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Arachnoiditis and epidural fibrosis: the Relationship to chronic pain

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Abstract

Arachnoiditis and epidural fibrosis, conditions of scarring during healing after laminecto my for lumbar degenerative disorders, have been clinically associated with persistent chronic pain in some patients.Although accepted as causative of the pain by many physicians, there has been some concern that these conditions may not be responsible for pain production, especially because studies with magnetic resonance imaging have found similar conditions of scarring in symptomatic and asymptomatic patients.This paper reviews the literature on those conditions and leads to the conclusion that scarring, of itself, does not appear to be related to chronic pain, although neuropathic pain related to underlying spinal cord or nerve root damage may be present along with scarring.

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References and Recommended Reading

  1. Horsley V: A clinical lecture on chronic spinal meningitis: its differential diagnosis and surgical treatment. BMJ 1909, 1:513–517.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Elkington J St C: Meningitis serosa circumscripta spinalis. Brain 1936, 59:181–203.

    Article  Google Scholar 

  3. Hoffman GS: Spinal arachnoiditis: what is the clinical spectrum? I. Spine 1983, 8:538–540.

    Article  CAS  PubMed  Google Scholar 

  4. de la Porte C, Siegfried J: Lumbosacral spinal fibrosis (spinal arachnoiditis): its diagnosis and treatment by spinal cord stimulation. Spine 1983, 8:593–603.

    Article  PubMed  Google Scholar 

  5. Meilman PW, Leibrock LG, Leong FTL: Outcome of implanted spinal cord stimulation in the treatment of chronic pain: arachnoiditis versus single nerve root injury and mononeuropathy. Clin J Pain 1989, 5:189–193.

    Article  CAS  PubMed  Google Scholar 

  6. Wester K: Dorsal column stimulation in pain relief. Acta Neurol Scand 1987, 75:151–155.

    Article  CAS  PubMed  Google Scholar 

  7. Yoshida GM, Nelson RW, Capen DA, et al.: Evaluation of continuous intraspinal narcotic analgesia for chronic pain from benign causes. Am J Orthop 1996, 693–694.

  8. Cauchoix J, Ficat C, Girard B: Repeat surgery after disc excision. Spine 1978, 3:256–259.

    Article  CAS  PubMed  Google Scholar 

  9. Benoist M, Ficat C, Baraf P, et al.: Postoperative lumbar epiduro-arachnoiditis. Spine 1980, 5:432–435.

    Article  CAS  PubMed  Google Scholar 

  10. Keogh AJ: Meningeal reactions seen with myodil myelography. Clin Radiol 1974, 25:361–365.

    Article  CAS  PubMed  Google Scholar 

  11. Jorgensen J, Hansen PH, Steeskov V, et al.: A clinical and radiological study of chronic lower spinal arachnoiditis. Neuroradiology 1975, 9:139–144.

    Article  CAS  PubMed  Google Scholar 

  12. Wilkinson HA, Schuman N: Results of surgical lysis of lumbar adhesive arachnoiditis. Neurosurgery 1979, 4:401–409.

    Article  CAS  PubMed  Google Scholar 

  13. Epstein BS: The Spine: a Radiologic Text and Atlas. Philadelphia: Lea & Febiger; 1976:681–689.

    Google Scholar 

  14. Blumstein A, Baker AB: Arachnoiditis (diffuse proliferative leptomeningitis), 1942.

  15. Carroll SE, Wiesel SW: Neurologic complications and lumbar laminectomy. Clin Orthop Rel Res 1992, 284:14–23.

    Google Scholar 

  16. Shipton EA: Low-back pain and the post-laminectomy pain syndrome. SAMJ 1989, 76:20–23.

    CAS  PubMed  Google Scholar 

  17. Johnson A, Ryan MD, Roche J: Depo-medrol and myelographic arachnoiditis. Med J Aust 1991, 155:18–20.

    CAS  PubMed  Google Scholar 

  18. Martin RJ, Yuan HA: Neurosurgical care of spinal epidural, subdural, and intramedullary abscesses and arachnoiditis. Orthop Clin North Am 1986, 27:125–136.

