ARACHNOIDITIS

It is an inflammatory process involving the arachnoid lining of the thecal sac and the Cauda Equina nerve roots, producing severe, incapacitating pain and neurological disability.

Is this a new disease?

As a disease, it has been known for over 90 years under various names. (Meningitis serosa circumscripta spinalis, adhesive spinal arachnoiditis, chronic spinal meningitis, meningitis serosa spinalis, spinal meningitides and radiculo-myelopathy, chronic adhesive arachnoiditis).

It can affect various places in the body, such as in the head, at the junction between the head and neck and all over the spine (cranial, servico-medullary, thoracic, lumbosacral).

With the passage of time, changes have been found in a number of clinical features found in earlier types.

Does everyone agree about the causes and treatments of Arachnoiditis?

What arachnoiditis actually means clinically, its relation to myelography, the role of surgery and of steroids in its genesis and in its treatment, are a matter of great controversy.

Prof Hoffman (1983), has stated that the conventional spectrum of arachnoiditis is probably only the 'tip of the iceberg'.

Prof Jayson (1990), stated that many patients with lumbar spondylosis may have degrees of arachnoiditis and peridural fibrosis that are of clinical significance yet unrecognised by conventional examination.

The frequency, prevalence and prognosis of Contrast media induced arachnoiditis are only now becoming known, and its magnitude is greater than previously thought.

Dr Burton (1994), has suggested that worldwide, a figure close to a million cases over the past 50 years is possible.

Research in the United States on myelography related arachnoiditis, led to disclosures that resulted in a dramatic introduction of legislation in the 1994 U.S. Congress to monitor all myelography. (H.R.2079)

Arachnoiditis and the patient

Arachnoiditis sufferers have often been considered to have functional disorders; disappointed by this lack of recognition from the medical profession, they have formed self-help groups around the world.

They have shown that arachnoiditis is a major world-wide public health problem. It leads to chronic disability, long term drug/alcohol dependence and suicidal tendencies. The average life span is shortened by 12 years., (Guyer,1989), and there is no known cure.

Arachnoiditis thus, remains a therapeutic challenge for the medical profession.

Factors which have been found to lead to Arachnoiditis.

Myelography related

• Oil-based contrast media.
• Increased volume of contrast injected.
• Hyperosmolarity of aqueous contrast.
• Difficulty in performance of myelography.
• Non-removal of Oily media
• Oil/Hyperosmolar myelography prior to surgery. Repeat Oil or Aqueous Hyperosmolar myelography.
• Blood in CSF at time of Iophendylate myelography.
• Interval: Laminectomy Epidural injections
• Short time between myelography

Surgery related

• Presence of spinal stenosis.
• Difficult discectomy.
• Dural/arachnoid tears
• Intradural surgery
• Fibrillay cotton residues from patties/swabs.