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  4. Delayed symptomatic spinal adhesive arachnoiditis after surgery for thoracolumbar flexion-distraction injury: A case report

Delayed symptomatic spinal adhesive arachnoiditis after surgery for thoracolumbar flexion-distraction injury: A case report

International Journal of Surgery Case Reports, 2020 · DOI: https://doi.org/10.1016/j.ijscr.2020.08.040 · Published: August 25, 2020

SurgerySpinal DisordersResearch Methodology & Design

Simple Explanation

Adhesive arachnoiditis is an uncommon condition resulting from inflammation of spinal nerves. This case report describes a patient who developed delayed symptomatic thoracolumbar adhesive arachnoiditis after spinal surgery for a traumatic flexion-distraction injury. The patient, a 51-year-old man, initially underwent surgery to address a flexion-distraction injury. However, three months post-surgery, he developed severe pain and sensory issues, leading to a diagnosis of adhesive arachnoiditis at the surgical site. Treatment with gabapentin led to a significant reduction in the patient's symptoms. The authors suggest that developments in MRI technology aid in evaluating such lesions and that gabapentin may be a beneficial treatment option.

Study Duration
Not specified
Participants
A 51-year-old man
Evidence Level
Level 4; Case Report

Key Findings

  • 1
    Delayed symptomatic spinal adhesive arachnoiditis can occur after surgery for thoracolumbar flexion-distraction injuries.
  • 2
    MRI is a useful tool for evaluating previously operated lesions due to advancements in technology and the resolution and reduced artifacts from titanium instrumentation.
  • 3
    Gabapentin may be a good treatment option for delayed-onset postoperative adhesive arachnoiditis.

Research Summary

This case report describes a 51-year-old man who developed delayed symptomatic spinal adhesive arachnoiditis with cauda equina syndrome three months after undergoing surgery for a traumatic thoracolumbar flexion-distraction injury. The patient's symptoms included severe pain, sensory loss, and sphincter dysfunction, which were diagnosed through MRI findings indicative of adhesive arachnoiditis at the previous injury site. Treatment with gabapentin led to a dramatic improvement in the patient's symptoms, and he eventually regained the ability to ambulate with a cane. The authors suggest considering arachnoiditis as a possible cause of delayed symptoms after spine trauma.

Practical Implications

Diagnostic Awareness

Spine surgeons should be aware of delayed arachnoiditis as a potential complication following spinal surgery, especially in cases of traumatic injuries.

Treatment Strategy

Gabapentin may be considered as a treatment option for patients presenting with delayed-onset postoperative adhesive arachnoiditis.

Imaging Utility

MRI is critical for identifying affected spinal structures and diagnosing adhesive arachnoiditis, particularly with advancements in metal artifact reduction techniques.

Study Limitations

  • 1
    Single case report limits generalizability
  • 2
    Lack of control group
  • 3
    Retrospective study design

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