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Arachnoiditis

What is Arachnoiditis?

Arachnoiditis is a condition where the lining of the spinal nerves and spinal cord is inflamed. This inflammation can make them “sticky” where they begin to stick together. This can impact on their function. The condition most commonly affects the spinal nerves of the cauda equina. These nerves are located within a fluid filled (cerebrospinal fluid) sac, called the dura. The cauda equina is located below the point in the spine where the spinal cord ends (L-1, L-2). In its most severe form, the spinal nerves begin to “stick together” in a condition called “adhesive arachnoiditis”.

What are the causes of Arachnoiditis?

Arachnoiditis can be caused by the following:

  • Spine injuries
  • Chemicals injected in the spinal fluid for medical reasons
  • Complications from spinal surgery
  • Infections from bacteria and viruses

Why does Arachnoiditis cause pain?

Arachnoiditis is an inflammatory condition. In this case, the lining of the spinal nerves (rootlets) is inflamed. Nerves are very sensitive to inflammation. An inflamed nerve typically cause a sharp burning sensation.

What are the symptoms of Arachnoiditis?

Here are some of the common symptoms of arachnoiditis:

  • Electric shock sensations in the legs
  • Muscle cramps and twitching
  • Numbness, tingling or weakness in the legs
  • Problems with bowel and bladder control
  • Sexual dysfunction
  • Problems controlling the movement of the legs

How do spine specialists diagnose Arachnoiditis?

Spine specialists use the information gained from the patient history, a physical examination, and special tests to make the diagnosis of Arachnoiditis.

  1. History

A history of spinal surgery, spine trauma, spine infection or a previous spine injection followed by consistent burning pain in the legs is suspicious for Arachnoiditis.                         

      2. Physical Examination

Here are some physical examination tests often performed by spine specialists to diagnose Arachnoiditis:

  1. Sensation (sensory) testing of the legs
  2. Strength (motor) testing of the legs
  3. Reflex testing of the legs
  4. Gait testing
  5. Anal sphincter test (rectal exam)

 

      3. Tests

The following spine images and tests may be used in diagnosing Arachnoiditis:

a. MRI Scans

MRI scans are the study of choice to diagnose arachnoiditis. The spinal nerves can be seen and evaluated for signs of inflammation. It is especially obvious when adhesive arachnoiditis is present, since the clumping of the nerve roots is easily seen. Intravenous contrast is often given for added clarity.

b. CT-Scans

CT scans combined with a myelogram (dye injection into the spinal fluid) can show arachnoiditis. However, an MRI is usually preferred as the myelogram would involve injecting medication into the spinal fluid around the spinal nerves which are already inflamed. This could potentially aggravate the condition.

c. Eelectromyogram/Nerve Conduction Study (EMG/NCS)

EMG/NCS are used to evaluate the function of the spinal nerves. It can also be suggestive of arachnoiditis. This test can be combined with an MRI scan to help with the diagnosis.

How is Arachnoiditis treated?

There is no cure for arachnoiditis. Surgical attempts to open the dura and treat the spinal nerves directly has not been shown to help. However, the following are some treatments available to help the symptoms:

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. exercises and can all help with the pain from this condition.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from and to and Maintaining and improving mobility can be accomplished through specific techniques of PT. Desensitization (making the nerve and tissue less sensitive) techniques for nerve pain are also available.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from to and such as chairs and computer accessories.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

  1. Nerve Pain Medications
  2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  3. Muscle Relaxants
  4. Antidepressants
  5. Pain Killers

H. Spinal Injections

Epidural steroid injections can be helpful in some patients:

  1. Lumbar Interlaminar Epidural Steroid Injection
  2. Caudal Epidural Steroid Injection

I. Implanted Pain Devices

    1. Spinal Cord Stimulation

This technology can be useful to help control some of the symptoms of arachnoiditis.                      

                 2. Implanted Pain Pumps

Medication for the pain from Arachnoiditis can delivered to the spinal fluid and spinal nerves with the help of Intrathecal Pain Pumps.