WHAT IS ARACHNOIDITIS
BY: DR. Charles V. Burton, M.D.
Arachnoiditis is no mystery. While a great deal is now known a great deal
remains to be learned. Unfortunately, very little incidence and prevalence
data has been accumulated. It is my hope that I will be able, in the future,
to provide more information on this subject, in other formats, to all those
who might be interested. Clearly a real knowledge and educational void exists
in regard to this most important subject.
WHAT IS ARACHNOIDITIS?
It is an inflammatory response of the brain and spinal leptomeninges 9th
pia mater and arachnoid membrane to a number of different factors leading
to scarring (deposition of collagen by fibroblast cells) of a variable degree
of these structures. Why this process appears to be self-limited in most
cases and potentiates in other cases is not known. My neurosurgical colleague,
Frank Mayfield, believed that auto-immune factors were important.
IS ARACHNOIDITIS COMMON?
Actual incidence and prevalence are not known but if arachnoiditis per se
was studied it would probably turn out to be fairly common . It occurs to
some degree following body trauma, infection (quite common prior to the
20th century), spinal surgery and a "normal" response to the introduction
of foreign body substances introduced into the subarachnoid space.
WHAT IS ADHESIVE ARACHNOIDITIS?
This is a form of arachnoiditis characterized by severe scarring. Individuals
with severe scarring are typically those who have the clinical problems,
disability and incapacitation.
The pain associated with adhesive arachnoiditis is especially cruel because
it is constant and resistant to therapy. In the 20th century, the most common
cause of arachnoiditis appears to be related to the use of "oil"
based substances for the purposes of myelography.
WHAT IS THE INTERNATIONAL INCIDENCE OF ADHESIVE ARACHNOIDITIS?
No one really knows the answer to this question. The "expert"
opinions on adhesive arachnoiditis range between 1 to 5% of all individuals
having oil based myelography.
WHAT IS CALCIFIC ARACHNOIDITIS?
In some cases of adhesive arachnoiditis, the severe scarring around spinal
nerves gradually calcifies. This appears to be capable of producing an even
greater compromise of these nerves and can result in paraparesis with bowel
and bladder dysfunction.
CAN WATER SOLUBLE MYELOGRAPHY CAUSE ADHESIVE ARACHNOIDITIS?
Yes! All foreign body substances can cause it but the liklihood of it happening
from water soluble myelography is low (but has been reported). It would
be rare following non-ionic water soluble myelography. More typically, water
soluble myelography can cause acute inflammatory reaction (not typically
causing much scarring) which can be serious and is capable of causing permanent
nerve injury.
WOULD I HAVE A MYELOGRAM?
With what I know, I would much prefer a non-invasive CAT or MRI scan performed
by a radiologist qualified in spine studies.
WHAT IS THE BEST WAY TO DIAGNOSE ADHESIVE ARACHNOIDITIS?
With a non-invasive MRI performed by a qualified radiologist using technically
appropriate scanners.
HOW CAN ADHESIVE ARACHNOIDITIS BE TREATED?
There are no really good treatments for this condition. Surgical removal
of the scar tissue just hasn't provided much help to patients but there
are many things which can be done to provide meaningful help. These include
medication, physical exercise and therapy, pain rehabilitation programs
as well as implanted electronic pain relief devices.
CAN EPIDURAL STEROID INJECTION CAUSE ARACHNOIDITIS?
The epidural space, unlike the subarachnoid space, is most resistant to
inflammatory change. Epidural injections are generally safe just so long
as an individual has a patent epidural space (can be obliterated by previous
disease or surgery). The problems with epidural injections occur when they
are actually deposited into the subarachnoid space.
Some of the steroid preparations (particularly Depo Medrol [tm]) can act
as foreign body substances similar to oil based myelographi preparations
in producing adhesive arachnoiditis.
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