results in the clumping or sticking of nerve
roots together inside the spinal fluid. The
nerves adhere together and therefore technical
name of the condition is "adhesive
arachnoiditis". The arachnoid is a thin spidery
membrane which covers nerves and the spinal
cord. When subjected to infection or trauma,
this membrane can become sticky and
ultimately grow over the nerves, embedding
them into the thick wall which contains the
spinal fluid (dura mater). Arachnoiditis occurs
intradurally (inside the dura) whereas
peridural fibrosis occurs extradurally in the
epidural space. They are thought to be
somewhat related conditions but
the nerves in the epidural space
are covered by a tough coating
called myelin which protects
them. Inside the dura where
arachnoiditis occurs, there is no
such protective coating thereby
leaving the nerves exposed to
injury or inflammation. The most
common causes of arachnoiditis in
the early 21st century are meningitis, spine
surgery and trauma (automobile, etc.). The
incidence of arachnoiditis after spine surgery in
patients undergoing re-operation for pain
ranges from 3.5% (J Spinal Disord 1999 Aug;12(4):287-92
Findings and outcome of revision lumbar disc surgery) to 16%
(Acta Med Port 1998 Jan;11(1):59-65 Lumbar arachnoiditis].Ribeiro
C, Reis FC). A far less common cause today is
myelography (myelogram), however before
1988 when oil based myelogram contrast was
used, myelograms were a significant cause of
arachnoiditis. Other causes include sources as
diffuse as electrocution injury, radiation
therapy, tuberculosis, cocaine, HIV, etc. A
cause not related in any scientific study but for
which there are a few case reports in the
literature are epidural steroid injections. There
is NO evidence of epidural analgesia for labor
pain causes arachnoiditis and studies have
demonstrated no relationship (Br J Anaesth. 2004
Jan;92(1):109-20. Obstetric epidurals and chronic adhesive
arachnoiditis)
DIAGNOSIS: Based on a history of unexplained
pain, one of the major risk factors, and
unequivocal evidence on MRI, myelography, or
myeloscopy. If there are no radiological or
myeloscopy findings, it is not possible to make
a diagnosis of arachnoiditis.
SYMPTOMS: This condition is may be very
painful, and can cause extremity and low back
pain, tingly sensations and numbness in the
lower extremities, bowel and bladder
irregularities, unusual rashes, sweating
abnormalities, and many other diffuse
symptoms occurring in the lower extremities.
There is generally no correlation between the
MRI findings and patient symptoms which leads
some to question the significance of
arachnoiditis given the diffuse and non
objective symptoms present in many patients.
TREATMENT: There are no cures for
arachnoiditis. The disease is slowly
progressive and can result in progressive loss
of motor and sensory function. The diagnosis is
made by MRI and/or myeloscopy (passing a
scope into the dura to look for arachnoiditis).
Treatments revolve around pain medications
and neuromodulation techniques such as spinal
cord stimulation and intrathecal infusion pump
therapy.
Many other therapies have been attempted
without success.
The best way to avoid arachnoiditis is in
avoidance of predisposing factors such as open
spinal surgery, repeated spine surgery,
myelography unless needed for confirmation of
other tests such as MRI, etc.
One of the most extensive articles on
arachnoiditis is found at the link below,
although it should be noted that it contains
many major errors such as statements that
Depomedrol contain ethylene glycol which is
also found in antifreeze. Depomedrol has
absolutely no ethylene glycol. Another major
error is the assertion (unsubstantiated) that
epidural steroid injections are the major cause
of arachnoiditis and yet another is that millions
of people have developed arachnoiditis after
spine surgery. There is simply no clinical or
scientific support for such hyperbole.
http://www.cofwa.org/AASYNDROME-10-03.pdf
Sara Smith-Jones MB 1999 Survey of 319 Arachoiditis
Patients: Symptoms Reported
Pain 100%
Stiffness 79%
Muscle cramps / twitches / spasms 81%
Weakness 82%
Balance difficulties 70%
Numbness / tingling 86%
Bladder / bowel / sexual dysfunction 68%
Difficulty in thinking clearly / decision making / memory 63%
Depression / anxiety 62%
Sleep disturbance 84%
Increased sweating 63%
Heat intolerance 58%
Intermittent low grade fevers 28%
Flu-like feeling and malaise 42%
Raised ESR / white cell count 14%
Enlarged lymph nodes 10%
Joint pains 72%
Skin rashes 32%
Frequent infections 20%
Sinusitis 32%
Slow healing / tendency to scar easily 29%
Limb / generalised swelling 38%
Reflex Sympathetic Dystrophy 3
Trouble swallowing 27%
Angina type chest pain (but no heart disease found) 31%
Weight gain 50%
Reduced mobility (i.e. house / chair / bed bound?) 68%
Allergies (new, e.g. multiple drug allergies) 25%
Dizziness / vertigo 44%
Dry eyes / mouth 58%
Bruising 39%
Fatigue 76%
Dental problems (tooth / gum) 28%
Low potassium 10%
Abnormal blood tests 13%
Abnormal kidney function 7%
Abnormal liver enzymes 7%
Chemical Hepatitis 1
Osteoporosis 14%
Shortness of breath 32%
Lung problems 10%
Gastrointestinal problems:
General 41%
Irritable Bowel Syndrome 8%
Visual problems 45%
(Women) Menstrual irregularities (if pre-menopausal) / early menopause / painful periods
14%
Note: Many of these symptoms are vague or non-distinct as
are seen in a multitude of conditions unrelated to
arachnoiditis