    Google Scholar 

  19. Guyer DW, Wiltse LL, Eskay ML, et al.: The long-range prognosis of arachnoiditis. Spine 1989, 14:1332–1341.

    Article  CAS  PubMed  Google Scholar 

  20. Jayson MIV: Vascular damage, fibrosis, and chronic inflammation in mechanical back pain problems. Semin Arthritis Rheum 1989, 18(suppl 2):73–76.

    Article  CAS  PubMed  Google Scholar 

  21. Auld AW: Chronic spinal arachnoiditis: a postoperative syndrome that may signal its onset. Spine 1978, 3:88–91.

    Article  CAS  PubMed  Google Scholar 

  22. Benner B, Ehni G: Spinal arachnoiditis: the postoperative variety in particular. Spine 1978, 3:40–43.

    Article  CAS  PubMed  Google Scholar 

  23. Shaw MDM, Russell JA, Grossart KW: The changing pattern of spinal arachnoiditis. J Neurol Neurosurg Psychiatry 1978, 41:97–107.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Charlesworth CH, Savy LE, Stevens J, et al.: MRI demonstration of arachnoiditis in cauda equina syndrome of ankylosing spondylitis. Neuroradiology 1996, 38:462–465.

    Article  CAS  PubMed  Google Scholar 

  25. Stookey B: Adhesive spinal arachnoiditis simulating spinal cord tumor. Arch Neurol Psychiatry 1927, 17:151.

    Article  Google Scholar 

  26. Selinsky H: Disseminated spinal arachnoiditis. Arch Neurol Psychiatry 1936, 35:1262.

    Article  Google Scholar 

  27. French JD: Clinical manifestations of lumbar spinal arachnoiditis: report of thirteen cases. Surgery 1946, 20:718–729.

    CAS  PubMed  Google Scholar 

  28. Burton CV: Lumbosacral arachnoiditis. Spine 1978, 1:24–30.

    Article  Google Scholar 

  29. Laus M, Alfonso C, Tigani D, et al.: Failed back syndrome: a study on 95 patients submitted to reintervention after lumbar nerve root decompression for the treatment of spondylotic lesions. Chir Organi Mov 1994, 79:119–126.

    CAS  PubMed  Google Scholar 

  30. Hoppenstein R: A new approach to the failed, failed back syndrome. Spine 1980, 5:371–379.

    Article  CAS  PubMed  Google Scholar 

  31. Skalpe IO: Adhesive arachnoiditis following lumbar myelography. Spine 1978, 3:61–64.

    Article  CAS  PubMed  Google Scholar 

  32. Mooij JJ: Spinal arachnoiditis: disease or coincidence?. Acta Neurochir (Wien) 1980, 53:151–160.

    Article  CAS  PubMed  Google Scholar 

  33. Wilkinson HA: The Failed Back Syndrome, Etiology and Therapy. Philadelphia: Harper & Row; 1983.

    Google Scholar 

  34. Wilkinson HA: Intrathecal depo-medrol: a literature review. Clin J Pain 1992, 8:49–56.

    Article  CAS  PubMed  Google Scholar 

  35. Brodsky AE: Cauda equina arachnoiditis: a correlative clinical and roentgenologic study. Spine 1978, 3:51–60.

    Article  CAS  PubMed  Google Scholar 

  36. North RB, Kidd DH, Zahruk M, et al.: Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 1993, 32:384–395.

    Article  CAS  PubMed  Google Scholar 

  37. Cavanaugh S, Stevens J, Johnson J: High-resolution MRI in the investigation of recurrent pain after lumbar discectomy. J Bone Joint Surg 1993, 75:524–528.

    Google Scholar 

  38. Dullerud R, Morland TJ: Adhesive arachnoiditis after lumbar myelography with Dimer-X and depo-medrol. Radiology 1976, 119:153–155.

