Arachnoiditis is a rare and serious medical condition characterised by inflammation of the arachnoid membrane, which surrounds and protects the nerves of the spinal cord. This inflammation can lead to the formation of scar tissue and cause symptoms, such as chronic pain, numbness, and tingling in the lower back, legs, and feet. In severe cases, it can result in neurological problems. We spoke to our expert Dr Kranthi Mohan, Consultant – Neurologist, Gleneagles BGS Hospital, Kengeri, Bengaluru, who explained this condition and listed its treatment and management measures.
This condition involves persistent inflammation of the arachnoid mater and the subarachnoid space, with the primary impact being on the spinal cord. “The meninges, crucial membranous structures safeguarding the Central Nervous System (CNS), consist of three layers: the dura mater, arachnoid mater, and pia mater. The subarachnoid space, located between the arachnoid and pia mater, houses Cerebrospinal Fluid (CSF), essential for CNS function by providing nutrients and maintaining fluid balance,” said Dr Mohan.
Also Read: Decoding Spinal Cord Injuries: Expert Lists Types And Levels Of Injury
Aetiology and Pathophysiology
- Chemical Factors: Exposure to neurotoxic substances like sulfite-containing preservatives, spinal anaesthesia agents, or accidental chemical injections
- Mechanical Factors: Trauma, surgical manipulation of meninges, spinal surgeries, and intervertebral disc herniation
- Inflammatory Conditions: Including autoimmune disorders like ankylosing spondylitis, Guillain-Barré syndrome, and infectious diseases, such as syphilis, tuberculosis, HIV, and fungal infections
- Idiopathic Occurrence: In some cases, arachnoiditis may develop without any identifiable triggering event
“Following an insult, scar tissue formation within the meninges ensnares nerve roots, impairs blood circulation, diminishes oxygenation, and fosters the accumulation of metabolic waste products. These changes lead to debilitating pain and neurological deficits in affected individuals,” said Dr Mohan.
Clinical Symptoms Of Arachnoiditis
Arachnoiditis manifests through a spectrum of symptoms. Here are some of the symptoms shared by the expert:
- Common Symptoms: Chronic back pain, radicular pain (pain radiating along nerve roots), and sensory disturbances
- Less Common Symptoms: Gait abnormalities, motor weakness, and neurogenic bladder or bowel dysfunction
- Late-onset Urinary Symptoms: Present in 23% of cases, characterised by urgency, increased frequency, and occasionally incontinence
- Other Manifestations: Rarely, patients may experience paraplegia or isolated low-back pain
According to StatPearls, the progression of arachnoiditis varies greatly; for some individuals, it remains stable, while for others, it worsens over time. Most patients have a relatively stable functional disability, with symptoms that do not significantly worsen or improve after diagnosis, though the severity of symptoms can vary.
Diagnosis Of Arachnoiditis
“Accurate diagnosis of arachnoiditis relies on imaging studies, such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) myelography, which exhibit high sensitivity and specificity for chronic adhesive Arachnoiditis,” added Dr Mohan.
In cases of diagnostic uncertainty or suspicion of tumours, a spinal cord biopsy may be necessary to confirm the absence of neoplastic growth.
Treatment and Management
Management of Arachnoiditis primarily aims at symptom relief and improving quality of life. Dr Mohan listed the treatment and management of this rare condition as follows:
- Pharmacological Interventions: Include Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids for pain control, and adjunctive therapies, such as duloxetine, gabapentin, pregabalin, and muscle relaxants like baclofen.
- Interventional Procedures: Thecaloscopy with cyst and adhesion dissection, along with pain-modulating neurostimulation techniques, may provide temporary relief, although recurrence is possible.
Prevention For Arachnoiditis
Preventive strategies for arachnoiditis focus on minimising risk factors:
- Minimising Invasive Procedures: Limiting unnecessary spinal interventions
- Infection Prevention: Rigorous aseptic techniques during procedures
- Careful Use of Spinal Medications: Ensuring judicious administration of intrathecal injections and myelogram dyes
- Patient Education: Emphasising healthy lifestyle practices to reduce spinal injury risks, such as maintaining optimal weight and preventing conditions like subarachnoid haemorrhage and disc herniation
Bottomline
Dr Mohan concluded, “Arachnoiditis poses significant challenges due to its complex aetiology and debilitating symptoms. Early recognition, accurate diagnosis, and comprehensive management are essential in mitigating its impact on patients' lives. By implementing preventive measures and optimising therapeutic interventions, healthcare providers aim to improve outcomes and enhance the well-being of individuals affected by this condition.”
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your own professional if you are dealing with any health issues to avoid complications.]