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Correlación de hallazgos radiológicos con los eventos adversos que posiblemente hayan causado aracnoiditis

2005; Q106299148; Volume: 12; Issue: 5 Linguagem: Espanhol

2254-6189

J. Antonio Aldrete, R. F. Ghaly, Tracy L. Brown, Luis A. Vascello, F. H. Montpetit, S. C. Johnson,

Neurosurgical Procedures and Complications

espanolEl diagnostico clinico de aracnoiditis se caracteriza por dolor ardiente, quemante con disestesia, disfuncion vesical, rectal y sexual que se presentan despues de un evento adverso durante una intervencion en la columna vertebral; puede ser confirmado por una resonancia magnetica o por un mielograma seguido de una tomografia de la columna lumbar. En este estudio se revisaron a posteriori los estudios de imaginologia de 436 pacientes referidos a una clinica de dolor con el diagnostico de aracnoiditis con el objeto de identificar patrones especificos de imagenes radiologicas que permitieran la identificacion de la posible etiologia de esta enfermedad. La causa aparente fue correlacionada con la aparicion de cambios neurologicos presentandose despues de inyecciones, intervenciones u operaciones de la columna vertebral. Fueron notados deficits neurologicos en 160 pacientes despues de mielogramas, anestesia raquidea o peridural, parches epidurales de sangre, inyecciones de esteroides o neuroliticos para tratar dolor cronico. De estos enfermos, 11 (6,8%) tenian raices inflamadas, 135 (84,3%) tenian raices en racimo y en 12 casos (7,5%) las raices se adherian al saco dural. Dos casos de siringomielia fueron notados en pacientes que tuvieron anestesia peridural toracica o lumbar alta. De 276 pacientes, otros en los que el diagnostico clinico de aracnoiditis se presento despues de intervenciones quirurgicas de la columna vertebral, 259 pacientes (93,8%) tenian raices en racimo, 152 (55%) tenian un saco dural deformado, y fibrosis peridural se noto en 241 enfermos (87,3%). Pseudomeningoceles y calcificaciones intratecales se notaron en 21 (7,6%) y en 4 (0,15%) de los casos operados, respectivamente. Se deduce que las imagenes radiologicas en casos de aracnoiditis causados por inyecciones e intervencionismo, se caracterizan unicamente por raices en racimo. Mientras que en los pacientes operados tienen, ademas de raices en racimo, deformidades del saco dural y tejido cicatricial y fibrotico en el espacio epidural intervenido quirurgicamente. EnglishClinical diagnosis of arachnoiditis is characterized by a burning, ardent pain with dysesthesia and vesical, rectal and sexual dysfunction that appear after an adverse event during a spinal surgical procedure; it can be confirmed through magnetic resonance or myelogram followed by lumbar spine tomography. In this study, a retrospective review was conducted of image studies from 436 patients referred to a pain clinic with diagnosis of arachnoiditis in order to identify specific patterns on the radiological images that could help to determine the potential etiology of this disease. The apparent cause was correlated to the appearance of neurological changes after spine injections, interventions or surgical procedures. Neurological deficits were observed in 160 patients after myelograms, rachidian or peridural anesthesia, epidural blood patches or injection of steroids or neurolytic drugs for the management of chronic pain. Eleven (6.8%) of these patients had inflammation of roots, 135 (84.3%) had roots in bunches and 12 cases (7,5%) had roots adhered to the dural sac. Two cases of syringomyelia were observed in patients with thoracal or high lumbar peridural anesthesia. Of 276 other patients in which the clinical diagnosis of arachnoiditis was established after spine surgical procedures, 259 patients (93.8%) had roots in bunches, 152 (55%) had a deformed dural sac and peridural fibrosis was observed in 241 patients (87.3%). Pseudomeningocele and intrathecal calcifications were observed in 21 (7.6%) and 4 (0.15%) of the surgical cases, respectively. It is concluded that radiological images in cases of arachnoiditis caused by injections and invasive procedures are only characterized by roots in bunches. However, surgical patients have, in addition to roots in bunches, deformation of the dural sac and healing and fibrotic tissue at the epidural space undergoing surgery.