Spinal arachnoiditis
Introduction
Introduction to spinal arachnoiditis Spinal arachnoiditis is a chronic inflammatory process of the arachnoid membrane. Under the influence of certain causes, the arachnoid membrane is gradually thickened, causing damage to the spinal cord and nerve roots, or forming a cyst to block the medullary cavity, or affecting the blood circulation of the spinal cord. Eventually leads to dysfunction. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Cause of spinal arachnoiditis
(1) Causes of the disease
1. Infection: The main cause of this disease is that there is often a history of cold infection, fever, swelling, tuberculosis, appendicitis, pelvic inflammatory disease, meningitis, etc., and some people think that it is caused by viral infection.
2. Trauma: It is also a common cause. For example, after spinal fracture and dislocation and spinal cord surgery, 54 cases of spondylolisthesis have been reported to have arachnoid adhesions.
3. Spinal and spinal cord lesions: epidural abscess, subdural abscess, intraspinal abscess, intraspinal tumor, spinal vascular malformation, subarachnoid hemorrhage, disc herniation, spinal tuberculosis, osteomyelitis, etc. The lesions can be complicated by arachnoiditis or arachnoiditis after treatment.
4. Stimulation of chemical drugs: such as intrathecal antibiotics and various contrast agents, anesthetics and other chemical drugs.
5. The reason is unknown: although there are many causes, but a considerable number of cases still can not find the cause, the proportion can be as high as 44% to 66%.
(two) pathogenesis
The arachnoid itself has few vascular supplies and lacks inflammatory response. Under the stimulation of pathogens, the vascular-rich dura mater and the soft meninges can have active inflammatory reactions. The lesions often involve several spinal segments, and the cobwebs in the chronic phase. The fiber of the membrane is thickened, the color is gray, the transparency is lost, and it is cloudy. Sometimes white spots of different sizes appear. These lesions often adhere to the dura mater, soft membrane, spinal cord or nerve root, and the early spinal cord surface vasoconstriction and expansion The blood vessel wall is thickened, the vascular lumen is reduced, the spinal cord undergoes secondary changes and softening or cavities are formed, the margin of the cavity is connective tissue, and glial cells proliferate around. Arachnoid adhesions and cyst formation can directly compress the spinal cord, resulting in partial spinal cord deficiency. Hemorrhagic degeneration, severe spinal cord softening and necrosis, inflammatory adhesions can be divided into localized and diffuse, due to arachnoid adhesions, the formation of one or multiple cysts, thickened arachnoid membrane constitutes the cyst, the fluid in the capsule gradually Increased, constitutes compression of the spinal cord, therefore, spinal cord ischemia and compression caused by arachnoid adhesion and cyst formation is the disease of this disease Foundation.
Prevention
Spinal arachnoiditis prevention
Timely treatment and prevention of various primary diseases; prevention of spinal cord adjacent tissue infection involving the spinal arachnoid; strict implementation of routine operation procedures to prevent iatrogenic infections caused by neurosurgery and diagnosis and treatment operations.
Complication
Spinal arachnoiditis complications Complication
High intracranial pressure syndrome can occur.
Symptom
Spinal arachnoid inflammation symptoms common symptoms urinary incontinence sensory disturbance sensory separation reflex hyperthyroidism spinal cord arachnoid cyst muscle atrophy
1. History and course of disease
Mostly subacute or chronic onset, the course of disease can be from a few months to several years, the symptoms are light and heavy, and often have a remission period, may have a history of cold, fever or trauma, some have no obvious cause of spinal cord stimulation or paralysis symptoms Frequently, the symptoms are aggravated after a fever, injury, and fatigue, and the symptoms are relieved after rest, physiotherapy or anti-inflammatory treatment.
2. nerve root stimulation symptoms
Is the most common first symptom, the disease occurs in the dorsal side of the spinal cord, manifested as spontaneous pain, often a wide range and limited to 1 or 2 nerve roots, some radiated or banded along the nerve root distribution area Symptoms, when coughing, sneezing or exercise can make the symptoms worse, lumbosacral and cauda equina lesions can cause low back pain and radiation to the lower extremities, manifested as sciatica, nighttime symptoms worsen, and often bilateral.
3. Sensory disorder
It is the common symptom of the second place, but the symptoms of spinal cord conduction damage are more than a few months or years after the symptoms of spinal cord root stimulation. The level of sensory disturbance is not obvious, the distribution is irregular, and it is often inconsistent with movement disorders. Sometimes there is pain, and the sense of temperature disappears and the sense of separation is normal.
4. Movement disorders
The performance of progressive muscle weakness, cervical and thoracic lesions showed lower extremity spastic paralysis, hyperreflexia, clonic and pathological reflexes, lumbosacral lesions often appear in both lower limbs flaccid paralysis and varying degrees of muscle atrophy.
