Arachnoiditis

Last updated
Arachnoiditis
ARACHNOIDITIS.JPG
Myelogram showing arachnoiditis in the lumbar spine
Blausen 0044 Arachnoiditis.png
Illustration of Arachnoiditis
Specialty Neurosurgery

Arachnoiditis is an inflammatory condition of the arachnoid mater or 'arachnoid', one of the membranes known as meninges that surround and protect the central nervous system. The outermost layer of the meninges is the dura mater (Latin for hard) and adheres to inner surface of the skull and vertebrae. [1] The arachnoid is under or "deep" to the dura and is a thin membrane that adheres directly to the surface of the brain and spinal cord. [1]

Contents

Signs and symptoms

Arachnoid inflammation can lead to many painful and debilitating symptoms which can vary greatly in each case, and not all people experience all symptoms. [2] [3] [4] Chronic pain is common, including neuralgia, while numbness and tingling of the extremities can occur with spinal cord involvement, and bowel, bladder, and sexual functioning can be affected if the lower part of the spinal cord is involved. [2] [3] [4] While arachnoiditis has no consistent pattern of symptoms, it frequently affects the nerves that supply the legs and lower back. [2] [3] [4] Many patients experience difficulty sitting for long (or even short) periods of time due to discomfort or pain. [4] [2]

Etiology

Arachnoiditis has been described as having many different etiologies. As an infectious source, tuberculosis, [5] [6] syphilis, [5] [6] candida, [6] mycosis, [6] and HIV. [2] As a mechanical source, spinal and cranial surgery, [7] trauma, [8] and disc herniation. [8] Prior disease including ankylosing spondylitis, [5] [9] autoimmune vasculitis, [2] and Guillain-Barré syndrome [2] have been known to cause arachnoiditis. Chemical causes include morphine, [10] myelograms with oil-based radiographic contrast agents, [10] phenolic solutions, [11] chlorhexidine, [12] epidural injection of steroids and antibiotics, [5] blood in subarachnoid hemorrhage, [13] epidural blood patches and anesthetics. [14] [15]

Oftentimes, the precise cause of arachnoiditis is not known due to the variable latency from cause to symptom onset. With growing incidence of spine surgery, a common cause of arachnoiditis is lumbar spine procedures. [16]

Pathogenesis

The above etiologies can cause inflammation of the arachnoid, leading to arachnoiditis. This inflammation is enough to cause pain and even potentially neurological deficits - symptoms caused by nerves not communicating properly with the body's mechanisms for sensation and movement. [3] [17] The inflammation can lead to the formation of scar tissue and adhesion that can make the spinal nerves "stick" together, a condition where such tissue develops in and between the leptomeninges - between dura and arachnoid or pia and arachnoid. [17] This condition can be very painful, especially when progressing to adhesive arachnoiditis. Adhesive arachnoiditis occurs when inflammation leads to recruitment of cells to the area and fibrous exudate, and ensuing deposition of collagen forms bands that could cause ischemia or even atrophy of the spinal cord or nerve roots. [17] [18] Chronic inflammation could lead to arachnoiditis ossificans, in which the inflamed arachnoid becomes ossified, or turns to bone, and is thought to be a late-stage complication of the adhesive form of arachnoiditis. [19] More serious complications can occur, including spinal cord swelling, myelomalacia, cauda equina syndrome, and hydrocephalus. [18] [20]

Diagnosis

Diagnosis is based on a combination of clinical findings, patient examination, and imaging evaluation. [21] The most common affected area is the lumbar region of the back, and includes the classic symptomatic triad of back pain, neurological deficits, and MRI with notable adhesions. [22] For the ossificans form of the condition, unenhanced CT may better show the presence and extent of arachnoid ossifications, and is complementary to MRI, as MRI can be less specific and findings can be confused with regions of calcification or hemosiderin. [23] [24]

Treatment

Arachnoiditis can be difficult to treat and treatment is generally limited to alleviation of pain and other symptoms. [25] While arachnoiditis may not yet be curable with the potential to be life-altering, management including medication, physical therapy, and if appropriate, psychotherapy, can help patients cope with the difficulties it presents. [25]

