RESUMEN
Fifty patients with arachnoiditis were studied, and long-term follow-up ranging from 10 to 21 years was obtained on 36 (72%). Prior to developing arachnoiditis, 90% originally had intervertebral disc disease, Pantopaque (Alcon Surgical, Ft. Worth, Texas) myelography, and subsequent lumbar spine surgery. Pain and functional disability tended to remain the same as at the time of diagnosis, although severity of symptoms fluctuated. Increased neurologic deficits were more frequently due to surgical intervention than to the natural course of the disease. Urinary symptoms characterized by urgency, frequency, and occasional incontinence, with no other apparent cause, developed late in 23%. Although the majority were able to walk and drive a car without limitation, ability to return to previous full-time occupations was markedly limited. The majority depended on daily narcotic analgesics; a few admitted to alcohol abuse. There were two deaths by suicide. Although other deaths were not directly related to arachnoiditis, the average lifespan was shortened by 12 years. Treatment results were disappointing. Arachnoiditis may be disabling; however, longterm follow-up indicates that progression of symptoms and functional impairment are not the natural course of the disease.
Asunto(s)
Aracnoiditis/fisiopatología , Adulto , Anciano , Aracnoiditis/diagnóstico por imagen , Aracnoiditis/terapia , Evaluación de la Discapacidad , Electromiografía , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Laminectomía/efectos adversos , Masculino , Persona de Mediana Edad , Mielografía/efectos adversos , Dolor , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Vejiga Urinaria/fisiopatología , Trastornos Urinarios/etiologíaRESUMEN
Fractures of the thoracic spine (T2-T12) should be considered as a separate entity because of the anatomic features of the rib cage and spinal canal in this region. Fifty-seven patients sustained this injury over a 10-year period (16% of thoracic, thoracolumbar, and lumbar fractures). Twenty-eight fracture dislocations, 25 compression fractures, and 1 burst fracture were seen. Three injuries, combining elements of a burst fracture and a dislocation, were designated "burst-dislocations." Apart from compression fractures, a direct blow was often the implicated mechanism of injury. Significant associated injuries were uncommon. Fracture-dislocations were often associated with neurologic injury and compression fractures with long-term pain. Operative treatment appeared to afford the best results for stabilization and pain relief.