    Article  CAS  PubMed  Google Scholar 

  39. Duke RJ, Hashimoto SA: Familial spinal arachnoiditis: a new entity. Arch Neurol 1974, 30:300–303.

    Article  CAS  PubMed  Google Scholar 

  40. Jenik F, Tekle-Haimanot R, Hamory BH: Non-traumatic adhesive arachnoiditis as a cause of spinal cord syndromes: investigation of 507 patients. Paraplegia 1981, 19:140–154.

    Article  CAS  PubMed  Google Scholar 

  41. Klekamp J, Batzdorf U, Samii M, Bothe HW: Treatment of syringomyelia associated with arachnoid scarring caused by arachnoiditis or trauma. J Neurosurg 1997, 86:233–240.

    Article  CAS  PubMed  Google Scholar 

  42. Pandya PM, Keogh AJ: Case report: arachnoiditis following intracranial “thorotrast.”. Clin Radiol 1992, 45:141–143.

    Article  CAS  PubMed  Google Scholar 

  43. Gemma M, Bricchi M, Grisoli M, et al.: Neurologic symptoms after epidural anesthesia: report of three cases. Acta Anaesthesiol Scand 1994, 38:742–743.

    Article  CAS  PubMed  Google Scholar 

  44. Haisa T, Todo T, Mitsui I, et al.: Lumbar adhesive arachnoiditis following attempted epidural anesthesia: case report. Neurol Med Chir (Tokyo) 1995, 35:107–109.

    Article  CAS  Google Scholar 

  45. McIvor J, Krajbich JI, Hoffman H: Orthopaedic complications of lumboperitoneal shunts. J Pediatr Orthop 1988, 8:687–689.

    Article  CAS  PubMed  Google Scholar 

  46. Rosenberg SK, Stacey BR: Postoperative Guillain-Barre syndrome, arachnoiditis, and epidural analgesia. Reg Anesth 1996, 21:486–489.

    CAS  PubMed  Google Scholar 

  47. Mortara RH, Brooks WH: Chronic arachnoiditis after a pantopaque study of the posterior fossa. South Med J 1976, 69:520–521.

    Article  CAS  PubMed  Google Scholar 

  48. Cervellini P, Curri D, Bernardi L, et al.: Computed tomography after lumbar disc surgery: a comparison between symptomatic and asymptomatic patients. Acta Neurochir Suppl (Wien) 1988, 43:44–47.

    CAS  Google Scholar 

  49. Annertz M, Jonsson B, Stromqvist B, et al.: No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome: a study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients. Spine 1995, 20:449–453. These authors studied eight patients with persistent postoperative sciatic pain and eight patients without symptoms postoperatively using contrast-enhanced MRI. There were no differences between the two groups radiographically. Further, at repeat surgery in the symptomatic patients only epidural fibrosis was found. This led them to question the role of epidural fibrosis in the postdiskectomy syndrome.

    Article  CAS  PubMed  Google Scholar 

  50. Jinkins JR, Osborn AG, Garrett Jr D, et al.: Spinal nerve enhancement with Gd-DTPA: MR correlation with the postoperative lumbosacral spine. Am J Neuroradiol 1993, 14:383–394.

    CAS  PubMed  Google Scholar 

  51. Aldrete JA: Epidural fibrosis after permanent catheter insertion and infusion. J Pain Symptom Manage 1995, 10:624–631.

    Article  CAS  PubMed  Google Scholar 

  52. Crul BJP, Delhaas EM: Technical complications during long term subarachnoid or epidural administration of morphine in terminally ill cancer patients: a review of 140 cases. Reg Anesth 1991, 16:209–213.

    CAS  PubMed  Google Scholar 

  53. Deutsch AL, Howard M, Dawson EG, et al.: Lumbar spine following successful surgical discectomy: magnetic resonance imaging features and implications. Spine 1993, 18:1054–1060.

    Article  CAS  PubMed  Google Scholar 

  54. Tullberg T, Rydberg J, Isacsson J: Radiographic changes after lumbar discectomy: sequential enhanced computed tomography in relation to clinical observations. Spine 1993, 18:843–850.

    Article  CAS  PubMed  Google Scholar 

  55. Montaldi S, Fankhauser H, Schnyder P, et al.: Computed tomography of the postoperative intervertebral disc and lumbar spinal canal: investigation of twenty-five patients after successful operation for lumbar disc herniation. Neurosurgery 1988, 22:1014–1022.

