INTRODUCTION

This article aims to give an overview of this complex and relatively uncommon condition, so that patients and their physicians have a clearer understanding, and can work together to combat the devastating effect it can have on people’s lives.

Arachnoiditis is a chronic, insidious condition that causes debilitating, intractable pain and a range of other neurological problems. It has been regarded as rare by the medical community, but Burton reported as early as 1978([1]) that it is “common in patients with severe back and/or leg pain and functional impairment due to the failed back surgery syndrome.”

Arachnoiditis is the third most common cause of Failed Back Surgery Syndrome (FBSS), after stenosis and recurrent disc problems. Arachnoiditis was previously the second most common cause. This was largely due to the adverse effects of oil-based myelography. The incidence has decreased, but a high proportion of cases of clinically significant adhesive arachnoiditis is now found to be due to the adverse effects of epidural steroids such as Depo-Medrol (Depo-Medrone).

Table of Contents

Introduction
NEXT: THE SCALE OF THE PROBLEM
ARACHNOIDITIS OR EPIDURAL FIBROSIS?
NOMENCLATURE
THE INFLAMMATORY NATURE OF ADHESIVE ARACHNOIDITIS
PATHOLOGY
CLASSIFICATION
CAUSES
THE IATROGENIC ASPECT OF ADHESIVE ARACHNOIDITIS
PRESERVATIVES IN SPINAL INJECTIONS
PROGNOSIS
THE SYNDROMIC NATURE OF SYMPTOMS IN ADHESIVE ARACHNOIDITIS (Warning: LONG)
COMPLICATIONS OF ADHESIVE ARACHNOIDITIS
DIFFERENTIAL DIAGNOSIS
CLINICAL ASSESSMENT
DIAGNOSTIC TESTS
TREATMENT OPTIONS (Warning: LONG)
MULTIPLE CHEMICAL SENSITIVITY
LOOKING TO THE FUTURE
APPENDIX I: AUTOIMMUNE ASPECTS
APPENDIX II: SYRINGOMYELIA
ADDENDUM - May 2000
REFERENCES