Medications that have been used to treat arachnoiditis include nonsteroidal anti-inflammatory drugs, [26] and pulse steroid therapy with methylprednisolone, [26] [2] [27] and multi-modal pain regimens. [2] Surgical intervention generally has a poor outcome and may only provide temporary relief, [25] but some cases of surgical success have been reported. [28] Epidural steroid injections to treat sciatic pain have been linked as a cause of the disease by the U.S. Food and Drug Administration as well as in other research, and are therefore discouraged as a treatment for arachnoiditis as they will most likely worsen the condition. [29] [30] [31] Some patients benefit from motorized assistance devices, although these types of devices may be beyond the reach of those with limited means.[ citation needed ]

Prognosis

Arachnoiditis is a chronic disorder with no known cure, [25] and prognosis may be difficult to determine because of an unclear correlation between the beginning of the disease or source and the appearance of symptoms. For many, arachnoiditis is a disabling disease that causes chronic pain and neurological deficits, [23] and may also lead to other spinal cord conditions, such as syringomyelia. [32] [33]

Related Research Articles

<span class="mw-page-title-main">Syringomyelia</span> Disorder in which a cyst forms in the spinal cord

Syringomyelia is a generic term referring to a disorder in which a cyst or cavity forms within the spinal cord. Often, syringomyelia is used as a generic term before an etiology is determined. This cyst, called a syrinx, can expand and elongate over time, destroying the spinal cord. The damage may result in loss of feeling, paralysis, weakness, and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. It may also lead to a cape-like bilateral loss of pain and temperature sensation along the upper chest and arms. The combination of symptoms varies from one patient to another depending on the location of the syrinx within the spinal cord, as well as its extent.

<span class="mw-page-title-main">Lumbar puncture</span> Procedure to collect cerebrospinal fluid

Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Examples of these conditions include meningitis and subarachnoid hemorrhage. It may also be used therapeutically in some conditions. Increased intracranial pressure is a contraindication, due to risk of brain matter being compressed and pushed toward the spine. Sometimes, lumbar puncture cannot be performed safely. It is regarded as a safe procedure, but post-dural-puncture headache is a common side effect if a small atraumatic needle is not used.

<span class="mw-page-title-main">Pia mater</span> Delicate innermost layer of the meninges, the membranes surrounding the brain and spinal cord

Pia mater, often referred to as simply the pia, is the delicate innermost layer of the meninges, the membranes surrounding the brain and spinal cord. Pia mater is medieval Latin meaning "tender mother". The other two meningeal membranes are the dura mater and the arachnoid mater. Both the pia and arachnoid mater are derivatives of the neural crest while the dura is derived from embryonic mesoderm. The pia mater is a thin fibrous tissue that is permeable to water and small solutes. The pia mater allows blood vessels to pass through and nourish the brain. The perivascular space between blood vessels and pia mater is proposed to be part of a pseudolymphatic system for the brain. When the pia mater becomes irritated and inflamed the result is meningitis.

<span class="mw-page-title-main">Spinal anaesthesia</span> Form of neuraxial regional anaesthesia

Spinal anaesthesia, also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true analgesia, motor, sensory and autonomic (sympathetic) blockade. Administering analgesics in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation, some autonomic blockade, but no sensory or motor block. Locoregional analgesia, due to mainly the absence of motor and sympathetic block may be preferred over locoregional anaesthesia in some postoperative care settings. The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available.

<span class="mw-page-title-main">Subdural hematoma</span> Hematoma usually associated with traumatic brain injury

A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually but not always associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veins that cross the subdural space.

<span class="mw-page-title-main">Epidural administration</span> Medication injected into the epidural space of the spine

Epidural administration is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and nurse anesthetists to administer local anesthetic agents, analgesics, diagnostic medicines such as radiocontrast agents, and other medicines such as glucocorticoids. Epidural administration involves the placement of a catheter into the epidural space, which may remain in place for the duration of the treatment. The technique of intentional epidural administration of medication was first described in 1921 by Spanish military surgeon Fidel Pagés.

<span class="mw-page-title-main">Epidural space</span> Space between the dura mater and vertebrae

In anatomy, the epidural space is the potential space between the dura mater and vertebrae (spine).

