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Spinal Arachnoiditis

Published online by Cambridge University Press:  18 September 2015

Stephen I. Esses
Affiliation:
Division of Neurosurgery, Toronto General Hospital and the Department of Surgery, University of Toronto
T.P. Morley*
Affiliation:
Division of Neurosurgery, Toronto General Hospital and the Department of Surgery, University of Toronto
*
Room 222, 7th Floor, Eaton Wing, Toronto General Hospital, 101 College Street, Toronto, Ontario M5G 1L7.
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Summary:

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A review of the literature points to the many causes of arachnoiditis and the failure of treatment to arrest or reverse its effects. The true incidence cannot be determined, although it is probably lower than might at first appear from the published articles. In the radiological literature the diagnosis seems to derive from an examination of the films alone, often without reference to the clinical findings or appearance at operation. While attempts at treatment are usually unsuccessful, some iatrogenic cases can be prevented by the avoidance of intrathecal steroid injections or unduly rough or repeated surgical exploration of the lumbar vertebral canal.

Type
Review Article
Copyright
Copyright © Canadian Neurological Sciences Federation 1983

References

Abel, R. Jr., Nelson, D.A. and Bernat, J.L. (1977). Complications from methylprednisolone acetate (Depo-Medrol) when injected into the orbit, subarachnoid, or subdural spaces. Del. Med. J. 49, 331343.Google ScholarPubMed
Ahlgren, P. (1973). Long term side effects after myelography with water-soluble contrast media: Conturex, Conray Meglumin 282 and Dimer-X. Neuroradiology 6, 206211.CrossRefGoogle Scholar
Ahlgren, P. (1978). Amipaque myelography without late adhesive arachnoid changes. Neuroradiology 14, 231233.CrossRefGoogle ScholarPubMed
Auld, A.W. (1976). Chronic spinal radiculopathy with particular reference to spinal arachnoiditis. A surgical viewpoint. J. Florida M.A. 63, 889891.Google ScholarPubMed
Auld, A.W. (1978). Chronic spinal arachnoiditis. A postoperative syndrome that may signal its onset. Spine 3, 8892.CrossRefGoogle ScholarPubMed
Autio, E., Suolanen, J., Norrback, S. and Slatis, P. (1972). Adhesive arachnoiditis after lumbar myelography with meglumine iothalamate (Conray). Acta Radiol. (Diagn) (Stockh) 12, 1724.Google ScholarPubMed
Baum, E.S. and Holton, C.P. (1972). Intrathecal methotrexate. Lancet 1, 380381.CrossRefGoogle ScholarPubMed
Benner, B. and Ehni, G. (1978). Spinal arachnoiditis. The postoperative variety in particular. Spine 3, 4044.CrossRefGoogle ScholarPubMed
Benoist, M., Ficat, C., Baraf, P. and Cavehoix, J. (1980). Postoperative lumbar epiduro-arachnoiditis. Spine 5, 432436.CrossRefGoogle ScholarPubMed
Bergeron, R.R., Rumbaugh, C.L., Fang, H. and Cravioto, H. (1971). Experimental Pantopaque arachnoiditis in the monkey. Radiology 99, 95101.CrossRefGoogle ScholarPubMed
Blau, J. and Logue, V. (1961). Intermittent claudication of the cauda equina. Lancet 1, 10811086.CrossRefGoogle Scholar
Brain, W.R. (1977). Diseases of the Nervous System. 8th. edition. Oxford, Oxford University Press. 740.Google Scholar
Burton, C.V. (1978). Lumbosacral arachnoiditis. Spine 3, 2430.CrossRefGoogle ScholarPubMed
Christensen, E. (1942). Chronic adhesive spinal arachnoiditis. Acta Psychiat. et Neurol. 17, 2338.CrossRefGoogle Scholar
Clark, K. (1969). Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. 2. Clinical and surgical significance. J. Neurosurg. 31, 495498.CrossRefGoogle ScholarPubMed
Compere, E.L. (1980). Arachnoiditis confusion. Int. Surg. 65, 305307.Google ScholarPubMed
Dale, A.J.D. and Love, J.G. (1967). Thorium dioxide myelopathy. J.A.M.A. 199, 606609.CrossRefGoogle ScholarPubMed
