Subject: Re: arachnoiditis
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by ccf neuro M.D.* on March 14, 1998 at 23:46:23:
In Reply to: arachnoiditis posted by Joady on March 04, 1998 at 20:02:48:

My husband hurt his back a year ago. The MRI said," L2/L3,large sequestered central
disc herniation occupying the anterior 2/3 of the spinal canal and compressing
the nerve roots of the cauda equina"
He had a microdiscectomy in Feb.1997. He is still experiencing all the same
symptoms as before the surgery, but to a lessor extent. He has numbness
in the fronts of his legs, pain in back, hips and legs and recently is experiencing
tingling and "strange feelings" in his ankles and feet(but from the knees to
his ankles are normal).
He has hesitancy with urination and also, if he walks for any length of time
now, numbness is extending into his groin. He cannot sit, stand or
walk for any length of time without aggravating all symptoms.
He lives on painkillers and anti-depressants
to help him deal with the effect this has had on his life.
We just go the results from another MRI and it says, "at L2/L3 most of the herniated
disc has been removed. There is still a small residual disc herniation on
the right posterolaterally which is mildly indenting the dural sac but not
producing and compression of the nerve roots of the cauda equina within
the dural sac. The neural foramina remain patent."

There is a loss of disc signal at L3-L4,L4-L5, and L5-S1,but at none of these
levels is there any disc herniation therefore there is no compromise of the
spinal canal.

The nerve roots of the cauda equina show a mild anterior deviation at L2/L3
suggesting that there are some subarachnoid adhesions present. The nerve roots
at the other levels are normal. There is no clumping of the nerve roots
or any enhancement.

We have been told about 2 lower bulging discs but they are not a problem at
this point. We have also learned about arachnoiditis and been told the
possible deterioration it may cause.
My question is, does this report confirm arachnoiditis? What is the
"sub"arachnoid? What is the difference?
I hope you can give us some insight on this and be able to put it into
layman's terms for us.
Although no one has a crystal ball, we would still like to be able to prepare
ourselves for what ever may be...whether it will probably progress? Is parapaliga
common from this?
It is bad enough for my husband to have to deal with his pain, but to deal with
the unknown is almost worse.

Thanks very much for any information you could give us on this report, Joady
------------------------------------------------------------------------------------------------------------------
Hello Joady,

Let me firat apologize for us having missed your question and the greater than usual delay in answering it. Arachnoiditis refers to inflammation and scarring tohether of nerve roots after a trauma, such as surgical intervention to remove a herniated disk. It is typically seen on MRI as a clumping together of the affected nerve roots, and enhancement (lighting up after contrast dye is given). Neither of these appear to be present in any significant degree from the report information you provide, although there is reference to some possible mild changes of this nature. Symptoms include burning and tingling and pain in the areas of the skin and body that the affected nerves supply sensation to. The arachnoid is the middle of three layers of the meninges, which are the covering membranes of the brain and spinal cord. The subarachnoid space by contrat is the space in between the arachnoid and the pia mater, the innermost of the 3 layers of the meninges. It is in this space that spinal fluid circulates. It is also the space where hemorrhage from a ruptured brain aneurysm occurs, to give you a couple of examples of practical ways that the space matters to us as neurologists. The treatment of true arachnoiditis can be extremely difficult. It does not typically cause enough scarring or damage to nerves to produce weakness or even true numbness, usually only chronic pain. Thus, I would not be worried about your husband becoming paraplegic, or losing control of his urination based on the information you have provided. If you are near the Cleveland area and are frustrated enough that you feel a second look at his situation and treatment options would be helpful, we would of course be happy to see him in consultation--- the department of neurology's appointment number is 1-800-223-2273 extension 45559. Please remember that the information we provide on the forum is intended strictly for general medical informational purposes only, and that the actual diagnosis and treatment of your husband's specific medical condition should remain strictly in conjunction with his treating physicians. We hope you find the information useful and understandable.

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