What is arachnoiditis? Symptoms and Treatment

Arachnoiditis is a painful condition that develops due to inflammation of the arachnoid membrane, one of the membranes that surround and protect the spinal cord . It is characterized by severe stinging, burning pain and neurological problems.

The brain and spinal cord that make up the central nervous system are surrounded by 3 layers of membranes. The innermost layer is the pia mater, and the outermost layer is the dura mater. The middle layer is the arachnoid membrane. Cerebrospinal membranes are mainly composed of connective tissue such as collagen and elastin. Injury, trauma, tumor, infection, genetic diseases, autoimmune diseases can cause damage and dissolution of the arachnoid membrane.

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Arachnoiditis Symptoms

Arachnoiditis does not cause the same symptoms in everyone. It mostly affects the spinal cord at the waist level and complaints occur due to the discomfort of the nerves going to the legs. The most common symptom is pain. In addition, tingling, numbness or loss of strength may occur in the legs. Feelings like electric shock may occur. There may be sensations as if a drop of water is sliding down the leg. The pain may be continuous and may decrease with certain positions. For example, some people may be comfortable standing, while others may be more comfortable lying on their back. There may be muscle cramps, spasms, and uncontrolled muscle twitches. Problems may occur in bladder, bowel and sexual functions. As the disease progresses, the symptoms may worsen and the person may become unable to work.

Inflammation may also occur in the neck region of the spinal cord or in the arachnoid membrane surrounding the brain. These are much rarer.

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Reasons

Inflammation of the arachnoid membrane leads to the formation of scar tissue. Nerve fibers coming out of the spinal cord become stuck together and cannot function normally. Inflammation (inflammation) of the arachnoid membrane may be due to:

  • Injury of the spinal cord as a result of direct trauma
  • Chemicals: The contrast agent used in myelography films has been implicated in some arachnoid cases. After this suspicion, the contrast agents used were changed. It is accepted that current contrast agents do not cause arachnoiditis. There is concern that some of the preservatives in epidural steroid injections may cause arachnoiditis.
  • Bacterial or viral infections: Diseases such as viral or fungal meningitis or tuberculosis can affect the spinal nerves. In history, arachnoiditis was first defined in the 19th century as a condition caused by infections, especially tuberculosis and syphilis.
  • Chronic, that is, long-term compression of the spinal nerve roots can lead to arachnoiditis. Conditions such as herniated disc, spinal canal narrowing can do this.
  • Spine surgery or other interventional procedures to the spinal cord area may pose a risk of arachnoiditis as a result of complications.

Diagnosis

Diagnosis can be difficult, as arachnoiditis is a rare disease. Computed tomography and magnetic resonance imaging (matrix) may aid the diagnosis. With EMG, it can be investigated whether the nerve roots are damaged or not.

Lumbo-sacral adhesive arachnoiditis is most common today. In lumbo-sacral MRI, the nerve roots of the cauda equina below the spinal cord are seen adhered to each other and to the arachnoid layer surrounding the spinal canal.

Treatment

There is no treatment that definitively cures arachnoiditis. Treatments are similar to those used in other chronic pain conditions. The focus of treatment is to increase the quality of life and functionality of the person by reducing pain and other complaints. Pain medications, physical therapy, exercise, and psychotherapy may be recommended. Regular walking, gentle stretching of the legs, hydrotherapy, breathing exercises, exercises with light weights can increase the circulation of the cerebrospinal fluid and prevent the adhesion of the nerve roots.

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Arachnoiditis pain is one of the most severe pains. Apart from standard pain treatments, intravenous lidocaine, vitamin C, and ketamine applications can provide long-term reduction in pain.

Surgical treatment is controversial because the results are not good enough. Steroid injections and implanted electrical stimulation treatments are also being tried.

A new 3-stage approach is proposed for the treatment of arachnoiditis. These stages are to suppress neuroinflammation, promote neuroregeneration, and control pain. The inflammatory process in arachnoiditis is carried out by glial cells. Some drug and hormone treatments are being studied to suppress glial cell activation. In addition, it has been discovered that the brain and spinal cord produce certain hormones to suppress inflammation and repair damaged nerve cells. External administration of these hormones, also called neurosteroids, can help heal arachnoiditis.

Keep reading : Read our article titled “Spinal Cord Inflammation – Transverse Myelitis ” .

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