Technically, arachnoiditis is a chronic inflammation of the arachnoid layer of the meninges (the layers of tissue covering the spinal cord and the brain). When scar tissue is deposited over these layers, as often occurs after back surgery, it clumps together and compresses nerve roots, cutting off blood flow. This leads to damaged and malfunctioning nerves. The scar tissue also restricts cerebrospinal fluid flow in the subarachnoid space; thus nerve roots cannot get nutrients.
Arachnoiditis is typically diagnosed in someone who has undergone back surgery and still suffers severe back pain that radiates down the legs and often to the feet. The pain has a persistent burning, stinging, or aching quality. The diagnosis is occasionally made when similar symptoms are felt in the neck, arms, or the mid back with radiation into the chest. This pain is typically unresponsive to pain medications and muscle relaxants.
The diagnosis of arachnoiditis is generally inaccurate because no signs of inflammation, such as redness, fever, or an elevated sed rate (blood test that identifies inflammation), are seen in these patients. All that is seen is scar tissue on the MRI. What percentage of people will develop a scar as evidenced on x-ray after back surgery? If you said 100%, you are correct. Each time a person undergoes surgery, a scar will develop. It is that simple.
The scar tissue was not present before the surgery, but the back and leg pains were. The surgery did not address the cause of the back and leg pain. Furthermore, the scar tissue seen on the scan most likely has nothing to do with the current pain complaints of the patient.
How does arachnoiditis develop?
A number of circumstances can cause arachnoiditis, including:
- Spinal surgery (especially multiple operations)
- Multiple punctures to the lumbar
- A serious car accident
- Certain dyes known as myelographic dyes
- Intraspinal injections, such as steroid injections
- Amphotericin B (an antifungal) and methotrexate (an antimetabolite)
- Spinal stenosis
- Chemonucleolysis with chymopapain
- Degenerative disc disease / chronic disc prolapse
- Subarachnoid hemorrhage
- An epidural blood patch
It is difficult to estimate exactly how each factor contributes to the development of arachnoiditis. However, the presence of more than one of the above factors may increase the risk.
What are the symptoms of arachnoiditis?
Arachnoiditis can create extensive scarring of the meninges, which can lead to a debilitating, constant burning pain usually mixed with sharp, stabbing pains. It occurs mainly in the limbs and lower back, but can spread up the spine and through the arms. Neurological problems often accompany arachnoiditis, leading to muscle jerks, spasms and muscle weakness, which in turn leads to bladder, bowel and sexual dysfunction, a swelling of the limbs, and cold extremities from poor circulation, as well as fatigue, malaise, depression, stress, loss of memory, muddled thinking, osteoporosis, weight gain and poor sleeping habits. Medication may create additional symptoms. Numbness in different parts of the body may also be experienced, and the body may be very sensitive to touch. Tight or heavy clothing may be extremely uncomfortable, a condition referred to as allodynia.
Arachnoiditis is one of many conditions typically diagnosed, using MRI or CAT scans, in someone who has undergone back surgery. While back surgery invariably leads to scar tissue, it does little to relieve the severe back pain experienced with arachnoiditis. The result is that eventually the scar tissue will be identified on the scans, and surgery will be repeated. The problem with this approach is that while the scar tissue was not there before the surgery, the back and leg pain were. The surgery does nothing to repair the sacroiliac ligament and, thus, does not alleviate the chronic pain that people with this condition experience.
Another standard practice of traditional medicine is epidural steroid injections. However, in the long run, these treatments do more damage than good. Cortisone shots have been shown to produce short-term pain benefit, but result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Spinal cord stimulator implantation is another traditional practice of modern medicine, but with limited results.
Looking for a second opinion on arachnoiditis?
Often patients undergo unsuccessful traditional treatments for arachnoiditis because they were misdiagnosed or underlying instability in the sacroiliac joint is actually the culprit. Often these are people diagnosed with “arachnoiditis” but who have a normal EMG. In this instance, consider approaching this condition from a more regenerative medicine approach with Prolotherapy. Prolotherapy treatments to weakened structures, such as the sacroiliac ligaments causing the pain of arachnoiditis, can help to permanently alleviate pain. Comprehensive Prolotherapy offers the excellent results in treating numerous types of spinal pain by stimulating repair of the ligaments and tendons which hold our spine and joints together. These areas known as fibro-osseous junctions are rich in sensory nerves.
If you have received a diagnosis of arachnoiditis and would like our opinion on your case, please contact us. We’d be happy to review your case to see if perhaps your pain mimics arachnoiditis, but the underlying cause of pain is actually joint and vertebral instability.