特点

Thoracolubmar adhesive spinal arachnoiditis: disease characteristics

中文关键词:  粘连性脊髓蛛网膜炎  临床表现  诊疗策略  疗效

英文关键词:Adhesive spinal arachnoiditis  Clinical manifestations  Diagnosis and treatment strategy  Therapeutic effect

中文摘要:

  【摘要】 目的：总结胸腰椎粘连性脊髓蛛网膜炎的特点。方法：回顾性分析2012年5月~2023年7月于我院诊治的35例胸腰椎粘连性脊髓蛛网膜炎患者的临床资料，其中男26例，女9例，年龄34~80岁（56.0±10.4岁）。继发于胸腰椎骨折患者17例，腰椎间盘突出症或合并腰椎椎管狭窄症患者12例，胸椎椎管狭窄症患者3例，硬膜内肿瘤患者3例。患者以躯干或下肢持续烧灼样疼痛或合并肢体痉挛为主要表现者14例；以麻木、无力为主要表现者17例，合并排尿障碍者13例，丧失行走能力者4例。通过CT脊髓造影和MRI明确胸腰椎粘连性脊髓蛛网膜炎的发生部位及影像学特点，记录治疗方案以及治疗前、治疗后3个月及末次随访时腰腿痛视觉模拟量表（visual analogue scale，VAS）评分和Oswestry功能障碍指数（Oswestry disability index，ODI），手术患者末次随访时采用McCormick分级评估患者恢复情况。结果：病变位于胸脊髓11例、脊髓圆锥7例、马尾神经14例、胸脊髓至脊髓圆锥或马尾神经长节段3例。11例患者行保守治疗，治疗前VAS评分7（7，8）分，ODI 54%（32%，64%），仅3例患者经保守治疗后疼痛症状轻度缓解，末次随访VAS评分7（6，8）分，ODI：50%（32%，64%）。24例患者行手术治疗，末次随访时9例患者术后症状无明显改善，术前及末次随访VAS评分均为8（8，9）分，ODI均为72%（60%，85%），McCormick分级为Ⅲ级；5例患者术后症状长期明显好转，可独立或借助辅助工具行走，且大小便功能有所恢复，术前VAS评分：7（6，8）分，ODI为58%（33%，68%），末次随访时VAS评分为4（3，4）分，ODI为32%（19%，35%），McCormick分级为Ⅰ级；3例患者术后症状恢复至Ⅰ级，2~6个月症状再次加重至Ⅱ级；6例患者术后恢复至Ⅰ~Ⅱ级，2周~2年出现症状加重至术前水平（Ⅲ级）；1例行脊髓电刺激装置置入，症状有所好转（Ⅱ级）。结论：胸腰椎粘连性脊髓蛛网膜炎保守治疗的疗效较为有限。手术治疗虽然在部分患者中能够取得显著的临床改善，但其效果在不同患者间存在明显的个体差异，部分患者术后症状无明显改善，甚至有患者术后症状复发或随时间推移症状加重。

英文摘要:

  【Abstract】 Objectives: To summarize the disease characteristics of thoracolumbar adhesive spinal arachnoiditis. Methods: The clinical data of 35 patients with thoracoland lumbar adhesive spinal arachnoiditis treated in our hospital from May 2012 to July 2023 were retrospectively analyzed, including 26 males and 9 females, aged 34 to 80 years (56.0±10.4 years). There were 17 cases secondary to thoracolumbar fracture, 12 cases of lumbar disc herniation or combined with lumbar spinal stenosis, 3 cases of thoracic spinal stenosis, and 3 cases of intradural tumor. 14 cases were primarily characterized by persistent burning pain in the trunk or lower limbs, or accompanied by limb spasms. Another 17 cases mainly presented with numbness and weakness. Additionally, 13 cases experienced urinary dysfunction, and 4 cases lost the ability to walk. Computed tomography myelography(CTM) and MRI were used to determine the location and imaging features of thoracolumbar adhesive spinal arachnoiditis. The treatment plans of patients were recorded, and the visual analogue scale(VAS) for lumbar and leg pain and Oswestry disability index(ODI) were observed before treatment, at 3 months after treatment and final follow-up. The McCormick grading was used to assess the recovery of patients who underwent surgery at the final follow-up. Results: The lesions were located in the thoracic spinal cord in 11 cases, the conus medullaris in 7 cases, the cauda equina in 14 cases, and long segments from the thoracic spinal cord to conus medullaris or cauda equina in 3 cases. 11 patients received conservative treatment, and the VAS score was 7(7, 8) and ODI was 54%(32%, 64%). Only 3 patients showed mild alleviation of pain symptoms after conservative treatment, with a final follow-up VAS score of 7(6, 8) and an ODI of 50%(32%, 64%). 24 patients underwent surgical treatment, and 9 of whom showed no significant improvement in symptoms at the final follow-up, with preoperative and final follow-up VAS scores of 8(8, 9) and ODI of 72%(60%, 85%), and McCormick grade Ⅲ; 5 patients had a significant long-term improvement in symptoms after operation, who could walk independently or with the aid of assistive devices and recovered to some extent in bowel and bladder functions, with preoperative VAS score of 7(6, 8) and ODI of 58%(33%, 68%) improving to 4(3, 4) and 32%(19%, 35%) respectively at final follow-up, and McCormick grade Ⅰ; 3 patients recovered to grade Ⅰ postoperatively, and worsened to grade Ⅱ between 2 and 6 months; 6 patients recovered to grade Ⅰ to Ⅱ postoperatively, with symptoms worsening to preoperative level (grade Ⅲ) between 2 weeks and 2 years; 1 patient was implanted with electrical spinal cord stimulation device, who was recovered in symptoms(grade Ⅱ). Conclusions: Conservative treatment for thoracolumbar adhesive spinal arachnoiditis is relatively limited in efficacy. While surgical treatment can achieve significant clinical improvement in some patients, its effects vary significantly among individuals. Some patients show no significant improvement in symptoms after surgery, and there are even cases where symptoms recur or worsen over time.