The role of epidural fibrosis and defective fibrinolysis in the persistence of postlaminectomy back pain.

Clinical features, contrast-enhanced lumbar tomographic findings, and biochemical plasma fibrinolytic parameters were critically assessed in 70 patients suffering severe, chronic postsurgical low-back and radicular pain to determine the cause of their persisting symptoms. Patients exhibited gross functional disability and significant impairment of plasma fibrinolytic activity, compared with 84 normal control subjects. This fibrinolytic defect appeared attributable to disproportionate increases in circulating plasminogen activator inhibitor-1 levels. Clinical features were slightly worse in patients with radiologic epidural fibrosis, whereas the frequency of radiologic abnormalities, including epidural fibrosis, was higher in patients with fibrinolytic abnormalities. The results, however, demonstrated no significant associations between patients' symptoms and signs and their biochemical and radiologic abnormalities.

[Practical significance of middle molecules of the blood in assessing the severity of the status of neurosurgical patients]. / Prikladnoe znachenie srednikh molekul krovi dlia otsenki tiazhesti sostonianiia neirokhirugicheskikh bol'nykh.

Study of the content of medium-size molecules (MM), residual nitrogen, creatinine, and urea in the blood of 80 neurosurgical patients with various diseases showed correlation between the severity of the patient's general condition and the MM level. No correlation was noted between the content of MM, creatinine, and urea. The MM level in the blood correlated with that of residual nitrogen in 20% of cases. The MM dynamics may serve as a prognostic sign of the course and outcome of the disease. The MM content corresponds to the severity of the patient's general condition and is not dependent on the etiological and pathogenetic factors.

Impaired fibrinolytic activity in defined chronic back pain syndromes.

Fibrinolytic activity was studied in 34 patients who had chronic low-back pain of defined types (spondylosis, post-laminectomy and postmyelography-proven arachnoiditis, postlaminectomy and postmyelography-possible arachnoiditis, chronic prolapsed intervertebral disc (PID), spinal stenosis, and nonspecific low-back pain). Fibrinolysis was significantly impaired in the back pain patients as a whole compared with matched controls. Similar changes were observed in all the different back pain syndromes. In the smaller subgroups, these did not reach significance but were significant in spondylosis, proven arachnoiditis, and nonspecific back pain. It is suggested that the abnormal persistence of a defect in fibrinolytic activity, leading to fibrin deposition and chronic inflammation, may be an important factor in the chronicity of many back pain syndromes.