Suspecting and Diagnosing Arachnoiditis
A review of the symptoms noted in a group of patients with arachnoiditis presents an analysis of clinical observations of this disease.
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Arachnoiditis (ARC) is a nonspecific inflammatory process usually caused by an invasion into the dural sac—whether by bacteria, blood, or injections of various irritant substances that produce a spectrum of pathological changes originating on the arachnoid membrane. The resulting inflammatory response eventually proliferates to other intrathecal neural elements leading to fibrosis and adhesions that involve the nerve roots, the arachnoid, the spinal cord, and the dura mater. This progression culminates in permanent disability characterized by severe intractable pain, neurological deficit, and other related symptoms.1 Although this process may involve any site where the arachnoid membrane and neural structures are found, the most common presentation occurs in the lumbosacral region affecting not only the distal spinal cord, but also the cauda equina’s nerve root and the sympathetic nerve fibers connected to them.,2 In addition to pain sensory alteration and motor deficits, it may also be accompanied by other symptoms such as low-grade fever, profuse diaphoresis, heat intolerance, nausea, bladder and/or bowel dysfunction, and sexual impairment. Evidently, this syndrome is, by far, more complex than the involvement of the meningeal layers. Whereas the main clinical features represent a physical injury producing functional damage or alteration, the ensuing devastating disease is always associated with unrelenting chronic pain and major psychological and social impacts.
Due to the scarcity of objective data regarding the correct diagnosis of arachnoiditis, the author and a group of collaborators (see acknowledgements) associated with the author’s clinical facilities have, over a period sixteen years, tabulated comprehensive data on arachnoiditis patients. The data was obtained from the clinical history from all the medical records available, patient physical and neurological exams, and a review all the available films in 489 patients in whom the diagnosis of arachnoiditis had been suspected or affirmed by other clinicians. All patients were seen personally by the author from 1989 to 2006. A good number of patients were refer to the author’s pain management facilities for diagnosis and treatment, with most patients coming from distant states or from other countries. Many other patients came of their own accord after they developed symptoms resembling arachnoiditis following a medically-related event that included incidental invasion of the vertebral canal. In the last decade, by far, the largest number of patients have also received, at one time, the diagnosis of Failed Back Syndrome (FBS). As a matter of clarification, it is important to note that not all the patients having arachnoiditis had FBS and not all the patients with FBS had ARC.