| Multimodal Procedures for Intractable Anal Pain Caused by Arachnoiditis Ossificans of the Cauda Equina |
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Han Ga Wi Nam, Hyung Sik Hwang, Kang San Kim, Sei Woong Jeon, Seung-Myung Moon, Je Hoon Jeong, Il-Yong Shin, Jae Jung Lee |
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Department of Neurosurgery, Surgery, College of Medicine, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea |
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| Abstract |
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We report the case of a patient suffering from chronic intractable anal pain (VAS 10) following spinal surgery, with arachnoiditis ossificans of the cauda equina. The anal pain (proctalgia) started after anterior spinal instrumentation and a laminectomy for an L2 fracture performed seven years ago. The patient underwent six pain-related surgeries involving removal of malpositioned screws, sacral nerve stimulation, spinal cord stimulation, and unilateral DREZ lesioning, with little success. On the other hand, intradural adhesiolysis of the cauda equina partially alleviated the anal pain, and the colostomy corrected the defecation problem. Thus, anal pain following spinal surgery should be distinguished from that arising from different pathologies and vefforts to treat it should begin as early as possible, before it becomes chronic and intractable. |
| Key Words:
Anal pain, Spinal cord stimulation, Arachnoiditis Ossificans, Dorsal root entry zone. |
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