The Myth about the Arachnoiditis Syndrome?
Arachnoiditis is the clumping together and tethering of the descending nerves to the inner lining of the water jacket that contains the fluid that supports brain and the cord in the spinal canal.
Myeloscopy is the procedure by the fluid filled space within the water jacket (dura) is explored with the patient in the aware state and able to attest to the presence of pain or symptoms, This reveals that such clumping is rare and is only symptomatic when the adjacent Dura is inflamed. X-ray analysis at the same time reveals that the position of this inflammation is located at the disc and foramen. It is only found to spread beyond where there has been infection or surgery within the Dura or after massive trauma with significant damage to the bones of the spine. These findings indicate that Arachnoiditis is a response to inflammation in the disc and that this is the source that needs to be treated and with this the symptoms will resolve. This is confirmed by the presence of uninflammed patches of Arachnoiditis which are asymptomatic.
Back and referred pain are prevalent throughout the community. Prior to the advent of CAT and MRI scans, Myelography, the insertion of an X-ray detectable dye in to the water jacket, was the main means of identifying the presence of disc protrusions and narrowing of elements of the spinal canal. The original oil based dye was blamed for producing Arachnoiditis. Whilst this might have occurred it was the inflammation outside the water jacket that was responsible for the symptoms and these merely increased as part of the natural progression of the Degenerative Disc Disease process. Since then water based Myelography has been developed which is far less likely to produce the clumping.
What really causes pain in cases in the Arachnoiditis Syndrome?
Arachnoiditis Syndrome Sufferers may present with various combinations of back, buttock and leg pain, numbness, muscle weakness and often widespread “Dysaesthaesia”. This takes the form of diffuse often intense pain across the back, spreading up to the thoracic spine, down to involve the sacrum and coccyx, deeply in to the pelvis or perineum and extensively down one or both legs. The symptoms may present as pins and needles, cold or scalding water or a sense of ants crawling up and down the body in these territories. Unfortunately many physicians will reach for a psychological or arachnoiditic explanation for these symptoms. In fact the MRI scan may show the presence of a dehydrated (“Black”) disc possibly with a High Intensity Zone or leaking disc wall tear. The source can be confirmed by Spinal Probing and Discography in the aware state with the symptoms being compounded by the presence of scarring induced by a reaction to these leaking products. Unfortunately mis-diagnosis prevents such patients from receiving definitive Endoscopic Minimally Invasive Spine Surgery and they usually find themselves referred for palliative chronic pain management.
Neck pain with arm symptoms can also occur on rare occasions. These appear to emanate from inflammation at the lower lumbar spine presumably transmitted through the Posterior Longitudinal Ligament and secondary cervical malposture. This assumption is made because the symptoms settle by treatment of the L4/5 and L5/S1 disc levels by Endoscopic Minimally Invasive Spine Surgery and Muscle Balance Physiotherapy,
Why is diagnosis difficult?
Unfortunately Arachnoiditis Syndrome Sufferers may present with the rather confusing combinations of symptoms described above and because these exceed the patterns normally considered to be caused by irritation or compression of a single nerve, the patient is labelled as psychologically distressed, a malingerer or suffering with the Arachnoiditis Syndrome.
The first step is for the information gleaned from decades of aware state surgery and live patient feedback to be more widely disseminated amongst physicians and surgeons. Then MRI scans will be examined for High Intensity Zones, annular (disc wall) tears and dehydrated (“Black”) discs and a definitive treatment pathway can commence.
Can the sources of pain be pinpointed?
Aware state surgical examination enables the patient to give the surgeon feedback, guiding him or her to the point that is responsible for the pain. This ‘live’ approach allows the causal level in Arachnoiditis Syndrome Sufferers to be accurately defined and then the source of the pain outside the Dura to be viewed and addressed using endoscopic instruments through a tiny incision. In this way, neural anomalies and strange nerve combinations can be detected and diagnostic errors regarding the disc level responsible for the pain, avoided. Thus, the surgeon is guided to the precise source of pain at that specified inter-vertebral point and the understanding of the actual mechanisms underlying the causation of Arachnoiditis Syndrome Sufferers.
Is accurately targeted treatment possible?
Single targeted surgery enables Arachnoiditis Syndrome Sufferers to be precisely treated with the minimum of damage to tissues, reduced patient risk and enhanced long-term outcome and more essentially without the use of General Anaesthesia. This treatment, which is called ‘Foraminoplasty’ because it is carried out in the gaps or ‘Foramen’ between the vertebrae, allows the nerve to thoroughly liberated and the overriding joints or pointed fracture margins to be removed. This is only possible by the use of Endoscopic Minimally Invasive Spine Surgery where the full length of the exiting nerve can be explored and the points of irritation clearly demonstrated. In the breadth of presentations arising from Degenerative Disc Disease and Failed Back Surgery or Failed Chronic Pain management causing the inflammation outside the Dura, Endoscopic Lumbar Decompression & Foraminoplasty achieved a successful enduring positive outcome in 80% of cases.
What is wrong with conventional surgery?
The use of multi-level open surgery in Arachnoiditis Syndrome Sufferers including microdiscectomy, decompression, solid or flexible fusion and is an ‘overkill’ risking increasing the degree of clumping with negative side-effects including blood loss, potential nerve and tissue damage, extended post-operative care and unnecessarily operating on pain-free levels is fraught with aggravation of the current symptom status. It is not as effective as Foraminoplasty in addressing and ameliorating the effects of Arachnoiditis Syndrome Sufferers, rather it runs the risk of increased neurological complications as well as causing the complications of recurrent disc bulging, infection, nerve damage and scarring round the nerve, implant failure, major vessel damage or sexual dysfunction.
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