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Updated: Sep 11, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Postoperative arachnoiditis diagnosed by high resolution fast spin-echo MRI of the lumbar spine
1Department of Radiology, St. Mary's Hospital, London, UK.
Abstract:
Chronic adhesive arachnoiditis is cited as an important cause of recurrent pain and disability after extradural lumbar disc surgery. Myelography using oil-based or ionic water-soluble contrast media was a major contributing factor, and it was not possible to distinguish the prevalence of arachnoiditis probably due to surgery alone. Today it should be possible to make this distinction, which was the purpose of this study. Using high-resolution MRI in 129 patients symptomatic at least 1 year after surgery, a prevalence of arachnoiditis of 20% was found, which dropped to 3% when patients who had undergone oil-based myelography were excluded. Arachnoiditis was diffuse in 88% and focal in 12%. When oil-based media were involved it was focal in 13%, and when not, in one of three cases. It was concluded that arachnoiditis does occur after extradural lumbar disc surgery independently of the use of some myelographic contrast media, and that it may be diffuse or confined only to the operated level. Its prevalence was estimated at 4.6%, four cases focal and two cases diffuse. The causes and clinical significance can only be the subject of speculation.
Insights
Chronic adhesive arachnoiditis can cause pain after lumbar disc surgery. High-resolution MRI suggests a 4.6% prevalence, independent of myelography contrast media, though causes remain speculative.
Area of Science:
- Neurosurgery
- Radiology
- Pain Management
Background:
- Chronic adhesive arachnoiditis is a significant cause of post-surgical pain and disability.
- Distinguishing arachnoiditis caused by surgery versus myelography has been challenging.
Purpose of the Study:
- To determine the prevalence of arachnoiditis after lumbar disc surgery.
- To differentiate arachnoiditis occurrence independent of myelographic contrast media.
Main Methods:
- High-resolution MRI was used to evaluate 129 patients with symptoms over one year post-surgery.
- Prevalence was assessed, comparing patients with and without a history of oil-based myelography.
Main Results:
- Overall arachnoiditis prevalence was 20%, decreasing to 3% when excluding patients who had oil-based myelography.
- Arachnoiditis was predominantly diffuse (88%).
- Estimated prevalence independent of contrast media was 4.6% (4 focal, 2 diffuse cases).
Conclusions:
- Arachnoiditis can occur after extradural lumbar disc surgery, irrespective of myelographic contrast media.
- The condition can be diffuse or localized to the surgical site.
- Further research is needed to understand the causes and clinical significance.