Davidson, S. (1968). Cryptococcal spinal arachnoiditis. J. Neurol. Neurosurg. Psychiat. 31, 7680.CrossRefGoogle ScholarPubMed
Dujovny, M., Barrionuevo, P.J., Kossovsky, N., Laha, R.K. and Rosenbaum, A.E. (1978). Effects of contrast media on the canine subarachnoid space. Spine 3, 3135.CrossRefGoogle ScholarPubMed
Duke, R.J. and Hashimoto, S. (1973). Familial spinal arachnoiditis – a new entity. Trans. Am. Neurol. Assoc. 98, 98102.Google ScholarPubMed
Duke, R.J. and Hashimoto, S.A. (1974). Familial spinal arachnoiditis. A new entity. Arch. Neurol. 30, 300303.CrossRefGoogle ScholarPubMed
Dullerud, R. and Morland, T.J. (1976). Adhesive arachnoiditis after lumbar radiculography with Dimer-X and Depo-Medrol. Radiology 119, 153155.CrossRefGoogle ScholarPubMed
Echols, D.H. (1969). Sensory rhizotomy following operation for ruptured intervertebral disc. A review of 62 cases. J. Neurosurg. 31, 335338.CrossRefGoogle ScholarPubMed
Eldevik, O.P. and Haughton, V.M. (1978). The effect of hydration on the acute and chronic complications of aqueous myelography. Radiology 129, 713714.CrossRefGoogle ScholarPubMed
Eldevik, O.P., Haughton, V.M., Ho, K.C., Williams, A.L., Unger, G.F. and Larson, S.J. (1978). Ineffectiveness of prophylactic intrathecal methylprednisolone in myelography with aqueous media. Radiology 129, 99101.CrossRefGoogle ScholarPubMed
Elkington, J.St.C. (1936). Meningitis serosa circumscripta spinalis (spinal arachnoiditis). Brain 59, 181203.CrossRefGoogle Scholar
Enzmann, D.R., Norman, D., Mani, J. and Newton, T.H. (1976). Computed tomography of granulomatous basal arachnoiditis. Radiology 120, 341344.CrossRefGoogle ScholarPubMed
Erickson, D. (1979). Arachnoiditis caused by Pantopaque (letter). Spine 4, 279280.CrossRefGoogle Scholar
Feder, B.H. and Smith, J.L. (1962). Roentgen therapy in chronic spinal arachnoiditis. Radiology 78, 192198.CrossRefGoogle ScholarPubMed
Freilich, D. and Swash, M. (1979). Diagnosis and management of tuberculous paraplegia with special reference and tuberculous radiculomyelitis. J. Neurol. Neurosurg. Psychiatry 42, 1218.CrossRefGoogle ScholarPubMed
Goldstein, N.P., McKenzie, B.F., McGuckin, W.F. and Mattox, V.R. (1970). Experimental intrathecal administration and methylprednisolone acetate in multiple sclerosis. Trans. Am. Neurol. Assoc. 95, 243244.Google ScholarPubMed
Gordon, A.L. and Yudell, A. (1973). Cauda equina lesion associated with rheumatoid spondylitis. Ann. Intern. Med. 78, 555557.CrossRefGoogle ScholarPubMed
Grainger, R.G. (1978). Chronic spinal arachnoiditis (letter). Br. Med. J. 2, 1294.CrossRefGoogle Scholar
Graybill, J.R. and Ellenbogen, C. (1973). Complications with the Ommaya reservoir in patients with granulomatous meningitis. J. Neurosurg. 38, 477480.CrossRefGoogle ScholarPubMed
Greig, J.H. and Wignall, N. (1966). A case of arachnoiditis associated with Pantopaque myelography. J. Can. Assoc. Radiol. 17, 198199.Google ScholarPubMed
Hansen, E.B., Fahrenkrug, A. and Praestholm, J. (1978). Late meningeal effects of myelographic contrast media with special reference to metrizamide. Br. J. Radiol. 51, 321327.CrossRefGoogle ScholarPubMed
Haughton, V.M., Ho, K.C. and Unger, G.F. (1977). Arachnoiditis following myelography with water-soluble agents. Radiology 125, 731733.CrossRefGoogle ScholarPubMed
Haughton, V.M., Eldevik, O.P., Ho, K.C., Larson, S.J. and Unger, G.F. (1978a). Arachnoiditis from experimental myelography with aqueous contrast media. Spine 3, 6569.CrossRefGoogle ScholarPubMed
Haughton, V.M., Ho, K.C., Unger, G.F., Larson, S.J., Williams, A.L. and Eldevik, P. (1978b). Severity of post-myelographic arachnoiditis and concentration of meglumine iocarmate in primates. Am. J. Roentgenol. 130, 313316.CrossRefGoogle Scholar
