Adhesive Arachnoiditis (AA), once considered a rare inflammatory disease, is now emerging as a more common condition, affecting the lumbar and sacral regions of the spinal canal. This disease, which inflames the nerve roots of the cauda equina and the arachnoid-dural covering (meninges) of the spinal canal, can lead to the formation of adhesive masses, causing nerve entrapment, impaired spinal fluid flow, and potentially resulting in intractable pain, neurologic impairments, and autoimmune manifestations.
A Closer Look at Adhesive Arachnoiditis
Today, the primary culprits are spine disorders that alter the natural structure and posture of the spinal column, such as protrusion of lumbar and sacral intervertebral discs, which cause narrowing of the canal and compression and displacement of nerve roots. Other contributing factors include scoliosis, spondylolisthesis, osteoporosis, arthritis, and genetic connective tissue disorders like Ehlers-Danlos syndrome (EDS).
Prevalence and Impact
Recent analyses suggest that between 1.75 million and 7 million adult Americans may have AA, making it a condition that is now found in every community and medical practice globally. This prevalence has necessitated a comprehensive understanding and approach to identifying and managing AA among healthcare practitioners.
Diagnosing Adhesive Arachnoiditis
Diagnosis often involves a thorough examination of the patient’s history, symptoms, and physical examination, supported by a contrast MRI of the lumbar-sacral spinal canal. Symptoms may include increased back pain, dizziness, leg weakness, burning skin sensations, and urinary issues. While there is no specific blood test for AA, elevated inflammatory markers and hormonal deficiencies may be present.
Treatment Strategies
Pharmacological
- Low dose naltrexone 0.5 mg to 7.0 mg twice a day
- Ketorolac (injection or troche) 15 mg to 60 mg on 1 to 3 days a week or bi-monthly
- Corticosteroid: methylprednisolone 2.0 mg to 4.0 mg or dexamethasone .5 mg to .75 mg 1 to 3 days a week or bi-monthly
- Curcumin 900 mg to 1800 mg a day
- Pregnenolone 200 mg to250 mg a day
- Diet: high protein, low carbohydrate, high vegetable-fruit
Physical measures to be done daily
- Walk with arm swings
Full length stretching of arms, legs, and feet - Water soaking: tub, shower, jacuzzi, pool
- Side-to-side leaning and stretching
Pain control
- Standard treatment with analgesic, neuropathic, and adrenergic/stimulant agents
Naltrexone should not be prescribed to patients who take opioids. Substitutes include diclofenac, indomethacin, acetazolamide, or metformin.
The Road Ahead
The emergence of AA as a more common condition necessitates a robust, multi-faceted approach to management and treatment. The progressive nature of AA, coupled with its potential to significantly impact quality of life, underscores the importance of aggressive anti-inflammatory treatment and pain control.
Conclusion
Understanding and managing Adhesive Arachnoiditis requires a comprehensive, empathetic, and informed approach. By recognizing its prevalence and impact, healthcare providers can better navigate the complexities of diagnosis and treatment, ultimately enhancing the quality of life for those affected by this condition.
If you or someone you know is experiencing persistent back pain and other related symptoms, it’s crucial to seek professional help promptly. Contact the Pain Healing Center to explore diagnostic procedures and tailor a treatment plan for your unique needs. Don’t endure the pain; reach out to us and embark on your journey towards relief and healing today.
Note: This article is based on the information and research provided in the cited article: Tennant F, Porcelli M, Guess S. Adhesive Arachnoiditis: No Longer a Rare Disease. Pract Pain Manag. 2020;20(3). Always consult healthcare professionals for accurate diagnosis and treatment.
Questions And Answers
What is Adhesive Arachnoiditis (AA)?
Adhesive Arachnoiditis is an inflammatory condition that affects the arachnoid layer of the meninges within the lumbar and sacral regions of the spinal canal. It can cause nerve roots to inflame and adhere together, forming an inflammatory-adhesive mass that can disrupt spinal fluid flow and cause nerve damage, resulting in pain and various neurologic impairments.
How prevalent is AA in the modern world?
Previously considered rare, AA is now recognized as a condition that potentially affects between 1.75 million to 7 million adult Americans. It is found in communities and medical practices worldwide, making it crucial for healthcare providers to understand its identification and management.
What are the primary causes of AA in the current era?
Today, AA is commonly caused by spinal conditions that alter the natural structure and posture of the spinal column, such as protrusion of lumbar and sacral intervertebral discs. Other prevalent spine disorders like scoliosis, spondylolisthesis, osteoporosis, and arthritis can also lead to AA, as can genetic connective tissue disorders like Ehlers-Danlos syndrome (EDS).
How is AA diagnosed?
Diagnosis of AA involves a thorough examination of the patient’s history, symptoms, and physical examination, followed by a confirmatory contrast MRI of the lumbar-sacral spinal canal. The MRI helps visualize the typical appearance of AA, providing a clear picture of the condition inside the spinal canal.
What are the treatment approaches for managing AA?
Treatment for AA encompasses both physical and pharmacologic measures. Physical measures like daily walks and stretching are crucial, while pharmacologic treatment primarily targets controlling the neuroinflammation actions of AA. Agents like naltrexone, ketorolac, and corticosteroids like methylprednisolone or dexamethasone are commonly recommended. Additionally, new therapeutic approaches, including neuroregenerative efforts and intravenous infusions, are being explored.
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