Endoscopic Treatment of Lumbar Arachnoiditis

Abstract

Objective: The diagnosis of lumbar arachnoiditis remains complex and often inconclusive. Using the technique of lumbar subarachnoidal endoscopy (thecaloscopy), the pathology can be identified and the patient treated with long-term effects on the symptoms.

Method: Endoscopic operations were performed on 23 patients suffering from varying symptoms with an enlarged lumbar subarachnoidal space. Having confirmed the diagnosis of lumbar arachnoiditis, a number of endoscopic operations ranging from adhesiolysis to subarachno-epidurostomy were carried out.

Results: Radicular symptoms in lumbar arachnoiditis were successfully relieved by various endoscopic dissection techniques, such as restoration of the improved CSF flow by subarachno-epidurostomy along the rootlet. This has been identified as one of the causal factors of the clinical symptoms. In cases where lumbar pain persists in spite of a previous thecaloscopy, further treatment with a lumboperitoneal shunt device has proved most successful.

Key words

Lumbar arachnoiditis - thecaloscopy - endoscopic treatment - spinal endoscopy

References

• 1 Horsley V. Chronic spinal meningitis; its differential diagnosis and surgical treatment.  Brit Med J. 1909;  1
• 2 Burton CV. Lumbosacral arachnoiditis.  Spine. 1978;  3 24-30
• 3 Petty PG, Hudson P, Hare WS. Symptomatic lumbar spinal arachnoiditis: fact or fallacy?.  J Clin Neurosci. 2000;  7 395-399
• 4 Nelson DW. Intraspinal therapy using methylprednisolone acetate. Twenty-three years of clinical controversy.  Spine. 1993;  18 278-286
• 5 Nelson DA, Landau WM. Intraspinal steroids: history, efficacy, accidentally and controversy with review of United States Food and Drug Administration report.  J Neurol Neurosurg Psychiatry. 2001;  70 733-744
• 6 Huewel NM, Perneczky A, Urban V. Neuroendoscopic techniques in operative treatment of syringomyelia.  Acta Neurochir (Wien). 1993;  123 216
• 7 Hellwig D, Riege T, Benes L, Bertalanffy H. Neuroendoscopy of the spinal canal historical review, indications and results.  Reprinted from: 4th International Congress on Minimally Invasive Neurosurgery. Barcelona Spain June 17-20, 1999; Editor: E. Ferrer.
• 8 Warnke JP, Koppert H, Bensch-Schreiter B, Dzelzitis J. Thecaloscopy. Part III - First clinical application.  Minim Invas Neurosurg. 2003;  46 94-99
• 9 Warnke JP, Morguela S, Tschabitscher M, Dzelzitis J. Thecaloscopy. The endoscopy of the lumbar subarachnoid space. Part II: Anatomical landmarks.  Minim Invas Neurosurg. 2001;  44 181-185
• 10 Warnke JP, Tschabitscher M, Nobels A. Thecaloscopy. The Endoscopy of the lumbar subarachnoid space. Part I: Historical review and own cadaver studies.  Minim Invas Neurosurg. 2001;  44 61-64
• 11 Hoffman GS. Spinal arachnoiditis: what's the clinical spectrum?. Part I.  Spine. 1983;  8 538-540
• 12 Hoffman GS, Ellsworth CH, Wells EE. et al. . Spinal arachnoiditis: what's the clinical spectrum? Part II.  Spine. 1983;  8 541-551

Correspondence