This section of the website is to provide examples of physical abnormalities to assist medical practitioners in early identification of AA cases. Early identification will lead to earlier treatment to prevent the serious complications of AA.
Two Types of Physical Abnormalities
AA has multiple pathologic effects which produce two basic types of physical abnormalities.
- Neurologic Deficits
- Anatomic Derangement of Back
Neurologic Deficits: AA entraps cauda equina nerve roots inside the lower spinal canal. Both the entrapment and permanent damage done to the nerve roots by inflammation may cause neurologic defects in the nerve connections to the bladder, bowel, rectum, sex organs, legs, and feet. Such symptoms as difficulty with urination, defecation, sexual performance, and leg and foot weakness may develop. Nerve damage may be severe enough to cause a foot drop or need for a cane or walker to ambulate. The person with AA may not be able to fully extend and flex their legs and feet. In severe instances, weakness and inability to extend and flex the legs and feet may require a wheelchair or even force the person into a bed-bound state. The persons who have had these neurologic deficits are mainly those who were undiagnosed for many years and did not have specific treatment for AA.
AA in the lower spinal canal can impair the ability to fully extend the arms. The cause is believed to be contractures of the paraspinal musculature which connects the lower back to the shoulder and arm muscles. These individuals cannot extend their arms upward to full extension. The contractures are believed to occur due to chronic seepage of spinal fluid through the arachnoid-dural (meninges) covering of the spinal canal into the musculature and other soft (non-bony) tissues around the spinal column. Again, these individuals tend to be persons who have been undiagnosed for an extended period without the benefit of specific treatment.
Few neurologic deficits are subject to photographic demonstration, but they can be detected by a medical professional’s physical examination. One exception is the person who demonstrates leg and foot deficits by use of a cane or walker.
Anatomic Derangements of Back: The anatomic derangements of the back of persons with AA may be profound and most striking to the eye. There are multiple reasons why the anatomic structures of the back may derange. These derangements may, in themselves, produce pain and disability in addition to that of AA.
Here are the multiple causes of anatomic back derangements in persons with AA:
- Spine disorder (herniated discs, arthritis, scoliosis, vertebral collapse) that initiated AA
- Severe pain that causes leaning or splinting to relieve pain
- Neurologic deficits which cause abnormal posture
- Spinal fluid seepage with resultant toxicity, inflammation, and contractures of muscles, skin, and other tissue
Physical Appearance of Anatomical Derangements
- Creasing on one side of back
- Leaning or splinting to one side
- Midline indentation or crevice
- Muscle areas of atrophy and hypertrophy
- Skin folds
Photographs: Shown here are photographs of the backs of persons with MRI-confirmed AA. It is well-recognized that other spine disorders may cause similar anatomic derangements, but the intent is to recognize anatomic derangements that provide a reason to investigate for the presence of AA.
Adhesive arachnoiditis patient with indented spine groove and asymmetry of muscle groups. Patients are bent to the right. They have unsteady gait and can’t stand straight up.
Severe contractures and indentation with AA and spinal fluid leakage.
Indentation of adhesive arachnoiditis (AA) due to tissue contractures and chronic spinal fluid seepage.
Crease in tissue leans left.
Spinal fluid leakage and rods penetrating.
Multiple spine surgeries and now has adhesive arachnoiditis. Note the areas of tissue atrophy.
Mid-line indentation and skin contracture caused by adhesive arachnoiditis (AA) and necessity of spine surgery.
Adhesive arachnoiditis patient. Note the mid-center “caving” and crease on left side due to “leaning” left.
Mid-line indentation in an AA patient.