DIAGNOSTIC TESTS

As arachnoiditis does not present with a discrete clinical picture of specific motor, sensory and reflex abnormalities, diagnosis tends to rest on tests such as MRI or CT scans. There are, however, still some centres which perform myelograms as diagnostic procedures for arachnoiditis. Taking into consideration the fact that any foreign agent introduced into the spine has the potential to cause arachnoiditis, the rationale behind this type of testing seems questionable. Burton ([59]) points out that whilst the incidence of arachnoiditis following non-ionic water-soluble myelographic agents is “quite small”, if the “wrong water-soluble agents, or the wrong concentrations of agents, are administered there can be serious consequences such as permanent neurological injury or death.” Moreover, he goes on to state that “It is important to understand that myelography has never really been a great diagnostic study…a poor means of demonstrating many important entities such as pathology in the foraminal zone of the vertebral canal.”

The current investigation of choice is a T2 weighted, fat suppressed, gadolinium enhanced, high resolution MRI scan. Ideally, this should be read by a neuroradiologist experienced with the appearance of arachnoiditis.

It is important that treatable causes of Failed Back Surgery Syndrome (FBSS) such as recurrent disc herniation, disc fragments or stenosis be excluded.

Further tests which demonstrate nerve damage include electromyography (EMG) and nerve conduction studies (NCS).

For bladder dysfunction, urodynamic studies may be required.

Table of Contents

Introduction
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
NEXT: TREATMENT OPTIONS (Warning: LONG)
MULTIPLE CHEMICAL SENSITIVITY
LOOKING TO THE FUTURE
APPENDIX I: AUTOIMMUNE ASPECTS
APPENDIX II: SYRINGOMYELIA
ADDENDUM - May 2000
REFERENCES