Haughton, V.M. and Ho, K.C. (1980). The risk of arachnoiditis from experimental nonionic contrast media. Radiology 136, 395397.CrossRefGoogle ScholarPubMed
Hoppenstein, R. (1980). A new approach to the failed, failed back syndrome, Spine 5, 371379.CrossRefGoogle Scholar
Howland, W.J., Curry, J.L. and Butler, A.K. (1963). Pantopaque arachnoiditis. Experimental study of blood as a potentiating agent. Radiology 80, 489491.CrossRefGoogle ScholarPubMed
Howland, W.J. and Curry, J.L. (1966). Experimental studies of Pantopaque arachnoiditis. I. Animal studies. Radiology 87, 253257.CrossRefGoogle ScholarPubMed
Hurteau, E.F., Baird, W.C. and Sinclair, E. (1954). Arachnoiditis following the use of iodised oil. J. Bone Joint Surg. 36, 393396.CrossRefGoogle Scholar
Iraci, G., Gerosa, L.T., Gerosa, M., Rigobello, L. and Zampieri, P. (1979). Opto-chiasmatic arachnoiditis in brothers. Ann. Ophthalmol. 11, 479487.Google ScholarPubMed
Irstam, L. and Rosencrantz, M. (1973). Water-soluble contrast media and adhesive arachnoiditis. I. Reinvestigation of nonoperated cases. Acta Radiol. (Diagn) (Stockh) 14, 497505.Google ScholarPubMed
Irstam, L. and Rosencrantz, M. (1974). Water-soluble contrast media and adhesive arachnoiditis. II. Reinvestigation of operated cases. Acta Radiol. (Diagn) (Stockh) 15, 115.Google ScholarPubMed
Irstam, L., Sundstrom, R. and Sigstedt, B. (1974). Lumbar myelography and adhesive arachnoiditis. Acta. Radiol. (Diagn) (Stockh) 15, 356368.Google ScholarPubMed
Irstam, L. (1978). Lumbar myelography with Amipaque. Spine 3, 7082.CrossRefGoogle ScholarPubMed
Jacobsen, H.H. and Lester, J. (1969). Diagnosis of spinal arachnoiditis by air myelography. Acta Neurol. Scand. 45, 376379.CrossRefGoogle ScholarPubMed
John, J.F. and Douglas, R.G. (1975). Tuberculous arachnoiditis. J. Pediatr. 86, 235237.CrossRefGoogle ScholarPubMed
Johnson, A.J. and Burrows, E.H. (1978). Thecal deformity after lumbar myelography with iophendylate (Myodil) and meglumine iothalamate (Conray 280). Br. J. Radiol. 51, 196202.CrossRefGoogle ScholarPubMed
Johnston, J.D.H. and Matheny, J.B. (1978). Microscopic lysis of lumbar adhesive arachnoiditis. Spine 3, 3639.CrossRefGoogle ScholarPubMed
Jorgensen, J., Hansen, P.H., Steenskov, V. and Ovesen, N. (1975). A clinical and radiological study of chronic lower spinal arachnoiditis, Neuroradiology 9, 139144.CrossRefGoogle ScholarPubMed
Kennedy, F., Effron, A.S. and Perry, G. (1950). The grave spinal cord paralyses caused by spinal anaesthesia. Surg. Gynecol. Obstet. 91, 385398.Google Scholar
Krause, F. (1907). Zur Kenntnis der ruckenmarkslahmungen. Verh. Kongr. inn. Med. pt. 1, 109113, pt. 2, 598622.Google Scholar
Lazar, M.L. and Bland, J.E. (1979). Microsurgical intradural lysis and Silastic dural patch grafting in lumbar adhesive arachnoiditis (letter). Neurosurgery 5, 771772.CrossRefGoogle Scholar
Lear, M. and Harvey, S.C. (1924). The regeneration of the meninges. Ann. Surg. 80, 536544.CrossRefGoogle ScholarPubMed
Liliequist, B. and Lundstrom, B. (1974). Lumbar myelography and arachnoiditis. Neuroradiology 7, 9194.CrossRefGoogle ScholarPubMed
Lombardi, G., Passerini, A. and Migliavacca, F. (1962). Spinal arachnoiditis. Br. J. Radiol. 35, 314320.CrossRefGoogle ScholarPubMed
Long, R.W. and Rachmaninoff, N. (1967). Spinal adhesive arachnoiditis with cyst formation: injection of cyst during myelography. J. Neurosurg. 27, 7376.CrossRefGoogle ScholarPubMed
McNeill, K.G., Harrison, J.E., Mirza, K.F., Tai-Pow, J., Geale, D.C. and Barnett, H.J.M. (1968). Thorium body burdens in humans following Thorotrast myelography and the incidence of myelopathy. Br. J. Radiol. 41, 755761.CrossRefGoogle Scholar
McKenzie, T. (1971). Nocturnal enuresis as a late complication of meningitis. Br. Med. J. 4, 662663.CrossRefGoogle ScholarPubMed