Spinal tumors are neoplasms located in either the vertebral column or the spinal cord. There are three main types of spinal tumors classified based on their location: extradural and intradural. Extradural tumors are located outside the dura mater lining and are most commonly metastatic. Intradural tumors are located inside the dura mater lining and are further subdivided into intramedullary and extramedullary tumors. Intradural-intramedullary tumors are located within the dura and spinal cord parenchyma, while intradural-extramedullary tumors are located within the dura but outside the spinal cord parenchyma. The most common presenting symptom of spinal tumors is nocturnal back pain. Other common symptoms include muscle weakness, sensory loss, and difficulty walking. Loss of bowel and bladder control may occur during the later stages of the disease.

<span class="mw-page-title-main">Cauda equina syndrome</span> Nerve damage at the end of the spinal cord

Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Onset may be rapid or gradual.

<span class="mw-page-title-main">Intrathecal administration</span> Drug injected into the spinal canal

Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space so that it reaches the cerebrospinal fluid (CSF) and is useful in spinal anesthesia, chemotherapy, or pain management applications. This route is also used to introduce drugs that fight certain infections, particularly post-neurosurgical. The drug needs to be given this way to avoid being stopped by the blood–brain barrier. The same drug given orally must enter the blood stream and may not be able to pass out and into the brain. Drugs given by the intrathecal route often have to be compounded specially by a pharmacist or technician because they cannot contain any preservative or other potentially harmful inactive ingredients that are sometimes found in standard injectable drug preparations.

<span class="mw-page-title-main">Spinal cord stimulator</span> SCS TREATMENT

A spinal cord stimulator (SCS) or dorsal column stimulator (DCS) is a type of implantable neuromodulation device that is used to send electrical signals to select areas of the spinal cord for the treatment of certain pain conditions. SCS is a consideration for people who have a pain condition that has not responded to more conservative therapy. There are also spinal cord stimulators under research and development that could enable patients with spinal cord injury to walk again via epidural electrical stimulation (EES).

Failed back syndrome or post-laminectomy syndrome is a condition characterized by chronic pain following back surgeries. Many factors can contribute to the onset or development of FBS, including residual or recurrent spinal disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness, spinal muscular deconditioning and even Cutibacterium acnes infection. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease.

Tethered cord syndrome (TCS) refers to a group of neurological disorders that relate to malformations of the spinal cord. Various forms include tight filum terminale, lipomeningomyelocele, split cord malformations (diastematomyelia), occult, dermal sinus tracts, and dermoids. All forms involve the pulling of the spinal cord at the base of the spinal canal, literally a tethered cord. The spinal cord normally hangs loose in the canal, free to move up and down with growth, and with bending and stretching. A tethered cord, however, is held taut at the end or at some point in the spinal canal. In children, a tethered cord can force the spinal cord to stretch as they grow. In adults the spinal cord stretches in the course of normal activity, usually leading to progressive spinal cord damage if untreated. TCS is often associated with the closure of a spina bifida. It can be congenital, such as in tight filum terminale, or the result of injury later in life.

<span class="mw-page-title-main">Neurogenic claudication</span> Medical condition

Neurogenic claudication (NC), also known as pseudoclaudication, is the most common symptom of lumbar spinal stenosis (LSS) and describes intermittent leg pain from impingement of the nerves emanating from the spinal cord. Neurogenic means that the problem originates within the nervous system. Claudication, from the Latin word for to limp, refers to painful cramping or weakness in the legs. NC should therefore be distinguished from vascular claudication, which stems from a circulatory problem rather than a neural one.

<span class="mw-page-title-main">Post-dural-puncture headache</span> Common side effect of lumbar puncture or spinal anaesthesia

Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater. The headache is severe and described as "searing and spreading like hot metal", involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. It is exacerbated by movement and sitting or standing and is relieved to some degree by lying down. Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are also common.

<span class="mw-page-title-main">Epidural blood patch</span> Blood injected epidurally to resolve a cerebrospinal fluid leak

An epidural blood patch (EBP) is a surgical procedure that uses autologous blood, meaning the patient's own blood, in order to close one or many holes in the dura mater of the spinal cord, which occurred as a complication of a lumbar puncture or epidural placement. The punctured dura causes cerebrospinal fluid leak. The procedure can be used to relieve orthostatic headaches, most commonly post dural puncture headache (PDPH).

