Effects of laminectomy and retained extradural foreign body on cauda equina adhesion.

Abstract

The histologic effects of posterior lumbar surgery and retained extradural foreign bodies on the cauda equina were investigated in rats over time. The following four groups of rats were provided: Group 1, sham operation (laminar exposure alone); Group 2, laminectomy alone; Group 3, laminectomy with retained extradural silk thread; Group 4, laminectomy with extradural kaolin; and the control. Histological study was performed on the transverse sections of laminectomized (L5) and nonlaminectomized (L4) areas. In Group 1, adhesive changes involving the cauda equina, consisting of dilatation of nutrient vessels, and eosinophilic exudative changes between the adhering cauda rootlets were seen the day after surgery, but the fibrinous adhesion was resolved spontaneously in all rats after 1 week without permanent sequelae. In Groups 2 and 3, postoperative adhesion of the cauda equina roots was conspicuous, but it resolved by 6 weeks. In Group 4, obvious adhesion persisted through the 12th week after surgery. Destruction of the myelin sheath and axonal loss of the cauda equina occurred in the first week after surgery in all the experimental groups except in the sham group. The severity and extent of the neural degeneration were mostly parallel to the severity of inflammatory changes in the epidural areas. At the nonlaminectomized area (L4) in each group, the arachnoid and cauda equina tended to congregate the day after surgery, but these changes were all transitory. The severity and persistency of the arachnoiditis and neural degeneration directly corresponded to the magnitude of the inflammation and wound healing processes. This seems to imply that careful surgical intervention with no use of foreign bodies is necessary to reduce postoperative adhesive arachnoiditis.