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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lumbar epiduro-arachnoiditis is a well-known complication of surgery of the intervertebral disc. The epidural fibrous scar is the normal outcome of inflammatory activity secondary to the mechanical tissue disturbance resulting from surgery. In certain individuals, perhaps genetically predisposed as excessive quantity of fibrous tissue is deposited in the epi and/or nitradural space. This abnormal situation, comparable to cheloid cutaneous scars, is perhaps at the origin of the clinical symptoms. The authors report the clinical and radiological signs observed in 38 patients having had at least one operation for discal hernia, and who underwent further operations in the aim of freeing the roots and the dural sack from fibrous compression. Results of excision of the epidural "cheloid" were good in 13 cases, and average in 8 others. There was a complete failure in 17 other patients. Three explanations were offered to explain the frequency of the failures: 1) formation of a new cheloid, 2) difficulty of neurolysis of the arachnoiditis, 3) possibility of intrinsic lesions of the nerve associated with the epiduro-arachnoiditis.
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PMID:[Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations]. 53 1

Syringomyelia management is showing some progressive improvements following surgical methods of investigation and treatment. Investigation of simultaneous pressure changes in the cerebrospinal fluid pathways has illustrated the importance of craniospinal pressure dissociation in impacting the cerebellar and medullary tissues in the foramen magnum in hindbrain related syringomyelia. Such pressure differences may be referred to as 'suck' and similar changes are to be found in non-hindbrain related forms of syringomyelia such as those associated with spinal arachnoiditis. When cavities have formed then impulsive movements may occur with them and enlargement of the cavities may be continued by sloshing of the fluid within them. Investigations have been improved following the widespread use of water soluble contrast media and CT scanning with reconstructions after myelography. A definite relationship between birth injury and hindbrain related syringomyelia has been established especially with cases showing arachnoiditis. The nature of the relationship to hindbrain hernia and basilar invagination remains unclear. Magnetic resonance imaging holds great promise particularly in showing hindbrain deformation in new-born babies, showing whether or not a communication commonly exists between the fourth ventricle and the cavities within the spinal cord in early childhood and also in outlining the changes in the spinal cord in the presence of acute traumatic paraplegia. Treatment still relies upon valved ventricular to extrathecal shunts for hydrocephalus, cranio-vertebral decompression to prevent suck and drainage of the syrinx in appropriate cases. Syrinx to extrathecal shunting may be preferred to shunts to the subarachnoid space. The peritoneum and the pleura are favoured sites and a valve is not necessary. The advances for the future may depend on earlier diagnosis and greater understanding of the mechanisms of pathogenesis in which MRI seems likely to play an increasingly important part.
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PMID:Progress in syringomyelia. 287 6

The persistence of lumbar and nerve root pain after nerve root decompression surgery may be attributed to one of five causes; 1) progression of the spondylotic disease in the presence of peridural fibrosis; 2) recurrence of disc herniation or new hernia; 3) stenosis of the spinal or nerve root canal; 4) arachnoiditis; 5) vertebral instability. In most patients with peridural fibrosis and worsening of spondylotic lesions regression of nerve root symptoms was obtained after several months of conservative treatment, which continues to constitute essential treatment for most patients with recurrence of lumbar symptoms. The authors report the results obtained with the surgical treatment of 95 patients performed between 1981 and 1991 and divided into the categories listed above. Of these patients, 70 were submitted to further decompression surgery while 25 were submitted to posterolateral vertebral fusion. Reintervention obtained useful results in 83% of the cases where there had been recurrence of disc herniation; nerve root release obtained positive results in 100% of the cases where there was stenosis. Results obtained after wide decompression were poor in all of the cases with arachnoiditis; in these patients conservative treatment with T.E.N.S. can obtain a fair amount of control over pain. Positive results were obtained in 84% of the 25 patients submitted to posterolateral fusion for the treatment of vertebral instability, with fusion obtained in 96% of the cases. Surgical treatment is indicated for psychotic, neurotic patients or those with insurance-related motivations only when the organic cause of the symptoms is clearly evident.
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PMID:Failed back syndrome: a study on 95 patients submitted to reintervention after lumbar nerve root decompression for the treatment of spondylotic lesions. 807 69

The authors consider poor results in lumbar disc surgery to be commonly caused by the following conditions: 1) recurrence of the hernia; 2) postoperative instability; 3) scarring entrapment of the spinal nerve roots; 4) coexisting local or general pathology; 5) arachnoiditis; 6) psychological causes and those where insurance is involved. In particular patients with insurance-related motivations or those affected with depressive syndromes are frequently observed among those submitted to lumbar surgery. The only indications for surgery include recurrence of disc herniation and postoperative instability. In any of the other situations further surgery often results in worsening of the patient's conditions, or it at any rate does not guarantee improvement in the conditions of the patients.
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PMID:Failed back syndromes: opinions and personal experiences. 807 70

Failed back surgery syndrome is the persistence or reappearance of pain after surgery on the spine. This term encompasses both mechanical and nonmechanical causes. Imaging techniques are essential in postoperative follow-up and in the evaluation of potential complications responsible for failed back surgery syndrome. This review aims to familiarize radiologists with normal postoperative changes and to help them identify the pathological imaging findings that reflect failed back surgery syndrome. To interpret the imaging findings, it is necessary to know the type of surgery performed in each case and the time elapsed since the intervention. In techniques used to fuse the vertebrae, it is essential to evaluate the degree of bone fusion, the material used (both its position and its integrity), the bone over which it lies, the interface between the implant and bone, and the vertebral segments that are adjacent to metal implants. In decompressive techniques it is important to know what changes can be expected after the intervention and to be able to distinguish them from peridural fibrosis and the recurrence of a hernia. It is also crucial to know the imaging findings for postoperative infections. Other complications are also reviewed, including arachnoiditis, postoperative fluid collections, and changes in the soft tissues adjacent to the surgical site.
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PMID:The postsurgical spine. 2676 41