Donald Corenman, MD, DC

I’m going to work backwards here. Let me start by stating that I will have a complete description of arachnoiditis in the next 6 months on this web site but unfortunately that doesn’t help you now. First- let me state what arachnoiditis is. The nerves in the spinal canal are surrounded by three membranes, the Pia mater, Arachnoid and Dura mater. The Dura holds in the cerebrospinal fluid, the salt water that your brain and spinal cord float in (remnants from living in the ocean at one time).

Arachnoiditis is exactly what it states- inflammation of the arachnoid. This can occur when there is compression of the nerves as in spinal stenosis (like you had previously), meningitis (the meninges are the lining of the nerves which includes the arachnoid), trauma or in the old days, the use of an oil based myelogram which was used to image the nerves prior to the MRI. We now have water based myelograms which do not cause arachnoiditis- thank God.

Arachnoiditis may cause symptoms but many patients with this problem have no symptoms- so don’t despair. The report from the radiologist does not note the presence of arachnoiditis, which does not mean it is not present, but it may not be there. You will find interpretation of films is not an exact science but dependent upon the skill of the physician.

So lets start at the beginning. The pain in your back and leg very well could be from the degenerative spondylolysthesis, central stenosis and foraminal stenosis at L2-3. The EMG will typically be negative (normal) if the nerve is not severely damaged- which is typical for this condition and therefore not a great test.

You must separate back pain in your mind from leg pain. If your leg pain occurs more with standing and walking and is relieved by sitting (not back pain but leg pain), the leg pain more likely than not is from the stenosis. Which side is the leg pain the worst? If your back pain is worse from sitting and lifting, this could be instability from the L2-3 segment. Don’t worry about the Tarlov cysts as these are common and typically asymptomatic.

See the section on SNRBs or selective nerve root blocks as this in my opinion is your next test to determine if surgery can be helpful. Get a new set of expert eyes on your diagnosis.

Good Luck!

Dr. Corenman

If you have Ankylosing Spondylitis and it has affected your neck and in addition, you have a disc herniation that is causing symptoms, that does not preclude you from surgery.

Dr. Corenman

An L2-3 sequestered disc herniation means a piece of the internal jelly of the disc (the nucleus) has extruded from the complete through and through tear of the disc wall and is separated from the disc laying as a free fragment in the spinal canal. Your question is excellent and it is most important to understand the answer. If you have read the web site, you will know that the disc has no blood supply and therefore, cannot heal the tear. In other words, the tear is permanent. What is to prevent another fragment from exiting the disc? The answer is nothing will prevent another fragment from extruding. This condition is called a recurrent disc herniation and the odds of it happening are about 10% in the active population.

During the surgery, the surgeon should probe the disc to make sure all the remaining nucleus is still “attached” and there are no further free fragments in the disc space. There are areas within the disc space that cannot be probed, so a loose fragment can be left inadvertently. There is a scar that forms over the tear of the disc, but it is a fraction of the strength of the original intact wall.

Well- your next question should be why not remove all the remaining nucleus to prevent further herniations? There is a two fold answer. First- the nucleus is the shock absorber for the two vertebral bodies it is sandwiched in between. Without the nucleus, there is a higher chance of lower back pain as the cushion is gone. The second problem stems from the cartilaginous end plates that line the bones of the vertebral end plates. These can sheer off without the nucleus buffering the shock of impact. These then become free fragments and if they herniate, much more compression of the nerve root occurs as these are the consistency of hard plastic where the original nucleus is the consistency of crab meat.

Hope this gives you enough information.

Dr. Corenman