This document discusses arachnoiditis, an inflammatory disease of the arachnoid membrane surrounding the spinal cord. It develops in three stages: initial nerve inflammation, scar tissue formation causing nerve adhesion, and complete nerve root encapsulation. Causes include trauma from surgery, chemical exposure, and infection. Symptoms include pain, paresthesia, sensory loss, and muscle weakness. Diagnosis involves MRI or CT myelography. Treatment includes corticosteroids, NSAIDs, rhizotomy for pain, and decompression surgery to remove cysts. Physical therapy techniques like exercises, heat, TENS, and neural mobilization can help manage symptoms.

2.  Arachnoid mater: the membranous layer
between the pia mater and the dura mater
that surround the brain and the nerves of the
spinal cord.
 Spinal nerves: 31 pairs of nerves that exit the
vertebral column through intervertebral
foramina as 2 rootlets. One anterior nerve
root and one posterior nerve root.

3.  Arachnoiditis of the spinal cord is a non
specific inflammatory disease of the
arachonoid membrane which is characterized
pathologically by thickening of the arachnoid
membrane with adhesion or adherence to the
dura matter and manifested clinically through
roots or radiclar signs and symptoms.

4. It develops in 3 stages, namely:
1) inflammation of the spinal nerves, distension of the
adjacent blood vessels, subarachnoid space
disappears and the scare tissue begins
2) the scar tissue increases, the nerves adhere to each
other and the dura
3) complete encapsulation of the nerve roots,
compression causes atrophy of the nerve roots and
the scarring tissues prevent the production of spinal
fluid in that area. It is terrmed Arachnoiditis Ossificans
if the scar tissue calcifies.

5.  The inflammation has 3 main causes:
1)Trauma–surgery: complications after multiple
back surgery may result in blood penetration in
the subarachnoid space, causing inflammation.
2) Chemical: exposure to oil based radiographic
contrast agents used in myelograms, or drugs
used for epidural injections.
3) Infection: viral or bacterial meningitis,
tuberculosis and syphilis affect the spine.

6.  This disorder is the third most common cause
of Failed Back Surgery Syndrome (FBSS).
Arachnoiditis due to surgery is precisely
localised, meanwhile the arachnoiditis due to
epidural injections is more diffuse.

7.  Arachnoiditis is usually seen in 40 to 60 years of age but rarely
below 20years.
 Onset: it can be acute or sometimes it may take months.Pain: pain
is usually localized type with a burning character. Later the
painstarts radiating down the lower limb due to nerve root
irritation.
 Paresthesia: this also takes place due to irritation of the sensory
nerve roots.
 Sensory loss: this occurs when the sensory nerve roots get
completely blocked.
 Muscle weakness with atrophy: although the anatomy of the
motor nerve roots make them less prone to get compressed, it can
happen in the later stage which will then give rise to weakness and
wasting of the corresponding muscles.

8.  Magnetic resonance imaging (MRI) is the
study of choice for the diagnostic evaluation
of arachnoiditis.
 For patients in whom MRI is contraindicated,
computed tomography (CT) myelography is
an acceptable alternative.

9.  The medical management usually consists of
corticosteroids in acute stage of
inflammation. NSAID for pain relief and
inflammation.
 Surgical management consists of Rhizotomy
in cases of unbearable pain.Surgical
decompression for removal of cyst.

10.  Oral medication or medication through an
intrathecal pump such as: non-steroidal anti-
inflammatory drugs (NSAIDs), methadon,
morphine, can be used to release neuropathic
pain.Antidepressants may reduce burning
neuropathic pain, but in much lower doses
than for depression. Diazepam is used for
muscle relaxation.

11.  -Invasive treatment such as intraspinal narcotic
analgesia (INA), epidural steroid and local
anaesthetic injections are not indicated because
there is a risk of exacerbating the inflammation
and worsening the patient’s condition.
-Spinal cord Electrostimulation (SCS) stand for
electrical stimulation by implanted electrodes
around the spinal cord in the area that is most
involved in causing pain. Some studies indicate a
50% success rate when all types of chronic pain
are considered.
-Surgery is not recommended because it causes
more scar tissue and more trauma to the already
irritated spinal cord.

12.  Moist heat mainly for reducing the muscle spasm.
 In case of radiating pain due to involvement of nerve
roots the patient may be treated withTENS. Even
in cases of paresthesiaTENS is usually used.
 Laser has been found to reduce the inflammation
and also break the adhesion in the deep seated
structures which helps in setting free the irritation
on the nerve roots thereby relieving the discomforts
of the patient.

13.  Active exercises like static exercises for the abdominus,
back extensor, gluteus and quadriceps helps in
reducing pain in the initial stages and also maintains the
tone in the muscles.
 Dynamic exercises may be started once the pain level
comes within the patient’s tolerance level.These exercises
may be continued by the patient throughout the life for
preventing any chances of recurrence.
 SLR: Active and passive SLR is given to lengthen the
neural structures and relieve the tension in them.This is
a type of neural mobilization that helps in relieving the
signs of radiculopathy.
 Gait training in cases of muscular weakness.

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