Meyer, M.W., Powell, H.C., Wagner, M. and Niwayama, G. (1978). Thorotrast induced adhesive arachnoiditis associated with meningioma and schwannoma. Hum. Pathol. 9, 366370.CrossRefGoogle ScholarPubMed
Naiman, J.L., Rupprecht, L.M., Tanyeri, G. and Philippidis, P. (1970). Intrathecal methotrexate (letter). Lancet 1, 571.CrossRefGoogle Scholar
Nelson, D.A. (1976). Arachnoiditis from intrathecally given corticosteroids in the treatment of multiple sclerosis (letter). Arch. Neurol. 33, 373.CrossRefGoogle ScholarPubMed
Oliva, L.A. and Parenteau, A.L’arachnoidite spinale. Traitement de cinq cas. Union Med. Can. 94, 750752.Google Scholar
Parker, K.R., Kane, J.T., Wicchers, D.O. and Johnson, E.W. (1979). Electromyographic changes reviewed in chronic spinal arachnoiditis. Arch. Phys. Med. Rehabil. 60, 320322.Google ScholarPubMed
Peterson, H.O. (1976). Commentary on myelography: Defence of Pantopaque. In Current Controversies in Neurosurgery edited by Morley, T.P.Philadelphia, W.B. Saunders.2835.Google Scholar
Quiles, M., Marchisello, P.J. and Tsairis, P. (1978). Lumbar adhesive arachnoiditis. Etiologic and pathologic aspects. Spine 3, 4550.CrossRefGoogle ScholarPubMed
Radberg, C. and Wennberg, E. (1973). Late sequelae following lumbar myelography with water-soluble contrast media. Acta Radiol. (Diagn) (Stockh) 15, 115.Google Scholar
Ransford, A.O. and Harries, B.J. (1972). Localized arachnoiditis complicating lumbar disc lesions. J. Bone Joint Surg. 54B, 656665.CrossRefGoogle Scholar
Rao, S.B. and Dinakar, I. (1971). Cerebrospinal fluid protein in spinal compression. J. Indian M.A. 57, 165166.Google ScholarPubMed
Reisner, L.S., Hochman, B.N. and Plumer, M.H. (1980). Persistent neurologic deficit and adhesive arachnoiditis following intrathecal 2-chloroprocaine injection. Anesth. Analg. 59, 452454.CrossRefGoogle ScholarPubMed
Savastano, A.A. (1968). Intrathecal steroid administration in postoperative arachnoiditis. R.I. Med. J. 51, 337338.Google ScholarPubMed
Shaw, M.D.M., Russell, J.A. and Grossart, K.W. (1978). The changing pattern of spinal arachnoiditis. J. Neurol. Neurosurg. Psychiatry 41, 97107.CrossRefGoogle ScholarPubMed
Stookey, B. (1927). Adhesive spinal arachnoiditis simulating spinal cord tumour. Arch. Neurol. Psychiatr. 17, 158178.CrossRefGoogle Scholar
Smith, R.W. and Loeser, J.D. (1972). Myelographic variant in lumbar arachnoiditis. J. Neurosurg. 36, 441446.CrossRefGoogle ScholarPubMed
Suolanen, J. (1977). Adhesive arachnoiditis after lumbar myelography. Ann. Clin. Res. 9, 257260.Google ScholarPubMed
Teng, P. and Papatheodorou, C. (1967). Myelographic findings in adhesive spinal arachnoiditis. Brit. J. Radiol. 40, 201208.CrossRefGoogle ScholarPubMed
Tkaczuk, H. (1976). Intrathecal prednisolone therapy in postoperative arachnoiditis following operation of herniated disc. Acta Orthop. Scand. 47, 388390.CrossRefGoogle ScholarPubMed
Turnbull, I.M., Shulman, R. and Woodhurst, W.B. (1980). Thalamic stimulation for neuropathic pain. J. Neurosurg. 52, 486493.CrossRefGoogle ScholarPubMed
Wadia, N.H. and Dastur, D.K. (1969). Spinal meningitides with radiculo-myelopathy. I. Clinical and radiological features. J. Neurol. Sci. 8, 239260.CrossRefGoogle ScholarPubMed
Ward, W., Matheson, M. and Gonski, A. (1976). Three cases of granulomatous arachnoiditis after myelography. Med. J. Aust. 2, 333335.CrossRefGoogle ScholarPubMed
Wilber, M.C. (1975). Sedation of active acupuncture loci in the management of low back pain. Am. J. Chin. Med. 3, 275279.CrossRefGoogle ScholarPubMed
Wilkinson, H.A. and Schuman, N. (1979). Results of surgical lysis of lumbar adhesive arachnoiditis. Neurosurgery 4, 401409.CrossRefGoogle ScholarPubMed
Wolfgang, G.L. (1972). Neurotrophic arthropathy of the shoulder – a complication of progressive adhesive arachnoiditis. Clin. Orthop. 87, 217221.CrossRefGoogle Scholar