Syringomyelia Associated with Arachnoiditis Developed after Spinal Anesthesia

Cheun, Jae Kyu; Kim, Ae Ra; Choi, Kyung Don

Abstract

The popularity of spinal anesthesia has decreased to some extent due to the widespread use of a balanced anesthesia technique, increasing interest in epidural anesthesia and fear of neurologic sequelae resulting from spinal anesthesia. The complication once most feared was adhesive arachnoiditis. However, in many study reports there were no instances of adhesive arachnoiditis, cauda equina syndrome or transverse myelitis. The majority of serious neurological symptoms appearing after spinal anesthesia can be attributed to coincidence or previously unrecognizaed disease. This is a case report in which the patient developed syringomyelia with chronic adhesive arachnoiditis. A 27-year-old patient, known to have adhesive arachnoiditis which developed after spinal anesthesia, was admitted to this institution for treatment of syringomyelia. He had history of a simple appendectomy done under spinal anesthesia on the 24th of November in 1976 and had experienced sensory changes and progressive motor weakness in the lower extremities 4 months after surgery. In January, 1978 he received an adhesiolysis operation after conservative therapy using steroid injections. Afterward, he developed syringomyelia resulting from adhesive arachnoiditis and had shunt surgery. He went home without significant improvement. However, it is unwise to make a final diagnosis and assume that the sequela was attributed only to the spinal anesthesia. It is important to seek other causes rather than to ascribe all to the spinal anesthesia because there are many other causative factors. In this case, it was not certain that adhesive arachnoiditis was a possible cause, but this could not be ruled out either. The prevention of complications and their causative factors must be carefully considered at all times in the practice of spinal anesthesia.