Arachnoiditis

Arachnoiditis Overview

Three membranes, the dura mater, arachnoid and pia mater surround the spinal cord and nerves. The dura mater, which is the outer most membrane, contains the cerebral spinal fluid (CSF) and nerves or spinal cord depending upon the level of the spine. Some individuals might have heard of a dural leak. This occurs when the spinal fluid (CSF) leaks out of a small hole in the dural membrane and causes a headache. A dural leak can be caused by an injection in the spinal column such as a spinal block or from surgery. Arachnoiditis is typically not related to a dural leak, except when a blood patch to seal the leak is not injected into the appropriate location.

The “fix” to a dural leak is something called a blood patch. A small amount of blood is withdrawn from a vein and then injected into the epidural space (the space above the dura). This blood will clot and most of the time will seal this pinhole leak. In the rare case that blood is inadvertently injected into the dural space instead of the epidural space (“epi” means “above” in Latin), the blood within the dural space can cause arachnoiditis.

The pia mater is the innermost membrane that lines the actual nerves within the canal. The arachnoid is the membrane sandwiched between the dura mater and the pia mater. The arachnoid membrane (the middle layer) has hundreds of small spider web type attachments from nerve to nerve and this explains how it was named. The word “Arachnoiditis” is a combination of two words taken from the root Latin. “Arachnoid” means spider and “itis” means inflammation of. This is similar to the term “appendicitis” where this means inflammation of the appendix.

Arachnoiditis is actually the inflammation of the arachnoid membrane. The nerves are coated by this membrane within the CSF and inflammation can cause scarring and the nerves to “stick together” in clumps. Interestingly enough- like many conditions of the spine, some people have this condition and never develop symptoms.

(Click to Enlarge Image) Axial MRI of severe central spinal stenosis- white arrow points to severe compression of canal.

(Click to Enlarge Image) Axial MRI post surgery – white arrow points to opened canal and nerve clumping-nerves stuck together.

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Causes of Arachnoiditis

Arachnoiditis is caused by a number of conditions. Arachnoiditis was more common in the 1970s and early 1980s when radiologists used an older type of oil based myelogram dye. This dye was used back then to visualize the spinal canal to look for canal compression and disc herniations. Thankfully- this dye is no longer used.

Arachnoiditis can be caused by the compression of spinal stenosis associated with degenerative spondylolysthesis (see section on this website). When an individual experiences back pain in the L4-L5, degenerative spondylolysthesis can often be the condition leading to the inflammation. Epidural steroids can be used to manage the pain of spinal stenosis and individuals can now live with this nerve compression of the spine associated with canal narrowing of the spine. There is however, a certain small percentage of these individuals living with stenosis that will develop arachnoiditis of the lumbar spine.

Arachnoiditis of the lumbar spine can also be caused by spinal cord trauma, infection of the spinal cord, inflammation, and even surgery. If there is a larger dural tear during surgery, there is a chance of arachnoiditis. If spinal cord trauma occurs such as in a motor vehicle accident and bleeding in the spinal canal results, arachnoiditis can form. Spinal cord trauma also includes fractures of the spine that disturb the nerves in the canal can cause this condition. Obviously infection can cause injury to the structures that have become infected and the arachnoid is no exception to this rule. Meningitis (the arachnoid is a meningie just like the dura and pia) can cause arachnoiditis. Tuberculosis is famous for causing arachnoiditis. Cancer in the central nervous system can cause arachnoiditis.

The pathology of arachnoiditis of the lumbar spine is that the small spider web connections scar, contract and stick the nerves together. This reduces the nerve membrane exposure to the CSF and injures the small blood vessels that line and feed these nerves. This lack of blood circulation and the direct scar injury to the nerve can cause chronic nerve discharge or blocked signals. The nerves also don’t move normally when scarred. A normal nerve moves back and forth in the canal up to an inch when the leg is flexed or extended just like a cable over a pulley. If the nerve is tethered, it can’t stretch and the mechanical deformation with movement can cause symptoms.

Chronic nerve membrane injuries caused by spinal cord trauma or damage to the spinal cord can cause spontaneous discharges, blocking of the signal or nerve tethering. The symptoms generated depend upon the function of the damaged nerve. If it is a proprioceptive nerve, pins and needles will result (paresthesias). If it is a motor nerve, weakness can occur. If it is a sensory nerve, numbness or even bizarre sensations can occur (hot water dripping down the leg). If it is a bowel or bladder nerve, dysfunction can occur. When aggravated, pain nerves will deliver aberrant pain signals. “Burning pain of the spine” is one of the characteristics of arachnoiditis but can be seen in any chronic nerve injury of the spine such as peripheral neuropathy or chronic radiculopathy.

Management of Arachnoiditis

Unfortunately, there is no cure for arachnoiditis- only management. Patients who have experienced spinal cord trauma or a spinal cord injury may suffer from this condition, but thankfully, many patients who have arachnoiditis don’t even know it is present and need no treatment. However, if treatment is needed, treatment will not be curative but is designed to manage the symptoms using therapy and medications for the spine. For severe flair-ups, epidural steroids can occasionally be temporarily effective.

A chronic pain specialist normally manages patients with arachnoiditis. This expert can originate from many different specialties such as internal medicine, occupational medicine or physical medicine.

A surgically implantable spinal cord stimulator can reduce the symptoms in some patients. If a patient decides to go that route, consultation with an implant specialist that has significant experience with this condition is important.

For more information on arachnoiditis of the lumbar spine, please contact Dr. Donald Corenman, back doctor and spine specialist in the Vail, Aspen, Denver and Grand Junction, Colorado area.

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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Arachnoiditis Overview

Are you suffering from symptoms of Arachnoiditis?

Causes of Arachnoiditis

Management of Arachnoiditis

About the Author: Donald Corenman, MD, DC