<span class="mw-page-title-main">Cerebrospinal fluid leak</span> Medical condition

A cerebrospinal fluid leak is a medical condition where the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord leaks out of one or more holes or tears in the dura mater. A CSF leak is classed as either nonspontaneous (primary), having a known cause, or spontaneous (secondary) where the cause is not readily evident. Causes of a primary CSF leak are those of trauma including from an accident or intentional injury, or arising from a medical intervention known as iatrogenic. A basilar skull fracture as a cause can give the sign of CSF leakage from the ear nose or mouth. A lumbar puncture can give the symptom of a post-dural-puncture headache.

<span class="mw-page-title-main">Tarlov cyst</span> Medical condition

Tarlov cysts, are type II innervated meningeal cysts, cerebrospinal-fluid-filled (CSF) sacs most frequently located in the spinal canal of the sacral region of the spinal cord (S1–S5) and much less often in the cervical, thoracic or lumbar spine. They can be distinguished from other meningeal cysts by their nerve-fiber-filled walls. Tarlov cysts are defined as cysts formed within the nerve-root sheath at the dorsal root ganglion. The etiology of these cysts is not well understood; some current theories explaining this phenomenon have not yet been tested or challenged but include increased pressure in CSF, filling of congenital cysts with one-way valves, inflammation in response to trauma and disease. They are named for American neurosurgeon Isadore Tarlov, who described them in 1938.

Spinal cord stroke is a rare type of stroke with compromised blood flow to any region of spinal cord owing to occlusion or bleeding, leading to irreversible neuronal death. It can be classified into two types, ischaemia and haemorrhage, in which the former accounts for 86% of all cases, a pattern similar to cerebral stroke. The disease is either arisen spontaneously from aortic illnesses or postoperatively. It deprives patients of motor function or sensory function, and sometimes both. Infarction usually occurs in regions perfused by anterior spinal artery, which spans the anterior two-thirds of spinal cord. Preventions of the disease include decreasing the risk factors and maintaining enough spinal cord perfusion pressure during and after the operation. The process of diagnosing the ischemic and hemorrhagic spinal cord stroke includes applying different MRI protocols and CT scan. Treatments for spinal cord stroke are mainly determined by the symptoms and the causes of the disease. For example, antiplatelet and corticosteroids might be used to reduce the risk of blood clots in ischaemic spinal stroke patients, while rapid surgical decompression is applied to minimize neurological injuries in haemorrhagic spinal stroke patients instead. Patients may spend years for rehabilitation after the spinal cord stroke.

<span class="mw-page-title-main">Caudal anaesthesia</span> Form of neuraxial regional anaesthesia

Caudal anaesthesia is a form of neuraxial regional anaesthesia conducted by accessing the epidural space via the sacral hiatus. It is typically used in paediatrics to provide peri- and post-operative analgesia for surgeries below the umbilicus. In adults it is used for chronic low back pain management.

