Postoperative lumbar epiduro-arachnoiditis. Diagnostic and therapeutic aspects.

Thirty-eight patients with the diagnosis of postoperative epiduro-arachnoiditis are reported upon. All had had previous surgery for disc herniation, and the diagnosis of epiduro-arachnoiditis was confirmed at repeat surgery. Massive epidural scarring with no coexistent pathologic condition was found in every patient, and adhesive arachnoiditis was noted in three. The common clinical presentation consisted of low-back pain and sciatica, and radicular pain was usually a continuation or a recurrence of the preoperative sciatic pain. Neurologic deficits were mild, and no patients with the classic picture of adhesive arachnoiditis were found. Myelographic patterns did not disclose any correlation with the clinical symptoms. Five myelograms were normal, while six others simulated a recurrent disc herniation. The results of scar excision were good in 13 patients, fair in eight, and a failure in 17.

[Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations]. / Sciatiques post-opératoires par fibrose épidurale et arachnoïdite lombaire. Résultats de 38 réinterventions.

Lumbar epiduro-arachnoiditis is a well-known complication of surgery of the intervertebral disc. The epidural fibrous scar is the normal outcome of inflammatory activity secondary to the mechanical tissue disturbance resulting from surgery. In certain individuals, perhaps genetically predisposed as excessive quantity of fibrous tissue is deposited in the epi and/or nitradural space. This abnormal situation, comparable to cheloid cutaneous scars, is perhaps at the origin of the clinical symptoms. The authors report the clinical and radiological signs observed in 38 patients having had at least one operation for discal hernia, and who underwent further operations in the aim of freeing the roots and the dural sack from fibrous compression. Results of excision of the epidural "cheloid" were good in 13 cases, and average in 8 others. There was a complete failure in 17 other patients. Three explanations were offered to explain the frequency of the failures: 1) formation of a new cheloid, 2) difficulty of neurolysis of the arachnoiditis, 3) possibility of intrinsic lesions of the nerve associated with the epiduro-arachnoiditis.