Patients who had iophendylate myelograms 20 years before may suddenly develop symptoms. People who thought their back problems had resolved two decades before may not relate the sudden development of severe spinal pain and other problems to a procedure performed so long ago.

BPAA has been receiving calls from women who relate the development of their back pain to spinal anesthesia administered for childbirth. Some of them knew from the very beginning that this was the cause of their back pain. One women recalls her doctor telling her that he had accidentally inserted the needle in the “wrong” place and that he had to redo the procedure. She suffered some paralysis immediately and had such severe headaches that she had to stay in the hospital for several weeks while her baby went home. She was told that she would recover fully, but this did not happen.

One member developed back pain when she bent over to make her bed. Her doctor tried traditional treatment methods, including bed rest, ice and heat. But they didn’t seem to help her pain. Physical therapy didn’t help either. She was referred to an anesthesiologist for treatment. This doctor felt that she might benefit from epidural steroid injections. He explained that they seemed to help some people while others gleamed no benefit at all. The member felt it was worth a try, after all the worse that could happen was that the injections wouldn’t work. The doctor made arrangements for her to receive her first injection at a local medical centre. Unfortunately, he did not use fluoroscopy which would have helped him to guide the needle. The member was later diagnosed with clinically significant adhesive arachnoiditis.

Fortunately substances injected into the epidural space do not cause harm. But there is a down side. According to a report by Renfrew et al, “Failure to gain the epidural space is inversely proportional to experience, but even experienced operators have been shown to gain the epidural space reliably in only 62% of patients. (14) Lumbar injections may fail to gain the epidural space in 17% to 30% of patients. (4)

Burton finds it unfortunate that intrathecal steroid methylprednisolone acetate (Depo-Medrol/Depo-Medrone) prepared as a suspension was injected with myelography contrast media in an attempt to reduce the risk of arachnoiditis, when in fact the opposite result was produced.

Over the years, studies have shown that a mixture of blood and Pantopaque (Myodil) produce severe arachnoidal inflammatory reactions. (4)

Earlier in the century, the most common causes of the development of arachnoiditis were Tuberculosis (TB) and syphilis. Tuberculosis arachnoiditis was made worse with the introduction of intrathecal therapy. (16) The advent of antibiotics reduced the risk of these infections, but they are making a comeback. Since doctors have been prescribing antibiotics for all of the various problems that plague their patients, TB and syphilis are more antibiotic resistant. If patients with these diseases develop back problems, doctors may not realize immediately that they have arachnoiditis.

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