Pantopaque “Arachnoiditis”

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PERSISTENCE or recurrence of sciatica following disc surgery is not uncommon and is due to a number of factors. Among these are the fact that removal of the protruded portion of the disc may not restore the joint to normal. Secondly, relief of pressure on the nerve root does not restore the nerve root to normal.Thirdly, surgical exposure of any spinal nerve root, normal or abnormal, causes it to become immobilized in the healing scar. A nerve root so immobilized is still pulled upon by certain movements whether or not the involved joint is fused. Fourthly, the diagnosis and surgical treatment of these lesions affecting the central nervous system are fraught with pitfalls even in the hands of experienced neurosurgeons.

Faced with the problem of trying to help such patients, and realizing that reoperation is seldom successful, we began to employ intraspinal injections of procaine hydrochloride and corticosteroids.1 The injections were followed by straight-leg raising exercises designed to stretch the adhesions about the nerve roots. In many patients the procaine was necessary because mobilization of the nerve root by these exercises was painful. In the beginning, these injections were given extradurally through the sacral hiatus.2 Later, in some of the patients who failed to respond, injections were given intradurally by spinal puncture, and relief was afforded. Gradually it was realized that when the patients had had a previous Pantopaque myelogram, the intradural treatment was apt to be more effective than the extradural.

The introduction of Pantopaque§ in 1940 facilitated the. . .



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