Pathophysiology and pain mechanism of iatrogenic lumbar adhesive arachnoiditis, its prevention and treatment

本课题对医源性腰椎粘连性蛛网膜炎（MedicagenalLuminaAbhesiveArachnoiditis，ALL）的病因、病理学、疼痛机制及蛛网膜细胞增生的病理机制进行了临床和基础研究，结果如下：1）LAA主要由脊髓造影和后路手术引起，在腰痛患者中的发生率约为1.2%。医源性LAA在老年退行性椎管狭窄患者中并不少见，但仅限于轻度粘连性蛛网膜炎。2）症状以多根刺激、感觉异常和麻痹为主，表现形式多样，随时间变化。根据术中所见、组织学检查和临床检查，对脊髓造影进行新的分期和分型。4）采用高效液相色谱法对191例下腰痛/脊髓病患者（包括13例典型LAA患者）脑脊液（CSF）中的5-羟色胺（5-HT）代谢产物进行分析。DOPAC和3-MT在LAA患者中无论穿刺部位如何都非常高，表明脑代谢紊乱的组合。5）通过蛛网膜细胞培养系统，研究了蛛网膜细胞异常增殖的条件，包括细胞的基本生长曲线和DNA合成。培养6天后，细胞具有吞噬功能和较高的DNA合成能力。本研究进一步研究了白细胞介素、超氧化物、各种炎症产物和异物对组织培养系统中细胞病理学的影响。6）为伴有LAA的腰椎管狭窄症患者开发了一种新的手术方法。

This project concerns about clinical and basic studies on iatrogenic lumber abhesive arachnoiditis (ALL), with the causes, symptomatology, pathology, pain mechanism and pathomechanism of the arachnoid cell proliferation.The result are summarized as follows; 1) LAA was mainly caused by myelography and posterior surgical intervention, and the incidence was approximately 1.2% in low-back pain patients. Iatrogenic LAA was not infrequently observed in patients with degenerative spinal stenosis in the elderly, but it limited in slight adhesive arachnoiditis.2) Symptoms were mainly corresponded to multiroots irritation, paresthesia and palsies with a bizarre pattern and changing with the time. Patients had a tendency to reveal specific pain behavior and emotional abnormalities.3) A new stage and myelographic type classifications were drawn from the intraoperative findings, histology and the clinical examinations.4) Cathecolamine and serotonin metabolites in the CSF were analyzed by HPLC in 191 low-back pain / myelogathy patients including 13 cases with typical LAA. DOPAC and 3-MT were very high irrespective of puncture site in LAA patients, suggesting a combination of disorders of of brain metabolism. No epinephrine abnormality was detected in LAA.5) Through the arachnoid cell culture system, conditions inducing sbnormal proliferation of the arachnoid cell has been investigated including basic growth curve and DNA synthesis of the cells. The cells showed a phagocytosis and high synthesis capacity of DNA at 6-day culture. This study is further performing on influences of interlenkins, superoxides, various inflammatory products and foreign bodies on the cell pathology in the tissue culture system.6) A new surgical procedure was developed for patients with lumbar spinal stenosis accompanied by LAA.