Arachnoditis same as Scar tissue?

[deborah ann]

Hi Dr.  I had a laminectomy, microdiscectomy and spinal decompression in June 98 for a large central to paracentral disc hernation at the L5.  I slipped on ice and thought I would get better in time...I did not realize the seriousness of the symptoms. My family Dr. diagnosed me with emergency Cauda Equina Syndromewhen I finally went in for an appointment.

Prior to surgery (6 months) I had problems with incontinence, sciatic in both legs,right foot drop and loss of reflexes in both knee and foot and fairly severe back pain adn numbness in the "saddle area".  My Neurosurgeon said that he was not certain her could reverse the damage already done...but that he had to stop the progression.  The thecal sac was completely blocked when I had a pre-surgical myelogram.  

I have not had relief of symptoms since surgery, and in January this year began to have an increase to my pain and discomfort.  My Neurosurgeon ordered a new MRI...the results are epidural fibrosis/granulation around the L5 nerve root and within the disc area of the L5 where the disc was removed.  

The report further stated that there are indications of Chronic Radiculopathy....my Neurosurgeon agreed and said that I have Residual Cauda Equina Syndrome and Chronic Radiculopathy....my questions is this...is scar tissue/epidural fibrosis/granulation the same thing as arachnoditis and will I continue to get weaker in my legs and foot?  My Neuro did not want to do surgery to remove the scar tissue because it will just grown back...how would you treat me?  Is Arachnoditis a progressive disease?  Is epidural fibrosis/granulation?  Would the Radiologist referred to it as arachnoditis...my N/S gave "looking for a recurrent disc herniation" as the reason for the MRI....I am confused about what all this means to my future...thank you

[CCF Neuro[P] MD, RPS]

Dear Deborah Ann:

Sorry to hear about your back problems. Scar tissue formation does occur after surgery and it is the reaction to the surgery or the healing process.  Unfortunately it is associated with it's own set of problems.  Archnoditis is a term that is used to define this inflammatory induced scar in the arachnoid.  The scar tissue usually will reach it limit and become quiet and non-progressive.  Your surgeon is correct in that if he removes it, reoccurance is certainly to happen.  The radiculopathy is the result of the scar tissue irritating the nerve roots as they emerge from the spinal cord.  

Deborah Ann you need to talk with your surgeon and neurologist. The outcome is based on your presentation, your rehab until now and the continuing rehab.  Spinal surgery is usually dependent on the lesion, surgeon and rehab.  The outcome is so individual that unless the physician knows the lesion and the surgery and surgeon, outcome prognosis is almost impossible.  Speak to the people involved with your surgery and rehab.  See what they have to say.

Sincerely,

CCF Neuro MD

[deborah ann]

Thank you Dr!  I know whenever you have "itis" attached to a word it indicates inflamation (inflammation)...so since it will be two years at the end of January since my injury, and it is 18 months since surgery, do you think the arachnoditis is calm now and I will stablize?  

Or will it remain active and this is why my Neurosurgeon said I will have to remain on pain pills, arthitis medication and muscle relaxants for life?  I have severe back pain, especially when standing,or same with sitting on a hard chair.

Walking is better, but that too is very limited.  I had 3 months of Physical Therapy, but now I do excersizes on my own.  Is this what is causing me to have so much pain in my back and leg(s)?, and will it improve when the arachnoditis settles down...or is this it for recovery and I will always have this pain.  

My N/S has deemed me Permamnently Disabled, and other than an annual check-up and the medications above, nothing else has been suggested or recommended.  Thank you!

[CCF Neuro[P] MD, RPS]

Dear Deborah Ann:

Your questions are not for me to answer, I have not done the physical exam, seen your MRI pre and post surgery, did the surgery, evaluated you during rehab, etc.  So, I do not have the information needed to give you this sort of information.  You will again have to talk to your rehab specialist and neurosurgeon (as previous posted).  Whether you scar tissue is stabilized is another question difficult for me to tell you.  The problem can worsen depending on the etiology of the problem prior to surgery.  However, the surgerical induced scar formation should be stabilized by now.  

Sincerely,

CCF Neuro MD

[Deborah Ann to CCF Neuro MD]

Thank you Dr. for your answers.

I realize how difficult it must be for you and other Dr.'s to not only answer our questions, sight unseen....but to give or not dash our hopes as well.  It is an amazing and I assume, very difficult job indeed. I thank you for your time and honesty.

[CCF Neuro[P] MD, RPS]

your welcome.

CCF Neuro MD