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Myelogram showing arachnoiditis in the lumbar spine
Arachnoiditis is inflammation of the arachnoid, one of the membranes known as meninges that surround and protect the nerves of the central nervous system, including the brain and spinal cord. The arachnoid can become inflamed because of adverse reactions to chemicals, infection from bacteria or viruses, as the result of direct injury to the spine, chronic compression of spinal nerves, complications from spinal surgery or other invasive spinal procedures, or the accidental intrathecal injection of steroids intended for the epidural space. Inflammation can sometimes lead to the formation of scar tissue and adhesion that can make the spinal nerves "stick" together. This can be extremely painful, especially in last stage adhesive arachnoiditis.
Arachnoid inflammation can lead to many painful and debilitating symptoms. Chronic pain is common, including neuralgia. Numbness and tingling of the extremities is frequent in patients due to spinal cord involvement. Bowel, bladder, and sexual functioning can be affected if the lower part of the spinal cord is affected. While arachnoiditis has no consistent pattern of symptoms, it frequently affects the nerves that supply the legs and lower back. Many sufferers find themselves unable to sit for long (or even short) periods of time, often due to severe pain as well as efferent neurological symptoms, such as difficulties controlling limbs. This is particularly problematic for patients who have trouble standing or walking for long periods, as wheelchairs don't help them. Some sufferers benefit from relatively new inventions, such as the Segway or less expensive alternatives. Standing wheelchairs are also available, although often expensive and limited compared to these alternatives. However, standing endurance and vibration tolerance should be considered before selecting a motorized assistance device.
It is critical that patients realize that arachnoiditis symptoms vary greatly, and not all sufferers experience all symptoms. Consequently—while typically significantly life-altering—the outcome, especially with physical therapy, appropriate psychotherapy, and medication, may be better than many patients fear when they first hear the diagnosis.
Arachnoiditis is a chronic disorder, with no known cure. Pain management techniques may provide some relief to patients. Prognosis may be hard to determine because of the lack of correlation between the beginning of the disease and the start of symptoms. For many, arachnoiditis is a disabling disease that causes chronic pain and neurological deficits. It may also lead to other spinal cord conditions, such as syringomyelia.
Arachnoiditis is difficult to treat. Treatment is limited to alleviation of pain and other symptoms. Surgical intervention generally has a poor outcome, and only provides temporary relief. Steroid injections, administered either intrathecally or epidurally have been linked as a cause of the disease, therefore they are generally discouraged as a treatment and may even worsen the condition. Doctors have different views about this disease so seeking a second opinion may be wise.
- PDR US-FDA 2010 DataSheet | Depo-Medrol | Pfizer
- DA Nelson, WM Landau | Intraspinal Steroids: History, Efficacy, Accidentality, and Controversy with review of United States Food & Drug Administration Reports | Neurosurgery/Psychiatry Review | 2001
- Further reading
- Duke RJ; Hashimoto SA (April 1974). "Familial spinal arachnoiditis. A new entity". Arch. Neurol. 30 (4): 300–3. doi:10.1001/archneur.1974.00490340028005. PMID 4816834.
- Arachnoiditis Information Page at NINDS
- Arachnoiditis; Familial spinal arachnoiditis (subtype); Spinal tuberculous arachnoiditis (subtype) at NIH's Office of Rare Diseases
- Online 'Mendelian Inheritance in Man' (OMIM) Spinal arachnoiditis -182950
- Arachnoiditis UK website offering information and a Facebook Support Group