Spinal Adhesive Arachnoiditis
Spinal Adhesive Arachnoiditis , Adhesive Arachnoiditis
Type of disease: Rare Condition or Disease
Spinal adhesive arachnoiditis is a rare pathology involving pia mater of the spinal cord and nerve roots. It can potentially lead to disability-many patients end up wheelchair-bound due to subsequent paraparesis. It is an infrequent but possible cause of lower extremities weakness in patients with a history of spinal surgery, epidural anaesthesia, myelography or spinal tumors. The aetiology of adhesive arachnoiditis is heterogenous. The most common causes include infections (bacterial, tuberculous, syphilitic), trauma (including consequences of surgical procedures), thecal sac contamination by intraspinal injection of various substances (iodine based contrast agents, corticosteroides) and spinal canal tumors. Magnetic resonance imaging (MRI) plays a crucial part in the diagnostic process of adhesive arachnoiditis. The most common MRI abnormalities are (in descending order): the presence of arachnoid cysts, clumping, thickening and displacement of nerve roots with their contrast enhancement, spinal cord swelling with T2 signal hyperintensity, arachnoid separations and spinal cord compression, displacement and anchoring, as well as atrophy of the spinal cord with formation of syrinx. The therapy of patients diagnosed with adhesive arachnoiditis is extremely difficult—there is no causative treatment, and symptoms based therapy and applied medication rarely bring expected results. Opioid and non-opioid painkillers, steroids and spinal cord stimulation can be named among the most widely used methods. Surgical approach (arachnoid dissection with duroplasty) remains controversial.