WEB ARTICLE
(Posted 1 October 2001)

Contents
Introduction/Methods
Results
Triggers/Treatments
Discussion
Conclusions
References

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Arachnoiditis: 
Part I - Comparitive Symptom Study
Part II - Red Blood Cell Shape Analysis

by L.O. Simpson & M.G. Anderson

CONCLUSIONS:

Red blood cell shape analysis has shown that increased flat cells occur in persons with symptomatic adhesive arachnoiditis. This places arachnoiditis in a similar category to other chronic disorders with characteristics common to many, especially that of chronic tiredness. It supports the contention that the pathophysiology for the fatigue and other symptoms is at least partly based on oxygen deprivation at tissue level.

Anecdotal evidence is presented to support the benefit of improving oxygen delivery by using Prostaglandin E 1, derived from dietary supplementation with EPO. This offers some hope to those afflicted with this rare and particularly devastating form of spinal impairment, the features of which have been reviewed in this New Zealand survey and compared with other reports.

Greater professional and public attention needs to be focussed on this condition. When patients with undiagnosed symptomatic adhesive arachnoiditis present with chronic back and leg pain associated with neurological deficits and fatigue, and a history of events related to the spine, physicians are faced with a diagnostic challenge for several reasons:-

• There is no specific pattern of signs and symptoms that can be considered typical of this disease.

• There is no specific diagnostic marker or indicator which can be used to confirm the diagnosis.

• Not all individuals who have a history of spinal trauma, investigations, surgery etc will develop symptomatic arachnoiditis, and scarring may be present in the spinal canal without any associated symptoms, consequently some medical professionals question whether such a disease entity exists at all.

• The presentation of adhesive arachnoiditis may be so similar to MS that many patients undergo investigations to exclude that condition. Demyelination, which is a feature of MS, has also been described in arachnoiditis.

• Patients with MS may undergo myelography to exclude Arnold Chiari syndrome and may subsequently develop arachnoiditis as well. (21)

• There are many causes of chronic pain following spinal surgery (Failed Back Surgery Syndrome); some may co-exist with subarachnoid scarring, making it difficult to determine the origin of the presenting symptoms.

• There is a bewildering overlap of symptoms common to arachnoiditis and other conditions such as FM, ME, MS, Lupus, spinal stenosis. Some patients are given a primary diagnosis of FM, others carry a dual diagnosis of arachnoiditis and FM.

Despite the existence of medical literature dating back almost  a century there remain many gaps in medical  knowledge about arachnoiditis, as was observed in Long’s excellent paper in 1992. (10). There are still no statistics on the prevalence of the condition.  Factors predisposing to the development of the disease remain unknown. There is as yet no cure and no really effective treatment for the condition as a whole nor for the major symptom of chronic intractable pain. Ideally every person with disabling arachnoiditis should be referred to a spinal unit for inpatient rehabilitation, aiming for maximal function through pain management, occupational therapy and physiotherapy etc., followed by regular monitoring. There are many avenues of research which need to be explored. It is to be hoped that by the end of the 21^st century the situation will have been adequately addressed so that this devastating disease will be merely of historical interest to the health providers of the future.