THE SCALE OF THE PROBLEM

Adhesive arachnoiditis is not a notifiable disease and is significantly under-diagnosed. During the Proceedings of the British House of Commons, March 25th, 1998, the issue of arachnoiditis due to Myodil was raised. In answer to the question of the number of cases within the last 20 years, the Under-Secretary of State for Health replied “the information requested is not available” ([2]).

Burton ([3]) has attempted to suggest an estimated figure for cases in the U.S., using results of an international study that showed lumbo-sacral adhesive arachnoiditis to be responsible for about 11% of all Failed Back Surgery Syndrome cases. Tying this in with the number of surgeries performed in the last 50 years, and an average rate of 25% FBSS, he estimates “at least 1,000,000 FBSS cases in the U.S. would then have been causally and primarily due to the production of lumbo-sacral adhesive arachnoiditis. If one brings in the rest of the world the case estimate would have to be doubled.”

Table of Contents

Introduction
THE SCALE OF THE PROBLEM
NEXT: 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