    Article  CAS  PubMed  Google Scholar 

  56. Van Goethem JW, Van de Kelft E, Biltjes IG, et al.: MRI after successful lumbar discectomy. Neuroradiology 1996, 38(suppl 1):S90-S96. Investigators studied 34 consecutive patients with successful outcomes after lumbar disk surgery using MRI, including gadolinium. They concluded that postoperative MRI studies must be interpreted with great care since features described in the failed back surgery syndrome are also found in asymptomatic postoperative patients.

    Article  PubMed  Google Scholar 

  57. Grane P, Tullberg T, Rydberg J, et al.: Postoperative lumbar MR imaging with contrast enhancement: comparison between symptomatic and asymptomatic patients. Acta Radiol 1996, 37:366–372. These authors compared 19 asymptomatic patients postoperatively with 42 symptomatic patients. They found no difference between symptomatic and asymptomatic patients in regard to epidural fibrosis when they were scanned 1 year after surgery.

    Article  CAS  PubMed  Google Scholar 

  58. Shulman M, Joseph NJ, Haller CA: Effect of epidural and subarachnoid injections of a 10% butamben solution. Reg Anesth 1990, 15:142–146.

    CAS  PubMed  Google Scholar 

  59. Haughton VM, Ho K, Larson SJ, et al.: Comparison of arachnoiditis produced by meglumine iocarmate and metrizamide myelography in an animal model. Am J Roentgenol 1978, 131:129–132.

    Article  CAS  Google Scholar 

  60. Howland WJ, Curry JL: Experimental studies of pantopaque arachnoiditis. I. Animal studies. Radiology 1966, 87:253–257.

    Article  CAS  PubMed  Google Scholar 

  61. Howland WJ, Curry JL, Bell RO: Experimental studies of pantopaque arachnoiditis. II. Laboratory studies. Radiology 1966, 87:257–258.

    Article  CAS  PubMed  Google Scholar 

  62. Beyer GA, Lipman BT, Haughton VM: Effect of arachnoiditis on pain threshold. Invest Radiol 1987, 22:781–785.

    Article  CAS  PubMed  Google Scholar 

  63. Hoffman GS, Ellsworth CA, Wells EE, et al.: Spinal arachnoiditis: what is the clinical spectrum? II. Arachnoiditis induced by pantopaque/autologous blood in dogs, a possible model for human disease. Spine 1983, 8:541–551.

    Article  CAS  PubMed  Google Scholar 

  64. Loeser JD, Peirce KR: Intraspinal alumina injection: the relationship between epileptiform focus, root scarring, and chronic pain. Pain 1978, 5:245–252.

    Article  CAS  PubMed  Google Scholar 

  65. Jakobsen JK: Clinical evaluations of a histologic examination of the side effects of myelographic contrast media. Acta Radiol Diagn 1973, 14:638–646.

    CAS  Google Scholar 

  66. Haughton VM, Ho KC: The risk of arachnoiditis from experimental nonionic contrast media. Radiology 1980, 136:395–397.

    Article  CAS  PubMed  Google Scholar 

  67. Pasaoglu A, Gok A, Patiroglu TE: An experimental evaluation of response to contrast media: pantopaque, iopamidol, and iohexol in the subarachnoid space. Invest Radiol 1988, 23:762–766.

    Article  CAS  PubMed  Google Scholar 

  68. Sehgal AD: Pantopaque arachnoiditis—an experimental and clinical study. Neurol India 1966, 14:92–94.

    CAS  PubMed  Google Scholar 

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  1. Department of Neurosurgery, University of Illinois, c/o 900 Westmoreland, Suite 209, 60045-9989, Lake Forest, IL, USA

    Ronald P. Pawl MD (Associate Professor)

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Pawl, R.P. Arachnoiditis and epidural fibrosis: the Relationship to chronic pain. Current Review of Pain 2, 93–99 (1998). https://doi.org/10.1007/s11916-998-0052-z

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