Complications to the network of nerves along the spine affect every aspect of our lives. Annually, there are at least 25,000 cases of arachnoiditis, and the causes range from infection complications to surgery. This neurologic pain condition is complex, and research is still ongoing. What experts do know is that when it comes to spinal pain management, it is essential to ensure people with the condition receive enough information and relief to live as comfortably as possible.

What Is Arachnoiditis?

The meninges are protective cerebrospinal membranes. The membrane between the innermost layer, the pia mater, and the outermost layer, the dura mater, is often called the arachnoid mater. Arachnoiditis is painful inflammation of this layer. Collagen forms between the pia and arachnoid layers, and the resulting fusion of the nerve roots interferes with blood supply, resulting in atrophy. This can happen at any location along the spine, though the chronic form of arachnoiditis once occured most often in the upper spine. Since the 1950’s, however, doctors have noted arachnoiditis is more common in the lumbar spine.

arachnoiditis meninges dura mater 7activestudio / Getty Images


Causes: Epidurals

LESI, lumbar epidural steroid injections, are pain-management injections given to individuals with spinal nerve inflammation, a symptom of herniated discs and other disc diseases. The doctor makes the injection outside the dura mater, and studies show that in some instances, adhesive arachnoiditis results. Doctors suspect that the steroid contains a polyether compound that spreads into the arachnoid layer from the dura layer, leading to nerve fusion.

epidural LESI nerve fusion matthewzinder / Getty Images


Causes: Meningitis

Meningitis is a viral or bacterial infection that causes inflammation in the meninges and symptoms such as muscle rigidity and fever. It can also lead to scarring, resulting in skin and tissue damage. Tuberculosis is still a problem in some less-developed countries, and this can lead to rare cases of intracranial TB meningitis and arachnoiditis. In some cases, the latter develops years after former and, unlike other manifestations of arachnoiditis, this form of the inflammation involves the spinal cord in addition to the arachnoid mater and the nerve roots.

meningitis tuberculous intracranial Sakurra / Getty Images


Optochiasmatic Arachnoiditis

The intersection of the optic nerves in the brain is the optic chiasm. Some individuals with tuberculous meningitis may experience headaches, vision impairment, or vision loss due to optochiasmatic arachnoiditis or OCA. This rare form of arachnoiditis happens when inflammatory masses seep fluid and gum up the optic nerves. In some cases, doctors report that between 25 and 72 percent of individuals with this form of meningitis experience OCA.

optic nerve optochiasmatic headaches Pontoppidan / Getty Images


Symptoms: Dysaesthesia

Pain seems to be the only consistent symptom of arachnoiditis. Some people may experience muscle spasms and cramps in the back, buttocks, and legs. They may also experience dysaesthesia, nerve damage that results in touch causing a diffuse, uncomfortable sensation. Some describe it as ants crawling through the body or pins and needles. Dysaesthesia in the neck and arm from lumbar spine arachnoiditis can happen, but it is rare.

dysaesthesia muscle spasms cramps pkline / Getty Images


Cauda Equina Syndrome

Latin for horse’s tail, cauda equina is the terminal point for lumbar spinal nerves and roots. Cauda equina syndrome occurs when someone with adhesive arachnoiditis develops paraplegia —  impairment in motor or sensory function of the lower extremities — or has reduced or lost functionality of their bowels, bladder, or genitals. Signs of dysfunction include constipation and an inability to completely empty the bladder, which can lead to urinary infection.

cauda equina paraplegia TomekD76 / Getty Images


Diagnosing Arachnoiditis

Apart from unrelenting pain and other systemic symptoms such as gastrointestinal issues and sexual dysfunction, there is no uniform way to diagnose arachnoiditis. After a physical, if the doctor suspects arachnoiditis, he may order an MRI or a CAT scan. If the doctor orders the use of contrast media during those tests and sees clumped nerve roots or scarring between the meninges, arachnoiditis is the diagnosis. However, the disease may also go undetected and is often mistaken for other back conditions.

MRI CAT diagnosis Visivasnc / Getty Images


Pain Management

There is no cure for arachnoiditis, and it is difficult to treat. Pain management and reduction are the first steps to finding relief. Doctors often recommend physiotherapy and regular exercise to improve daily functionality. They may also suggest psychotherapy; cognitive behavioral techniques can help restructure one's mental framework to better handle the presence of chronic pain.

physiotherapy pain management andresr / Getty Images


Surgical Options

For those with more severe symptoms, doctors may suggest surgery, but this option isn’t without controversy and skepticism. Some surgical procedures include spinal fusion or microdiscectomy, which relieves spinal nerve pressure. However, these options do not offer a long-term solution and risk worsening the condition. Studies suggest foraminoplasty, a minimally invasive endoscopic spine surgery, may be a suitable treatment. The procedure allows the surgeon to pinpoint and treat the precise area of irritation.

spinal fusion foraminoplasty pastorscott / Getty Images


Alternative Treatments

Some medical professionals are calling for more clinical trials of electrical stimulation as a treatment for arachnoiditis. In follow-up studies of patients with arachnoiditis who had electrodes placed in the spine for pain relief, approximately 38 percent felt the procedure reduced their pain and improved functionality. This indicates that the alternative treatment has the potential to be a better solution than traditional surgery.

electrical stimulation electrodes luchschen / Getty Images


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