Long did not find a consistent clinical pattern of symptoms. Instead he found the following: 302 patients (94%) had back pain that was aggravated by activity; 261 patients (81%) had leg pain; 40% had radicular pain and 41% had diffuse and apparently nonradicluar pain; 45 patients (14%) had major bowel and bladder dysfunction. The arachnoiditis was progressive in six patients (1.8%). Range of trunk motion was impaired in 292 patients (91%); forward and backward bending produced pain in all patients; chronic muscle contractions (usually secondary to surgery) were present in 301 patients (94%);motor loss in 237 (74%) and demonstrable sensory loss in 261 (81%); reflex changes were present in 308 (96%); straight leg raising was positive in 195 (61%).

Functional status was assessed by questioning the patients: 269 patients (84%) walked alone; 48 (15%) walked with aids; 1.2% were wheelchair bound; 295 (92%) complained of claudication with limitation of the distance they could walk; 36 (11%) were working full-time; 118 (37%) were working part-time or with limitations;

167 were retired secondary to back complaints (but could not be directly attributed to arachnoiditis in most); 82% drove without limitation; 12% were able to drive an automobile with aids; only 18 (5.6%) were unable to drive.

Sexual function was severely impaired. Only 8% described no abnormalities; 147 (45%) were able to perform sexually with impairment; 151 (47%) described severe impairment of sexual function.

Forty-five patients (14%) were taking no drugs of any kind and 64 (19%) were using non-narcotic analgesics (often in large quantities).

One patient sustained severe kidney damage from Propoxyphene (DarvonÒ) and two patients were found to have significant hepatic damage from the use of non-steroidal anti-inflammatory drugs; 167 (52%) used narcotics on a daily basis; 45 (14%) showed evidence of abuse and drug seeking behavior; 260 (81%) used a psychotropic drug, diazepam being the most common.

In the patients with spinal cord involvement, all had blocks on myelography; all had progressive neurological deficits; 2 with cervical arachnoiditis were quadriplegic with increasing respiratory deficiencies.

Patients with thoracic cord involvement were all becoming progressively paraplegic.

Therapy: Of the original 158 patients, 23 underwent microlysis of the adhesions, and 14, direct surgery upon an extradural defect without therapy of the arachnoiditis; 3 were given repetitive intrathecal steroids and in one patient, oral steroids were given as well; 32 patients were treated with spinal cord stimulation; 131 underwent in patient pain rehabilitation to maximize function while reducing drug utilization

In the second group of 163 patients, 12 underwent microlysis of the adhesions; 47 were operated on directly for other extradural problems; 42 were referred for spinal cord stimulation; one had an unsuccessful trial of brain stimulation; one was treated with intrathecal steroid injections; one had an intrathecal morphine pump; 72 were referred for inpatient pain rehabilitation.

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