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What is arachnoiditis?

Adhesive Arachnoiditis is a chronic, insidious inflammatory reaction of the arachnoid matter of the spinal meninges and intrathecal neural elements that cause debilitating, intractable pain and a range of other neurological problems. It has been regarded as rare by the medical community, but the true scale of the problem remains unknown for a variety of reasons.

The sad fact is that adhesive arachnoiditis remains a contentious diagnosis, which may reflect the medical profession’s reluctance to acknowledge this largely iatrogenic condition.

Dr Sarah Andrea Smith -Fox, MBS, states: 



that the article's aim is to facilitate a clearer understanding of arachnoiditis for both patients and their physicians, so that they can work together to combat the devastating effect the condition can exert upon people’s lives.

Many medical practitioners regard arachnoiditis as a rare dinosaur, considering it related to oil-based myelogram dyes, which are no longer in use. This misconception underlies a general tendency to underestimate the ongoing impact of the condition. Far from being a historical curiosity, adhesive arachnoiditis is a ‘clear and present danger’ which needs to be addressed thoroughly in order to reduce its future impact.

Symptoms & Signs

  1. neuropathic pain, often non-dermatomal*; mostly lower limbs, low back but may also affect upper half of the body
  2. secondary musculoskeletal pain +/- fibromyalgic symptoms; joint pains; headaches
  3. bladder/bowel control dysfunction +/- sexual dysfunction
  4. motor weakness, cramps (tonic)
  5. profuse sweating/temperature control problems; CRPS type appearance.*

will include allodynia, dysaesthesia, bizarre sensations (walking on glass, water running down the leg) transient lancinating pains/electric shock sensations; sensory inattention etc. as per other types of neuropathic pain. CRPS may appear as altered skin colour, swelling, change in sweating, exquisite sensitivity, after minor injury.

The course of the condition is such that it tends to fluctuate, with intermittent flare-ups, but overall most patients will plateau out' and remain fairly stable unless there is an event such as a fall, accident or further surgery, which can cause a rapid deterioration.-Smith-Fox

Causes

Arachnoiditis most commonly arises from spinal surgery (especially multiple operations), severe trauma to the spine, myelographic agents, especially the older oil-based dyes, viral and bacterial meningitis, tuberculosis, syphilis, HIV, intrathecal hemorrhage, ischemia of the neural tissues, intraspinal injections of steroids, epidural and spinal anesthesia, multiple lumbar punctures,  and blood in the cerebral spinal fluid (CSF)due to subarachnoid hemorrhaging, epidural blood patch or trauma - Aldrete

Measuring the problem

Expert Dr. Charles Burton, of the Institute of Low Back and Neck Care, Minnesota, has written extensively about arachnoiditis, and (4) has attempted to suggest an estimated figure for cases in the US, using results of an international study that showed lumbo-sacral adhesive arachnoiditis to be responsible for abo ut 11% of all Failed Back Surgery Syndrome cases. Tying this in with the number of surgeries performed in the last 50 years, and an average rate of 25% FBSS, he estimates “at least 1,000,000 FBSS cases in the US would then have been causally and primarily due to the production of lumbo-sacral adhesive arachnoiditis. If one brings in the rest of the world the case estimate would have to be doubled.”

Dr. Burton also suggests that between 1940 and 1980 about 450,000 oil-based myelograms were performed in the US every year, giving a total of 19 million*, of which he estimates 5% sustained clinically significant adhesive arachnoiditis (although probably all had anatomical arachnoiditis) as a result, which gives a figure of 950,000 sufferers in the US alone.




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