5. Sphincter disorders appear late or inconspicuous, with intermittent urinary retention or urinary incontinence.
Examine
Spinal arachnoiditis
The cerebrospinal fluid pressure was lower than normal or normal during lumbar puncture. The Queckenstedt test had partial obstruction accounting for 1/2, and complete obstruction accounted for 1/4. The color of cerebrospinal fluid was colorless transparent or yellow, and the protein content increased to varying degrees. In the case, the number of white blood cells is increased, mainly lymphocytes, sometimes the clinical symptoms are heavy and the obstruction is light. This point is different from the tumor. In a few cases, the symptoms can be aggravated after the lumbar puncture and drainage, and the same patient repeatedly wears the waist, sometimes Obstruction, and sometimes smoothness are the characteristics of this disease.
Spinal iodine angiography
Iodine oil is dispersed or spotted, or in the form of irregular strips. Similar to the "candle tear" distributed in the longer area of the spinal canal, the iodized oil flows slowly. When observed repeatedly, the formation of the iodine column can be inconsistent, generally lacking. Clear range limits, iodized oil blockage plane is not necessarily consistent with clinical symptoms, local abrupt occlusion or filling defects may occur, the shape of the occlusion end is irregular or jagged, and some cases are obstructed in a so-called "cup" shape. Different from the intraspinal tumor, it is generally not accompanied by signs of spinal cord displacement. The value of spinal iodine angiography is higher, but it is generally not used because it can make the condition worse.
2. CT and MRI examination
The value of CT scan is limited. CT scan of myelography (CTM) can show the change of adhesion. At the end of the dural sac, it shows irregular stenosis of the subarachnoid space of the spinal cord. The nerve roots stick to each other and lose normal performance. Adhesion to the surrounding dural sac is manifested as "empty spinal capsule". There is no nerve root in the dural sac. Only the contrast agent is filled, and the adhesion between the wall and the nerve root is thickened and the adhesion is serious. The nerve roots that are stuck together form a tubular shadow. Local adhesion to the dural sac can show irregularities of the nerve root and dural sac. The cyst formed by adhesion is connected to the subarachnoid space of the spinal cord, delaying the CTM visible contrast agent. In the cyst, MRI is mainly characterized by soft tissue shadows in the sagittal and axial positions of the medullary cavity, with long T1 and long T2 signals, irregular shape, intermittent; local cyst type is longer T1 With the long T2 signal, there is a placeholder effect, which can compress the spinal cord and nerve roots, and generally does not strengthen after injection of Gd-DTPA.
Diagnosis
Diagnosis and differentiation of spinal arachnoiditis
After a cold or fever and a systemic infectious disease, symptoms of spinal cord compression combined with multiple nerve root involvement, fluctuations in exacerbation and remission, multi-segmental sensory disturbance, unfixed level, bilateral symmetry Cerebrospinal fluid leukocytosis, spinal iodine oil angiography showed a spot-like distribution of oil column or irregular stenosis of the spinal cord, the diagnosis is generally not difficult, the typical performance of lipiodol angiography, often can be diagnosed.
Differential diagnosis
1. Intraspinal tumor
The onset is slow, there is no obvious reason, the symptoms are progressively aggravated, there is a clear plane of spinal cord involvement, the number of cells in the cerebrospinal fluid is not increased, and the protein content is increased. The X-ray film may have the change of the inner edge of the pedicle and the enlargement of the intervertebral foramen. Spinal cord iodine angiography showed a well-defined obstruction plane. MRI showed localized solids in the spinal canal or space-occupying lesions with cystic changes. Intramedullary tumors showed limited thickening of the spinal cord, TlW1 was slightly lower signal, and T2W1 was slightly higher signal. Or obviously high signal, the signal intensity is often uneven, all sides observe, the subarachnoid space around the lesion is narrowed or occluded, common secondary syringomyelia, the subdural tumor is often deformed by the spinal cord, and shifted to the opposite side. The subarachnoid space of the tumor side was widened, and the subarachnoid space of the tumor was narrowed. A linear low-signal dura mater was seen between the epidural tumor and the spinal cord. The epidural fat disappeared and the subarachnoid was adjacent. The lumen is narrowed and the spinal cord is compressed to the opposite side.
2. Disc herniation
More traumatic history, sudden onset, mostly nerve root involvement in the lumbosacral region, in the neck, thoracic or lumbar segmental type, can cause spinal cord or cauda equina nerve involvement, myelography contrast agent has filling defects in the intervertebral space plane or Obstruction, CT examination showed that the posterior margin of the disc was localized, and the MRI sagittal position showed that the disc was flattened and the dural sac was compressed.
3. Other diseases
Spinal vascular malformation, combined lateral degeneration and occipital neck deformity, etc., also need to be considered and excluded. It is not difficult to exclude the above diseases by CT and MRI.
