Arachnoiditis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 24, 2016
StartDiseasesArachnoiditis

A significant number of people who have undergone lumbar surgery or spinal surgery go on to complain about excessive pain in their vertebrae and in their extremities. This pain can be caused by a condition that affects the arachnoid mater which is one of the meninges. The meninges are three membranes that protect the brain and nerve endings of the spinal column. This nerve pain can be disabling and falls under the medical name arachnoiditis.

Contents

Definition & Facts

This disabling, chronic condition results from the degradation of the arachnoid mater, one of the membranes around the nerve endings of the spinal column (the other two are the dura mater and the pia mater). When this happens, the nerves rub against each other in their exposed condition causing pain and numbness.

These nerves can eventually become attached through the various fluids surrounding the nerve endings. This version of the condition is called adhesive arachnoiditis. Once this happens, the nerve roots can receive extra pressure from this adhered state.

When arachnoiditis progresses, fibrosis and scarring can start to develop on the nerve endings, resulting in further neuropathic problems for the patient.

Symptoms & Complaints

The primary symptom experienced with this condition is disabling pain. With most cases of arachnoiditis, the signs and symptoms will vary in severity based on the location of the spinal issue.

The location of damage and the parts of the body that experience pain aren’t always the same, but the places where patients encounter the most discomfort is typically in the lower lumbar area, perineum, legs, and feet.

In addition to these pain sites, neuropathic discomfort can also be experienced along the skin, where people who suffer with this condition can experience a burning sensation or a feeling as if something is crawling on the epidermis.

As a neurological disorder, patients with this condition also experience secondary discomforts that can range in severity. These can include a prevalence of headaches, vision problems, and gradual loss of hearing acuity. Many patients start complaining about discomfort mere weeks after a spinal or lower back procedure and the condition progresses from there.

Causes

Arachnoiditis is a medical condition that can most commonly be caused by surgery in and around the spinal region. Viral infection and bacterial infection are also potential causes of arachnoiditis. These are typically caused by viral meningitis, fungal meningitis, or any condition that can affect the spine like tuberculosis. There have also been reported cases of arachnoiditis that has been caused by some chemicals, such as the dyes used in myelograms or spinal diagnostic tests.

Any direct trauma to the spine that can damage these vulnerable membranes and expose the nerve endings can cause this condition. This can include trauma from blunt force to the area or trauma that results from the weakening of the area as a result of a condition like degenerative disc disease or spinal stenosis in its advanced stages.

As a neuropathic disease, arachnoiditis is a strong indicator that nerve damage has occurred in the spinal region. Arachnoiditis can occur in any area of the spine, but it has a tendency to manifest in the lower lumbar area. There is currently no cure for this condition, but there are treatment options that can lessen the pain.

Diagnosis & Tests

As this condition is prevalent in people who have had recent back or spinal surgery, physicians will inquire about a patient's medical history, including his or her history of back or spinal surgeries, as part of the diagnostic process. A medical professional may also perform a physical examination.

A magnetic resonance imaging (MRI) may be performed to gauge the severity of the condition in a patient. Unfortunately, an MRI may render unreliable findings or cause problems as a result of orthopedic implants; in a situation like this, a medical professional may instead utilize a computed tomography (CT) scan.

Both an MRI and a CT scan utilize dyes for contrast media, so a doctor may preclude each of these diagnostic tools based on the level of potential additional injury that certain myelogram dyes can cause to patients already having spinal issues.

Neurological examinations may be conducted because those that seem to have developed arachnoiditis will also experienced hindered reflexes, problems with the senses, and increased weakness. Some doctors may use these symptoms as a road to a diagnosis.

Treatment & Therapy

Any attempt at surgical pain alleviation can actually worsen the condition by adding additional scar tissue to the nerve endings and wearing away any remaining arachnoid sheathing, which will exacerbate symptoms.

Treatment of the condition can utilize multimodal medication management if the condition is at the chronic stage. Pain medications can include, but are not limited to ropivacaine or pregabalin. These medications help bring the pain down to a manageable level that the patient can tolerate.

In some cases, an intrathecal pump is prescribed. This pump is implanted subcutaneously near the spine and will administer strong pain medication automatically. The use of painkillers must be weighed against the fact that they can be highly addictive.

In addition to these pharmaceutical options, physical therapy is often suggested with patients who have arachnoiditis. Since this is a neurological disorder, patients tend to need this treatment in order to restore full functionality and to mitigate the pain.

Since there is a high incidence of depression with arachnoiditis due to the incessant pain, counseling or psychotherapy (talk therapy) are also suggested for the majority of patients. Some doctors also suggest relaxation techniques and meditation in order to increase a patient’s tolerance for pain.

Prevention & Prophylaxis

Unfortunately, many of the spinal and lower back procedures that can lead to this condition are deemed necessary for a patient’s health. However, many of the dyes that were found to be contributing to this condition have been replaced by water-based media.

Epidurals, which have a very small chance of causing arachnoiditis, have also been streamlined, so as not to cause the condition. The chemical corticosteroid, methylprednisolone which can cause arachnoiditis, has been banned in epidural or intrathecal procedures by certain countries.