Spinal arachnoiditis

VOL. 35, No. 413 Spinal arachnoiditis by G. Lombardi, M.D., A. Passerini, M.D., and F. Migliavacca, M.D. Radiological and Surgical Departments, Neurological Institute, via Celoria 11, Milan, Italy (Received October, 1961) In 1955 a radiological study on spinal arachnoiditis was published (Lombardi and Passerini); since then, many other cases have come under our observation. Out of a total of 41, there were 31 who had opera- tions and all these cases, studied by myelography, are now reported in this paper under the following headings: (1) Analysis of material, (2) Clinical diagnosis, (3) Radiological diagnosis and (4) Treatment. ANALYSIS OF MATERIAL Spinal arachnoiditis forms a rather heterogeneous group which is not very suitable for an overall study. For this reason, out of the whole myelographic material at our disposal, we chose only 41 cases of pure arachnoiditis (free from interference by other appeared after a minimum lapse of 10 years (average: 14 years), and in the remaining 2, only a few months afterwards. In 3 patients, the arachnoiditis was pre- ceded by trauma, without fracture, at the site of the lesion and the disturbances started after a few weeks, 7 months and 1 year respectively. The arachnoiditis appeared in 3 patients after subarachnoid haemorr- hage, with an interval of 2 weeks, 3 months and 11 years respectively; while in another 3 patients it occurred 4 months, 11 years and 12 years respectively after intrathecal injections of antitetanus serum. The cases of arachnoiditis studied through myelography in the present series includes only one appearing (a few months) after tuberculous meningitis, clinically cured. Age 0-10 - 10-20 3 TABLE 20-30 9 I 30-40 12 40-50 11 50-60 5 60-70 1 lesions at the site, disturbing the clinical and radiological findings). Thus, forms secondary to opera- tion, to vertebral fractures and to infective spondy- litis have been excluded from this enquiry along with those associated with angiomas, spinal tumours, hernia of the disc and diseases of the peridural space. For the same reason, the arachnoidal reactions which may appear around residues of oily contrast medium were also set aside. The 41 cases so chosen consisted of 15 females and 26 males, with a ratio between the two sexes of 1 : 1-8. The distribution according to age is indicated in Table I. The points of greatest frequency are found to correspond to the third, fourth and fifth decades of life. At the moment of diagnosis, the average age of the patients was 36 years—the same for both sexes— with extremes ranging from 10 to 60 years. The aetiology of spinal arachnoiditis is not always clear, and sometimes the supposed cause has only a presumptive value. Our patients include 8 whose case histories reveal a cerebrospinal meningitis treated and cured by means of repeated intrathecal injections of sulpha drugs: in 6 cases the spinal lesion The aetiological factor for these 18 patients (44 per cent) is convincing, while the illnesses found in the case histories of the other 23 are either too common or too far back in time to be considered as causes of the disease. In our series, there are no cases of arachnoiditis following spinal anaesthesia, the frequency of which has been reported by Kennedy, Effron and Perry (1950); Rosenbaum, Long, Hin- chey and Trufant, (1952); Seaman, Marder and Rosenbaum (1953) and Castorina, Sassaroli and Severini (1955). CLINICAL DIAGNOSIS The clinical picture of arachnoiditis is complex because of the overlapping of root and cord affec- tions, and also polymorphous showing irregular evolution of the affection whose site, extension and distribution vary from case to case. For these reasons it is easily confused with other spinal diseases. Arachnoiditis has a distinct preference for the dorsal segment of the spine, occurring at this site in 28 cases (68 per cent) while the lumbar portion was affected in another 7, and the cervical portion in 6 cases. 314

Spinal arachnoiditis

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