Thoracolubmar adhesive spinal arachnoiditis: disease characteristics

English Keywords:Adhesive spinal arachnoiditis  Clinical manifestations  Diagnosis and treatment strategy  Therapeutic effect

English Abstract:

  【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.