Symptoms and Treatment Options for Arachnoiditis
Arachnoiditis is an incurable inflammatory condition of the arachnoid membrane that can cause a wide range of neurological symptoms from mild to severe, with treatment focused primarily on symptom management rather than cure.
Symptoms of Arachnoiditis
Common Presenting Symptoms
- Chronic back pain that may be burning or severe in nature 1, 2
- Radiating pain down the legs that doesn't follow typical dermatome patterns 2
- Numbness and dysesthesia (abnormal sensations) 2
- Muscle weakness and neurological deficits 1
- Bladder, bowel, and/or sexual dysfunction 2
- Unexplained rashes (in some cases) 1
Advanced or Progressive Symptoms
- Urinary symptoms including urgency, frequency, and occasional incontinence (develops in approximately 23% of patients) 3
- Clumped nerve roots visible on imaging 2
- Fibrosis and scarring of the dural sac 2
- Potential development of syringomyelia in severe cases 2
Diagnostic Approach
Imaging
- MRI is the primary diagnostic tool for confirming arachnoiditis 1
- MRI findings may show clumped or adherent nerve roots, fibrosis, and dural sac deformities 2
- CT scan may be used as a complementary imaging modality 4
Differential Diagnosis
- Arachnoiditis can mimic other conditions including:
Treatment Options
Pharmacological Management
- NSAIDs for inflammatory pain control 2
- Narcotic analgesics for severe pain (majority of long-term patients depend on these) 3
- Corticosteroids (intravenous) may be beneficial in early stages to prevent progression of inflammation 2
Interventional Approaches
- Spinal cord stimulation may be considered, though outcomes are generally better for single nerve root injury than for arachnoiditis with multiple injured nerve roots 5
- Microsurgical dissection of adherent nerve roots may provide temporary relief in some cases 6
Surgical Considerations
- Surgical interventions should be approached with caution as they may increase neurological deficits 3
- Further spinal procedures are best avoided in patients diagnosed with arachnoiditis 2
Prognosis and Long-term Management
- Arachnoiditis is generally considered incurable 1
- Pain and functional disability tend to remain stable over time, though severity may fluctuate 3
- Most patients can walk and drive without limitation, but ability to return to previous occupations is often limited 3
- Long-term follow-up indicates that progression of symptoms is not the natural course of the disease for most patients 3
Important Considerations and Pitfalls
- Avoid additional spinal procedures in patients with confirmed arachnoiditis as these may worsen symptoms 2
- Recognize that quality of life can be significantly impacted, with some patients developing psychological complications including depression 3
- Be aware that while symptoms may not progressively worsen in most patients, the condition can significantly shorten lifespan (by approximately 12 years in one study) 3
- Monitor for suicidal ideation, as suicide risk is elevated in this patient population 3