lumbar adhesive arachnoiditis

Fibrotic process following inflammatory response to local tissue within the subarachnoid space. Etiology: (associated conditions) 1) multiple lumbar surgical procedures 2) oil-based myelography 3) chronic spinal infection 4) spinal cord injury 5) intrathecal hemorrhage 6) intrathecal injection of steroids & anesthetics 7) foreign bodies Pathology: 1) inflammation 2) fibrosis 3) adhesion of nerve roots 4) pain Clinical manifestations: 1) back pain 2) leg pain 3) motor, sensory & reflex deficits Radiology: - magnetic resonance imaging of lumbar spine Management: 1) NO satisfactory treatment 2) surgical treatment including: lysis of adhesion, dorsal rhizotomy, dorsal root ganglionectomy NOT beneficial 3) dorsal column stimulation for pain relief of variable benefit 4) epidural steroid injections of limited value

References

Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 78