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

本课题涉及医源性腰椎粘连性蛛网膜炎（ALL）的临床和基础研究，包括蛛网膜细胞增殖的病因、症状、病理、疼痛机制和病理机制。结果总结如下：1) LAA主要由脊髓造影和后路手术干预引起，在腰痛患者中发生率约为1.2%。医源性LAA在老年退行性椎管狭窄患者中并不罕见，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、麻痹为主，形态怪异，随时间变化。患者有表现出特定疼痛行为和情绪异常的倾向。3)从术中表现、组织学和临床检查中得出新的分期和脊髓学分型。4)采用高效液相色谱法分析191例腰痛/脊髓增生患者脑脊液中儿茶酚胺和5 -羟色胺代谢产物，其中13例为典型LAA。LAA患者不论穿刺部位，DOPAC和3-MT均较高，提示脑代谢紊乱。laa未检测到肾上腺素异常。5)通过蛛网膜细胞培养系统，研究了诱导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，细胞表现出较强的吞噬能力和较高的DNA合成能力。本研究进一步研究了组织培养系统中间质、超氧化物、各种炎症产物和异物对细胞病理的影响。6)为腰椎管狭窄合并LAA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.