About - Arachnoiditis is a rare and painful disorder caused by inflammation, irritation, or scarring of the arachnoid, one of the three protective membranes (meninges) that surround the brain and spinal cord. The condition most often affects the nerves and nerve roots in the lower part of the spinal canal. In some people, inflammation of the arachnoid can eventually lead to adhesions and scar tissue, causing the nerve roots to stick together or become compressed. This form is often referred to as adhesive arachnoiditis. Arachnoiditis can cause persistent nerve pain and a variety of neurological symptoms. The severity and pattern of symptoms can vary considerably from person to person. It is generally considered a chronic condition, and symptoms may remain stable, fluctuate, or gradually worsen over time.
Symptoms depend on the nerves affected and the severity of inflammation or scarring. Common symptoms may include:
Severe or persistent pain, particularly in the lower back, buttocks, legs, or feet
Burning, shooting, stabbing, or electric-shock-like pain
Pain that radiates from the back into one or both legs
Numbness or reduced sensation
Tingling or a pins-and-needles sensation
A crawling or unusual sensation on the skin
Muscle weakness
Muscle cramps, twitching, or spasms
Difficulty walking or maintaining balance
Joint or limb pain
Bladder-control problems
Bowel-control problems
Sexual dysfunction
Abnormal or reduced sweating in affected areas
Fatigue
Difficulty sleeping because of pain
Headaches
Dizziness
Nausea or vomiting
Hearing-related symptoms, including ringing in the ears (tinnitus)
Vision problems
Depression or other emotional difficulties related to chronic pain
Not everyone with arachnoiditis experiences all of these symptoms. Some symptoms may also occur because of the underlying condition or injury that caused the arachnoid inflammation.
Arachnoiditis may develop when the arachnoid membrane becomes inflamed or irritated. Persistent inflammation can sometimes result in scar formation and adhesions around the spinal nerve roots. Possible causes and associated factors include:
Arachnoiditis may occur after certain spinal operations or procedures, particularly when there is significant inflammation, bleeding, infection, or irritation around the spinal membranes.
Certain spinal injections have been associated with arachnoiditis in rare circumstances. However, the exact risk depends on the medication, technique, route of administration, and other factors.
A lumbar puncture, also known as a spinal tap, involves inserting a needle into the lower back to obtain cerebrospinal fluid. Rarely, complications associated with the procedure may contribute to inflammation around the spinal membranes.
Historically, some forms of myelography and certain contrast agents were associated with arachnoid irritation. Modern techniques and contrast agents have substantially changed the risk profile.
Repeated manipulation around the spinal canal, including some catheter or electrode procedures, may contribute to inflammation or scar formation in susceptible individuals.
In rare circumstances, medications administered directly into the spinal fluid (intrathecal chemotherapy) may be associated with inflammation of the meninges. In some cases, however, no definite cause can be identified.
The risk of developing arachnoiditis may be increased by conditions or procedures that cause inflammation, bleeding, infection, or direct irritation around the spinal cord and nerve roots. Potential risk factors include:
Previous spinal surgery
Significant spinal trauma
Certain spinal procedures
Previous meningitis or other spinal infections
Bleeding around the spinal cord
Multiple procedures involving the spinal canal
Certain inflammatory conditions affecting the spinal meninges
A risk factor does not mean that a person will necessarily develop arachnoiditis.
Diagnosing arachnoiditis can be challenging because its symptoms can resemble those of several other spinal and neurological disorders. A doctor may begin with a detailed medical history and neurological examination. Information about previous spinal surgery, injuries, infections, injections, lumbar punctures, or other spinal procedures can be particularly important.
Depending on the symptoms, doctors may recommend additional tests to exclude other causes of pain, weakness, numbness, bladder problems, or neurological symptoms. These may include:
Neurological examination
Nerve conduction studies
Electromyography (EMG)
Additional spinal imaging
Blood tests when infection or inflammation is suspected
A neurologist, neurosurgeon, pain medicine specialist, or another physician experienced in spinal disorders may be involved in the evaluation.
There is currently no universally effective treatment that reverses established arachnoid scarring. Treatment generally focuses on controlling pain, maintaining mobility and function, managing neurological symptoms, and improving quality of life. Treatment should be individualized according to the person’s symptoms, underlying cause, general health, and response to previous therapies.
A doctor may consider medications used to treat neuropathic pain and other types of chronic pain. Depending on the individual situation, treatment may include medicines such as:
Certain anticonvulsant medicines used for nerve pain
Certain antidepressant medicines used for neuropathic pain
Other appropriate pain-relieving medicines
Medication should only be taken under the guidance of a qualified healthcare professional.
Living with chronic pain can affect sleep, mood, work, relationships, and daily activities. Psychological support, pain-coping strategies, counseling, and treatment of associated depression or anxiety may be beneficial.
In selected patients, specialist pain-management teams may consider interventional treatments. The benefits and risks should be carefully evaluated because additional procedures involving the spinal canal can themselves carry risks.
Surgery is generally not a routine treatment for arachnoiditis. Procedures intended to remove scar tissue or separate adhered nerve roots may have limited or temporary benefits and can sometimes lead to further scarring. For this reason, surgery is usually considered only in carefully selected cases after specialist assessment.
New or rapidly worsening leg weakness, loss of bladder or bowel control, numbness around the groin or inner thighs, or severe neurological changes require prompt medical assessment because these symptoms can also indicate other spinal conditions that may require urgent treatment.
Arachnoiditis can be serious, particularly when it causes severe chronic pain, weakness, mobility problems, or bladder and bowel dysfunction. The severity varies considerably between individuals.
There is currently no established treatment that reliably reverses established arachnoid scarring. Treatment focuses mainly on controlling symptoms, maintaining function, and improving quality of life.
Not exactly. Arachnoiditis refers to inflammation or irritation of the arachnoid membrane. Adhesive arachnoiditis refers to a form in which inflammation and scarring cause adhesions involving the spinal nerve roots.
It can. When the nerves responsible for bladder or bowel function are affected, urinary or bowel symptoms may occur. New or rapidly worsening bladder or bowel dysfunction should be assessed urgently.
MRI of the spine is the main imaging study used when arachnoiditis is suspected. Findings such as clumping or abnormal positioning of nerve roots may support the diagnosis. A specialist will interpret the imaging together with the person’s symptoms and medical history.
The course varies. Some people have relatively stable symptoms, while others experience persistent or progressive problems. Symptoms may also fluctuate.
A neurologist may evaluate the neurological symptoms. Depending on the individual’s condition, a neurosurgeon, pain-management specialist, physical therapist, or other healthcare professional may also be involved.
Physical therapy may help some people maintain mobility, strength, flexibility, and function. The program should be individualized because overly strenuous activity may worsen symptoms in some patients.
Medical Disclaimer- This information is provided for general educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Arachnoiditis can have symptoms that overlap with other neurological and spinal conditions, and diagnosis should be made by a qualified healthcare professional based on the individual’s medical history, examination, and appropriate investigations. Do not start, stop, or change any medication or treatment without consulting your doctor. If you develop sudden or rapidly worsening weakness, loss of bladder or bowel control, severe numbness, or other significant neurological symptoms, seek urgent medical attention.
