Arachnoiditis is a very rare, very serious inflammation of the arachnoid mater, the membrane that covers the spinal cord. It causes disability in the form of pain that incapacitates and neurological deficit, mainly in the lumbar and thoracic areas of the spine, though it can rarely affect the entire spinal column. Understanding the anatomy and mechanisms through which this condition arises may help in comprehending the disease.
What is Arachnoiditis?
Arachnoiditis is a condition whereby the arachnoid mater, which is one of the protective three meninges layers that envelops the brain and spinal cord, becomes inflamed. The other two are the dura mater, at the outermost, and pia mater, at the innermost. Should the arachnoid mater get inflamed, it results in an extremely painful stinging and burning pain with many neurologic problems.
Spaces Within the Meninges
Epidural Space: Between the skull and dura mater, and between the dura mater of the spinal cord and the vertebral column.
Subdural Space: A potential space between the dura mater and the arachnoid mater that may open because of trauma, pathological processes, or a lack of cerebrospinal fluid.
Subarachnoid Space: The area between the arachnoid mater and pia mater, containing cerebrospinal fluid, which cushions and protects the brain and spinal cord.
Mechanism and Effects
Inflammation in the subarachnoid or subdural space is called arachnoiditis. It can cause a variety of pathological changes that include the following:
Collagen Deposits: Accumulation of collagen in the affected area
Scar Tissue: Scar tissue which may form and encapsulate nerve roots
Fibrosis: Thickening or scarring of tissue
Decreased Cerebrospinal Fluid Flow: Impairment in the flow of the cerebrospinal fluid
Clumping of Nerve Roots: The nerve roots may clump together leading to malfunction.
Impaired Blood Supply: There is a reduced blood supply to the affected nerves.
Nerve Atrophy: Wasting away of nerves.
Tethered Nerves: Nerves may become tethered or stuck in abnormal positions.
These changes very often lead to chronic pain and neurological deficit like muscle weakness and sensory disturbances.
Adhesive Arachnoiditis
In advanced cases, scar tissue could eventually bind the spinal nerves together into chronic adhesive arachnoiditis. This process leaves most sufferers paralyzed to the point of requiring a wheelchair and very handicapped; it is characterized by partial paralysis of the lower limbs, paraparesis.
Prevalence and Seriousness
This is a relatively rare condition, and thus an exact prevalence is unknown. In fact, many of the mild cases may remain undiagnosed or unreported. The incidence of lumbar arachnoiditis does seem to be increasing due to the increased performance of lumbar spine surgeries. Though it is not life-threatening, it has been shown that the arachnoiditis significantly interferes with the quality of life by continuous pain and neurological issues. Hence it is more important to approach a health professional well conversant with this condition to have appropriate treatment.
Symptoms and Causes
Symptoms of Arachnoiditis
The symptoms differ depending on the spinal nerve involved, ranging from mild to severe. Some common symptoms include:
In headaches, electric shock-like sensations and sharp, shooting pain
Tingling, numbness, or weakness in the legs
A feeling of insect crawling under the skin or water trickling down the leg
Inability to sit for a longer time
Muscle cramps, spasms, and uncontrollable twitching
Neurogenic bladder
Bowel dysfunction
Sexual dysfunction such as erectile dysfunction, vaginal dryness.
In such cases, as the condition advances, the symptoms can aggravate or become irreversible, leading to significant disability and inability to work due to constant pain.
Causes of Arachnoiditis
It is challenging to establish the exact cause of this condition since it is a rare condition and has a vast array of triggers. Some common causes include:
Complications from Spinal Surgery: Statistics show that up to 90% of cases of arachnoiditis are linked to surgeries performed in the lumbar region of the spine.
Direct Spinal Trauma: Falling from heights or accidents in vehicles may sometimes trigger arachnoiditis.
Chemical Irritation: Myelogram dyes used in the past, and preservatives in epidural steroid injections are known to cause arachnoiditis.
Infections: Bacterial infections such as meningitis and viral infections such as tuberculosis or HIV will infect the spine and cause arachnoiditis.
Chronic Compression of Nerves: Degenerative disc disease or spinal stenosis can cause chronic nerve
compression and lead to inflammation.
Less common causes include autoimmune diseases such as ankylosing spondylitis, Guillain-Barré syndrome, and autoimmune vasculitis.
Diagnosis and Tests
Diagnosing Arachnoiditis
Diagnosing arachnoiditis is not easy due to the rarity of its occurrence and lack of diagnostic laboratory tests. Doctors make a diagnosis primarily on clinical presentation and symptoms, which are complemented by imaging studies to reach a diagnosis. Imaging studies include an MRI or CT myelography.
Diagnostic Tests
Magnetic Resonance Imaging (MRI): Clear images of the spine give signs like nerve root thickening and clumping.
CT Myelogram: Relation of vertebrae, discs, spinal cord and nerves are studied to find out any evidence of arachnoiditis.
Lumbar Puncture: Removal of spinal fluid to be sent to the laboratory for infections
Electromyogram (EMG): Nerve damage is determined by electrical impulses.
Treatment and Management
Treatment for Arachnoiditis
Since there is no cure for arachnoiditis, the treatment is oriented towards pain relief and enhancing the quality of life and managing the symptoms. Following treatments are recommended:
Pain Management: NSAIDs, duloxetine, gabapentin, pregabalin, muscle relaxants.
Physical Therapy: Hydrotherapy, massage, stretching, and range-of-motion exercises.
Psychotherapy: Help through talking.
Aids to Mobility and Comfort: Adaptive devices.
Specific Treatments
Spinal Cord Stimulation: The device electrically stimulates the spinal cord to relieve pain from it.
Medicines: Over-the-counter drugs and prescription combine to offer pain relief. Prevention and Outlook
Preventing Arachnoiditis
Currently, there are no known ways to prevent arachnoiditis.
Prognosis
Arachnoiditis usually is a chronic condition and can get worse over time. Therapies may relieve the symptoms, but the condition usually results in a poor quality of life because of severe neurological issues and pain. Many individuals with bad cases of arachnoiditis become disabled, though most are able to walk and drive with few limitations.
Living with Arachnoiditis
Coping with arachnoiditis includes sticking to a treatment plan and living as healthy as possible. The most important self-care steps one can take include the following:
- Not smoking
- Balancing activity and rest and self-care
- Eating healthily
- Exercising as able
- Getting enough sleep
- Managing stress
- Participating in support groups
- Limiting alcohol consumption
- Thinking positively
- Utilizing pain management techniques such as meditation, aromatherapy, and mindfulness finding activities that alleviate symptoms
When to Seek Medical Attention
Arachnoiditis patients must ensure they have follow-up care regularly with their healthcare provider to have their symptoms and treatment plans assessed.
Living with chronic pain is difficult and has both physical and mental implications on health. Proper treatment and self-advocacy are critical, and support groups and therapeutic outlets can be key in stress management. Finding the right health care provider can assure one the best treatment plan to handle symptoms and improve quality of life.
