Secondary Adhesive Arachnoiditis

　　There are many reasons for the secondary adhesive arachnoiditis, including physical factors, chemical factors, biological factors, and many other unclear reasons. The most common specific causes in clinical practice are as follows:

　　1. Spinal Cord Myelography
　　Due to the lack of clarity of gas contrast and its stimulation to the meninges, causing severe headaches, chemical contrast agents are often used in clinical practice. However, both water-soluble and oil-based agents can cause arachnoiditis.

　　2. Spinal Cord Injury
　　With the development of industry and agriculture, as well as the modernization and popularization of transportation tools, especially the rapid development of expressways, spinal cord injuries are bound to increase accordingly. In developed capitalist countries, approximately 60 people out of every 100,000 residents are paralyzed cases mainly due to spinal cord injuries, and the number of cases of general spinal injuries is several times higher. In addition, the popularization of lumbar puncture (including subarachnoid blockage and other methods) and spinal surgery all constitute factors causing spinal canal injuries. Moreover, the rupture and hemorrhage of the soft meninges and the dura mater, even the most minor injuries, can cause arachnoiditis.

　　3. Compression factors
　　Mainly refers to intervertebral disc herniation and vertebral canal stenosis. The local nerve roots and spinal cord can develop edema, fibrin exudation, and adhesion due to circulatory and nutritional disorders of nerve tissue over a long period of compression, especially the arachnoid at the root canal is most prone to adhesion. Therefore, for such cases with a long course of disease, attention should be paid to the coexistence of arachnoiditis. Under certain circumstances, subarachnoid cleft can be incised at the same time as decompression surgery to relieve adhesions.

　　4. Infection of the vertebral canal or adjacent areas
　　Inflammatory lesions near the vertebral canal are generally widespread and severe, with poor prognosis, but they are extremely rare. Therefore, in cases of suspected intraspinal infection, especially after spinal surgery, it is necessary to use broad-spectrum antibiotics in high doses early. On the other hand, attention should also be paid to inflammation caused by subacute or low-grade infection, which should be treated early.

　　　Patients with secondary adhesive arachnoiditis generally have a history of intraspinal injection anesthesia, surgery, and trauma. Severe secondary adhesive arachnoiditis may be complicated by spasmodic paralysis.

　　Patients with secondary adhesive arachnoiditis generally have a history of intraspinal injection anesthesia, surgery, and trauma. The clinical characteristics are as follows:
　　1. Radicular pain Headache is an early symptom, mainly caused by the traction of adhesions on the spinal nerve roots. Since the root sheath is the earliest site of arachnoiditis, radicular pain is also manifested earliest.
　　2. Sensory disorders It often appears at the same time or slightly later than radicular pain, including sensations of crawling, hyperesthesia, and numbness. There are few cases of complete loss of sensation.
　　3. Motor disorders Mainly muscle weakness, severe cases may appear spasmodic paralysis, more common in those with a longer course of the disease.
　　4. Others Including weakened reflexes, muscle atrophy, and unsteady gait, all can be found in physical examination.

　　To prevent secondary adhesive arachnoiditis, timely treatment and prevention of various primary diseases are necessary. Controlling intracranial and extracranial infections, actively preventing and treating various cranial and spinal injuries, reducing intrathecal drug injections, all contribute to the prevention of secondary adhesive arachnoiditis.

　　The diagnosis of secondary adhesive arachnoiditis depends not only on clinical manifestations but also on auxiliary examination, which is an indispensable method for diagnosis. The commonly used examinations are as follows:
　　1. Lumbar puncture
　　The initial pressure is usually low, cerebrospinal fluid is slightly yellow or normal in color, protein quantitation is often increased, and there is an increase in lymphocytes.
　　2. X-ray examination
　　Generally, there are no positive findings on plain films, but for those who have undergone iodine oil contrast, candle wax-like or cystic shadows may appear on X-ray films. Those with this sign can be basically diagnosed. However, for those who have not undergone iodine oil contrast, it is not advisable to emphasize myelography for diagnosis.
　　3. MRI examination
　　The adhesive bands in the subarachnoid space can be shown as a faint shadow on the MRI transverse scan image, especially for those with a longer course of the disease, which is helpful for diagnosis.

　　Patients with secondary adhesive arachnoiditis should pay attention to eating soft and easily digestible foods, such as congee, soup, egg custard, vegetables, fresh fruit juice, etc., which is conducive to the digestion and absorption of nutrients. Patients should avoid spicy and刺激性 foods, smoking, drinking, and other habits. Patients should be strengthened in nursing care, and severe patients should be turned over and patted on the back regularly to prevent bedsores. During the rehabilitation period, patients are encouraged to strengthen limb function exercises, supplemented by acupuncture, physical therapy, and massage.
　

　　The treatment of secondary adhesive arachnoiditis still focuses on conservative therapy. When conservative therapy is ineffective or the primary disease requires surgery, simultaneous surgical treatment should be performed. The specific treatment methods are as follows:

　　First, non-surgical treatment
　　1. Drug therapy: Drugs that can relieve, soften, or eliminate adhesions can be selected, such as placental tissue fluid, α-chymotrypsin, trypsin, etc.
　　2. Intraspinal Oxygen Injection Therapy: For some cases, including early and middle-stage cases, after examination, it is proven that there are no other complications, 40-60ml of disinfected oxygen can be injected into the spinal canal at the same time as the cerebrospinal fluid examination through lumbar puncture, which also has a certain therapeutic effect, especially for those with adhesions after lower lumbar spinal canal surgery. It can not only relieve pain, limb spasm and other symptoms, but also may break the thinner and finer adhesion bands through the temporary high pressure formed in the spinal canal after injection; but it is ineffective for thicker adhesion bands, and surgical incision is still needed.

　　Second, surgical treatment
　　For those who are ineffective with non-surgical treatment and have severe symptoms that affect daily life, surgical treatment is required. The advantages are:
　　1. Relieve or eliminate pressure: It can reduce and relieve the traction and pressure on the spinal cord, spinal nerve roots, and their blood vessels in advance.
　　2. Improve blood supply: Due to the relaxation of blood vessels, the blood supply between the spinal cord and the nerve roots has been improved, and it also promotes the recovery of the spinal meninges itself. This not only benefits the improvement of neurological function but also corresponds to blocking the恶性 cycle of the disease. In addition to the application of certain drugs, it is possible to reduce the recurrence of adhesions or prevent their formation, thereby obtaining therapeutic effects.