Arachnoiditis describes pain that is caused by infection or inflammation of one of the spinal meninges, which are the protective membranes that surround the spinal nerve tissues. In most cases, symptoms are chronic and permanent, since there is no known cure for the condition and only limited effective treatment options.
Arachnoid-induced pain is highly similar to many other types of spinal neuropathy, since it involves the same structures and tissues. Many doctors liken the condition to the symptomatic expression of a partial pinched nerve, or of central spinal stenosis, since the disabling effects can be virtually identical.
Arachnoid inflammation is often misdiagnosed, since the condition is usually found in patients who demonstrate other structural abnormalities in the nearby spinal anatomy. In fact, a great many cases of arachnoid pain come about as a direct result of treatment that is rendered for the other atypical structural issue(s).
This report examines arachnoid pain syndromes and details the causes and treatments for the condition in order to assist patients who suffer with this enigmatic health crisis.
Arachnoiditis Definition
The arachnoid is the middle membrane of the meninges. It contains the pia mater and is contained by the dura mater. Within these membranes, the central nervous system tissues reside, including the brain, the spinal cord and the various spinal nerves, as well as the reservoir of cerebral spinal fluid.
The meninges, which compose the thecal sac, are designed to protect and insulate these most sensitive of all bodily tissues against trauma and infection.
The middle arachnoid layer demonstrates a web-like texture and appearance, providing the structure with its spidery nomenclature. Normally, this tissue layer is quite resilient, offering a barrier to contain fluid and disallow the penetration of harmful microorganisms into the neurological tissues. However, in some instances, the arachnoid can suffer inflammation or infection, leading to this terribly afflictive disorder.
Symptoms can range greatly, by location and severity, with some patients demonstrating localized and contained symptomatic expressions, such as those demonstrated in a particular nerve root, while others will suffer horrible systemic effects throughout the central nervous system.
Neurological symptoms might include burning sharp pain, paresthesia, weakness and other odd sensations in the skin, muscles or deep tissues.
Systemic consequences might include the inability to sit, stand, walk or find comfort in virtually any position. Other patients might suffer sexual dysfunction, incontinence or other consequences similar to cauda equina syndrome.
Causes of Arachnoiditis
Some cases of arachnoid inflammation are idiopathic. Meanwhile, other cases have known causes and contributors that might involve any of the following factors:
Spinal surgery is one of the most common causations. Contamination of the arachnoid layer is a terrible potential complication of many varieties of invasive spine care. Once harmful contamination has entered the arachnoid space, the effects might last for life, since the condition is highly treatment-resistant. Ironically, the conditions that required the surgery in the first place are virtually never as severe of the arachnoiditis that came about as a result of the intervention. In essence, the patient hopes to have a mild to moderate spinal issue corrected and instead ends up suffering from this catastrophic calamity.
Epidural injections are another known treatment modality that directly causes arachnoid inflammation. This can occur when an infection occurs after invasive penetration of the layer, but more often is the result of a misplaced injection into the intrathecal layers, instead of its target destination of the epidural space. The focus on the true cause of most arachnoid problems from epidural injections has been narrowed to the preservatives used in these chemicals. Once again, patients often endure an epidural as a moderate therapy for a minor spinal issue and instead are cursed with a chronic severe intrathecal infection that might never resolve. This same event can and does occur when epidurals are used for other purposes, such as during childbirth or during many varieties of surgery.
Some chemicals and pharmaceutical compounds have been linked to the causation of arachnoid inflammation concerns. These include dyes that were formerly used in contrast medical imaging, like Iophendylate, Pantopaque and Myodil.
General or systemic infection and disease processes can find their way in the intrathecal layers, including the arachnoid. The most common disease processes to cause arachnoid inflammation include spinal meningitis and tuberculosis, although many others can potentially be involved.
Spinal injury might result in arachnoid complications due to many serious and chronic degenerative problems, such as extreme stenosis or other nerve compression condition.
Adhesive Arachnoiditis
Arachnoid inflammation is actually measured in three distinct stages and frontier versions that transition one stage with the next.
Radiculitis is characterized by inflammation of the spinal nerve structures and the loss of the space through which the cerebral spinal fluid flows, called the subarachnoid space. This stage may or may not lead to more serious versions of the condition and is easily misdiagnosed as many other potential causations.
Arachnoid-specific inflammation is the second stage and composes the main body of this essay.
Adhesive arachnoiditis is the worst possible variety of the condition, wherein the arachnoid layer sticks together and to the various nerve tissues, enveloping them in contractive scar tissue that can create large areas of compression and subsequent neurological dysfunction. Once this stage occurs, there is little hope for effectual treatment or organic remission of the condition.
Arachnoid Treatment
There are no available cures for arachnoid concerns and few treatments that show any real promise. Worse still, some therapies are helpful in particular patients, yet exacerbate expressions and progression in others. Therefore, implementing any form of therapy is considered risky, until the tolerations and reactions of the patient are well known.
Some of the most common approaches to care include any or all of the following methods:
Pharmaceutical treatment is commonplace, with all manner of drugs being used to combat the symptoms of the disease, rather than attempting to resolve the disease itself.
Injection therapies are often utilized, but are particularly controversial, since these are known causes of the condition in the first place.
Surgery can be used to resolve acute portions of arachnoid nerve compression. However, results are generally poor and might lead to more significant and permanent neurological injury, paralysis or even death.
Electrostimulation can be utilized via TENS or spinal implants.
Physical and exercise therapy might help maintain physical functionality, but will do little to alleviate pain. In fact, most mobility work is extremely painful for the patient, often necessitating the use of ever-stronger pain management drugs just to preserve movement.
Arachnoiditis Summary
Diagnosis with arachnoid inflammation and/or infection is devastating, especially once patients begin to research the condition and realize its terrible severity. However, there is always hope.
Innovative therapies are in development that might be able to reverse the process. There are several promising drugs in the development process currently and others in clinical testing.
Additionally, some patients do recover to some extent organically. The condition does not have to progress forward to evermore severe degrees, although statistically, it often does. Organic remission is rare, but some patients seem to level out and are able to maintain nerve functionality thereafter.
No patient should feel that the diagnosis of arachnoid inflammation will inherently lead to systemic adhesive varieties of the condition. However, every diagnosed patient must be mentally and physically prepared for the worst, if case the condition does progress.
