ADHESIVE ARACHNOIDITIS: THE DISEASE IN 2020

Adhesive arachnoiditis (AA) is an inflammatory disease that occurs inside the spinal canal. It most often occurs in the lower spine known as the lumbar and sacral regions. The disease inflames nerve roots of the cauda equina and the arachnoid-dural covering of the spinal canal. Inflammation produces adhesions that merge or “glue” these two separate anatomic structures together into an inflammatory-adhesive mass inside the spinal canal. This space-occupying mass entraps nerve roots and blocks normal spinal fluid flow. Unless inflammation is controlled and suppressed, it causes dysfunction and death to the entrapped nerve tissue, severe pain, and progressive enlargement of the mass in a manner analogous to the growth of a cancerous tumor.

UNIQUE SYMPTOM PROFILE

The anatomic location of AA almost always involves nerve roots at or near the junction of the lumbar and sacral spines. A typical or unique symptom complex emerges and includes severe back pain that is relieved by reclining or standing. Sudden stabbing or shooting pains occur upon bending or twisting at the hips. A feeling of water dripping or insects crawling on the legs or trunk, burning feet, blurred vision, and difficulty starting or stopping urination are also common symptoms. Unless inflammation and adhesion formation are controlled by medication and other measures, the disease may lead to paralysis of the legs or feet, spinal fluid seepage, and autoimmune manifestations among other neurologic impairments. Any trauma including surgery or paraspinal/epidural injections may accelerate or initiate the development of AA.

RELATED CONDITIONS

AA is almost exclusively a lumbar-sacral disease, although it can very rarely occur in the thoracic and cervical spine areas. All references to AA on this website are for lumbar-sacral AA unless specifically noted. Two disorders are highly associated with AA: (1) Tarlov cysts; (2) Chronic Cauda Equina syndrome. Both disorders may precede the development of AA or even be the result of AA.

CAUSES

There are two basic underlying causes of AA:

  1. Structural spine abnormalities including scoliosis, osteoporosis, chronic intervertebral disc protrusions, and stenosis;
  2. Genetic, autoimmune, and infectious diseases including Ehlers-Danlos/Hypermobility (EDS) disorders, systemic lupus erythematosus, and viral infections.

Any trauma, surgery, or injection into the spinal canal or epidural space may accelerate the development of AA if a person has one of the underlying basic conditions.

TREATMENT

AA has four stages or categories of severity: mild, moderate, severe, and catastrophic. Treatment is most successful when the disease is in the mild or moderate stage. Treatment has two basic approaches:

  1. Medication
    1. Suppression of neuroinflammation
    2. Promotion of neuroregeneration
    3. Symptomatic pain relief
  2. Physiologic Measures
    1. Enhance spinal fluid flow
    2. Reduce retained electricity
    3. Increase oxygen
    4. Maintain leg and arm functions

AUTOIMMUNE DISORDER

AA, unfortunately, develops an autoimmune disorder due to neuroinflammatory waste and/or spinal fluid that finds its way outside the spinal canal.  The disorder will affect multiple organs.