This report concerns the outcome of 36 operations for spinal adhesive arachnoiditis (SAA) performed at Kyoto University Hospital since 1956; the follow-up period ranged from 1 to 25 years (average, 4 years 8 months). The original procedure involved intradural neurolysis after extradural decompression, but more recently microlysis was performed. The percentage of cases in which good results were obtained by nonmicroscopic lysis and microlysis was only 54.8%, however, when microlysis was followed by spondylodesis, the ratio increased to 80%, clearly showing the benefits of this new procedure. The authors therefore emphasize the value of spondylodesis following microlysis for symptomatic SAA.