Epidural Steroids & Arachnoiditis

  I have had three Lumbar Epidural Steroid Injections earlier this year due to a Grade II Spondylolisthesis. The Dr. injected 200 Mg. of methylprednisolone acetate diluted with 10 cc of saline, per treatment. Since the injections my problems have continued to get worse. I have read some of the Arachnoiditis web sites and I share many of the same symptoms, but probably all symptomatic Spondylolisthesis patients do also. I was wondering if there is a proven tie between the epidurals and getting Arachnoiditis. I see a Physiatrist tomorrow and would ask the question if there may be a link between the two. If there is a connection can a Dr. identify Arachnoiditis by examining MRI and X-rays?
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Hello Bob. Thank you for your interesting question. Arachnoiditis is the result of actual physical scarring of nerve roots as they come out of the spinal cord, and it is this scarring and the strangulation of the nerve roots that causes the symptoms of pain and/or numbness in the affected nerve roots. Spondylisthesis is a very different type of problem where one vertebrae has "slipped" forward relative to another, and is graded by the amount of such slippage. For each 25% of the width of the vertebral body (or less) of additional "slippage", the grade is increased by one. Thus, a grade 2 means that the one vertebrae has slipped 25-50% forward compared to the other, or in simpler terms is slightly less than halfway displaced. This slippage essentially tugs on and irritates the very same spinal nerve roots that archnoiditis affects, and can cause symptoms due to the stretching of the nerve roots, and inflammation resulting from the underlying arthritis that causes the spondylolisthesis in the first place. Epidural steroid injections may help alleviate the inflammation, but will have no effect whatsoever on symptoms caused by physical traction on nerve roots. Only surgery to realign and fuse the slipped vertebral body/ies can fix this problem, with all other treatments being measures that will only buy time at best. There are rare reports of local anesthetics like lidocaine, bupivicaine etc. causing nerve root irritation and very rarely even damage, such as is infrequently seen as a complication of epidural anesthesia for a surgery, for instance, but much much more often it is the underlying disease process itself rather than injected medications that are causing things to worsen. Corticosteroids in particular almost never cause such problems. If you would be interested in a second opinion regarding management of your spondylisthesis, the Cleveland Clinic Spine Center is an excellent team of physicians interested in treating such disorders. Dr. Ian Kalfas is our chief spinal neurosurgeon, and works in conjunction with Dr. Gordon Bell of Orthopedic Surgery to treat such disorders. Other spine center physicians provide medical management for such disorders, although again the ultimate treatment of spondylolisthesis is surgical only. Our number is 1-800-223-2273. Please remember that information provided on the forum is intended for general medical informational purposes only and that the actual diagnosis and treatment of your specific medical condition should be strictly in conjunction with your tretaing physician(s). We hope you find the information helpful.