WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

Back pain associated with bending the head or lifting the legs suggests the possibility of neural compression or of dural adhesions and should be assessed.

SCREENING AND DIAGNOSIS

It is not nessecary to screen for arachnoiditis. The diagnosis is primarily based upon advanced imaging findings with CT and/or MRI. Adhesive arachnoiditis is characterized by clumping of nerve roots in the spinal canal. This occurs secondary to the formation of scar tissue (adhesions) between the arachnoid membranes of adjacent spinal nerve roots. This is best identified on MRI studies. There may be associated intraspinal cysts and locuations. The clumping of nerve roots in the lumbar spinal canal is sometimes referred to as an empty thecal sac sign. The spinal canal appears devoid of the usual number of spinal nerve roots because they are adhered one another and often located in an eccentric location within the spinal canal making it appear as if there are no spinal nerves in the canal. Severe lumbar arachnoiditis can be associated with a ball of scar tissue and nerves roots bound together creating the appearance of a mass in the central spinal canal.

Conditions which may present with similar features include:

• Spinal stenosis with clumped or crowded nerve roots
• Intrathecal neoplasm
• Carcinomatous Meningitis
• Leptomeningeal spread of cancer

PROGNOSIS

The prognosis of symptomatic adhesive arachnoiditis is usually not good without therapeutic intervention. The condition is often associated with chronic pain. Treatment is usually focused on pain management. The rate of success using a spinal cord stimulator ranges from 30-70%. There is usually a better immediate response with the success rate of long term use dropping to as little at 30%. Surgery may be recommended to physically help break up adhesions which are felt to be contributing to signs or symptoms. The prognosis with surgical microlysis of adhesions is fair with an approximate 50% success rate.

COMPLICATIONS

The complications of arachnoiditis usually involve the development of neurological problems involving one or more nerve roots.