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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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The type of pain, its frequency, and the location were noted; psychosocial factors such as litigation, Worker’s Compensation claims, and work status were also recorded (see Table 2). Similarly, the frequency and type of bladder, rectal, and sexual dysfunction were noted. The occurrence of depression, anxiety and other emotional disturbances were evaluated in separate interviews by a psychologist. The imaging studies were interpreted by an experienced radiologist and by the author.

Table 1. Probable Causative Events In Patients With Arachnoiditis
Myelogram with Pantopaque, (pre 1986) 12 (2.4%)
Myelogram* followed by spinal surgery (post 1986) 16 (3.2%)
One Laminectomy (first) 38 (7.7%)
Laminectomy plus another procedure 18 (3.6%)
Laminectomy, (2nd or multiple) 76 (15.5%)
Spinal fusion with bone graft 36 (7.3%)
Spinal fusion with hardware 71 (14.5%)
Spinal anesthesia 45 (9.2%)
Epidural anesthesia (Lumbar) 51 (10.4%)
Epidural steroid injections (with incidental dural puncture) 53 (10.7%)
Pseudomeningocele following dural tears at laminectomy 27 (5.5%)
Other pain relief related procedure 29 (5.9%)
Thoracic epidural anesthesia (syringomyelia) 5 (1.0%)
Neuroplasty 5 (1.0%)
Vertebroplasty 4 (0.8%)
Spinal “taps" 3 (0.6%)
Total 489 (100%)
*In 1986, the production of oil-soluble contrast media for myelograms was discontinued in the USA.

Possibly Related Disorders

With certain frequency, some non-spinal related signs and symptoms appeared in patients diagnosed with ARC. Readers should be reminded that these statistics do not represent actual incidence of cases of ARC, but simply represent the frequency of each specific possible causative event in the group of patients included this series. Their incidence, as obtained from our group of patients, is shown in Tables 2 to 5. Patients related that these manifestations were not clinically manifested before the causative event which may have produced arachnoiditis, however this fact could not be specifically verified or denied from the review of their medical records.

Other illnesses, present in this group of patients, appeared to suggest the association of some ailments that may have more than a casual coincidence. For example, degenerative disc and/or facet joint disease of the cervical spine was noted in 32 patients (6.5%). Pulmonary disease was also diagnosed in 147 patients (30%)—all of which were, or have been cigarette smokers. Obesity (>20% over the patient’s expected body weight) was noted in 129 cases (26.3 %). Spondylolisthesis of the lumbar spine was present in 51 patients (10.4%) and lumbarization of S-1 or sacralization of L-5 vertebrae was reported in 129 (26.3%) and in 19 patients (3.8%), respectively. These abnormalities tend to render the spine unstable at a younger age. Similarly, the presence of short pedicles were noted in 112 patients (22.9%) from radiological studies and is important to consider since the narrower spinal canal appears to magnify symptoms caused by minor lesions. In such a case, a bulging disc, for example, would manifest as severe low back pain with radiculopathy. Another congenital defect is “spina bifida occulta" which again may not manifest with clinical symptoms until a mild injury to the spine results in exaggerated symptoms. See Figure 1 for the telltale presence of a “tuck-in" sacrum in the physical exam.

Last updated on: April 13, 2017
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