Clinical Diagnosis and Treatment of Adhesive Arachnoiditis: Handbook for the Medical Practitioner

Adhesive arachnoiditis is a spinal canal inflammatory disease in which cauda equina nerve roots are adhered or “glued” by adhesions to the arachnoid membrane of the spinal canal covering. It is associated with intractable pain, severe neurologic impairments, and premature death. Although considered a rare disease in the past, in this century it is re-emerging due to multiple factors. In the 18th and 19th centuries adhesive arachnoiditis was caused by the infections, syphilis and tuberculosis, and later by insoluble dyes used in spine radiograph. Today this disease is primarily caused by herniated intervertebral discs, autoimmune-collagen disorders, and genetic connective tissue diseases. Advances in magnetic resonance imaging (MRI) now permit a definitive diagnosis to be made of the disease. It is staged or categorized as mild, moderate, severe, and catastrophic. This handbook is a ready reference for medical practitioners to assist in the diagnosis and treatment of adhesive arachnoiditis. Included in the handbook are symptom profiles, laboratory tests, physical findings, and MRI abnormalities to identify and diagnose patients who have the disease. Treatment protocols are presented which contain nutritional, physiologic, and pharmacologic recommendations to assist medical practitioners in the care of patients with this tragic disease.