References

  1. 1 2 Ghannam, Jack Y.; Al Kharazi, Khalid A. (2023), "Neuroanatomy, Cranial Meninges", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30969704 , retrieved 2023-11-04
  2. 1 2 3 4 5 6 7 8 9 Peng, Huanhuan; Conermann, Till (2023), "Arachnoiditis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32310433 , retrieved 2023-11-08
  3. 1 2 3 4 Rice, I; Wee, M.Y.K.; Thomson, K (January 2004). "Obstetric epidurals and chronic adhesive arachnoiditis". British Journal of Anaesthesia. 92 (1): 109–120. doi: 10.1093/bja/aeh009 . ISSN   0007-0912. PMID   14665562.
  4. 1 2 3 4 Rice, I; Wee, M.Y.K.; Thomson, K (January 2004). "Obstetric epidurals and chronic adhesive arachnoiditis". British Journal of Anaesthesia. 92 (1): 109–120. doi: 10.1093/bja/aeh009 . PMID   14665562.
  5. 1 2 3 4 Shah, Jeshil; Patkar, Deepak; Parmar, Hemant; Prasad, Srinivasa; Varma, Ravi (2001-05-17). "Arachnoiditis associated with arachnoid cyst formation and cord tethering following myelography: Magnetic resonance features". Australasian Radiology. 45 (2): 236–239. doi:10.1046/j.1440-1673.2001.00911.x. ISSN   0004-8461. PMID   11380373.
  6. 1 2 3 4 Safi, Saleh; Thabat, Abdelnaser; Arshad, Mohamed; Hanoun, Mohamed (2021-09-01). "Arachnoiditis – A challenge in diagnosis and success in outcome – Case report". Interdisciplinary Neurosurgery. 25: 101219. doi: 10.1016/j.inat.2021.101219 . ISSN   2214-7519.
  7. ↑ Werner, Cassidy; Mathkour, Mansour; Scullen, Tyler; Dallapiazza, Robert F.; Dumont, Aaron S.; Maulucci, Christopher M. (July 2020). "Recurrent arachnoid cysts secondary to spinal adhesive arachnoiditis successfully treated with a ventriculoperitoneal shunt". Clinical Neurology and Neurosurgery. 194: 105835. doi:10.1016/j.clineuro.2020.105835. PMID   32305826. S2CID   215730361.
  8. 1 2 Wright, Michael H.; Denney, Leann C. (May 2003). "A Comprehensive Review of Spinal Arachnoiditis". Orthopaedic Nursing. 22 (3): 215–219. doi:10.1097/00006416-200305000-00010. ISSN   0744-6020. PMID   12803151.
  9. ↑ Bilgen, I. G.; Yunten, N.; Ustun, E. E.; Oksel, F.; Gumusdis, G. (1999-07-01). "Adhesive arachnoiditis causing cauda equina syndrome in ankylosing spondylitis: CT and MRI demonstration of dural calcification and a dorsal dural diverticulum". Neuroradiology. 41 (7): 508–511. doi:10.1007/s002340050793. ISSN   1432-1920. PMID   10450845. S2CID   44009176.
  10. 1 2 Davies, D. G. (January 1976). "Cerebrospinal fluid sampling technique and Astrup pH and PCO2 values". Journal of Applied Physiology. 40 (1): 123–125. doi:10.1152/jappl.1976.40.1.123. ISSN   0021-8987. PMID   2575.
  11. ↑ Jurga, Szymon; Szymańska-Adamcewicz, Olga; Wierzchołowski, Wojciech; Pilchowska-Ujma, Emilia; Urbaniak, Łukasz (2021-02-01). "Spinal adhesive arachnoiditis: three case reports and review of literature". Acta Neurologica Belgica. 121 (1): 47–53. doi:10.1007/s13760-020-01431-1. ISSN   2240-2993. PMC   7937595 . PMID   32833147.
  12. ↑ Iqbal, I. Mohamed; Morris, R.; Hersch, M. (November 2018). "Adhesive Arachnoiditis following Inadvertent Epidural Injection of 2% Chlorhexidine in 70% Alcohol—Partial Recovery over the Ensuing Eight Years". Anaesthesia and Intensive Care. 46 (6): 572–574. doi: 10.1177/0310057X1804600606 . ISSN   0310-057X. PMID   30447665.
  13. ↑ Tachibana, Toshiya; Moriyama, Tokuhide; Maruo, Keishi; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi (2014-11-01). "Subarachnoid-subarachnoid bypass for spinal adhesive arachnoiditis: Case report". Journal of Neurosurgery: Spine. 21 (5): 817–820. doi:10.3171/2014.7.SPINE131082. PMID   25170651.
  14. ↑ Tseng, Sheng-Hong; Lin, Swei-Ming (1997-12-01). "Surgical treatment of thoracic arachnoiditis with multiple subarachnoid cysts caused by epidural anesthesia". Clinical Neurology and Neurosurgery. 99 (4): 256–258. doi:10.1016/S0303-8467(97)00086-3. ISSN   0303-8467. PMID   9491300. S2CID   45501339.
  15. ↑ Carlswärd, C.; Darvish, B.; Tunelli, J.; Irestedt, L. (August 2015). "Chronic adhesive arachnoiditis after repeat epidural blood patch". International Journal of Obstetric Anesthesia. 24 (3): 280–283. doi:10.1016/j.ijoa.2015.04.005. ISSN   0959-289X. PMID   26119259.
  16. ↑ Gonzalez M., Claudia E.; Enriquez, Luis E.; Cruz A., Camilo (2012-05-01). "Arachnoiditis Following Spinal Anesthesia for Cesarean Section". Colombian Journal of Anesthesiology. 40 (2): 150–152. doi: 10.1016/S2256-2087(12)70031-7 . ISSN   2256-2087.
  17. 1 2 3 Killeen, T.; Kamat, A.; Walsh, D.; Parker, A.; Aliashkevich, A. (December 2012). "Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review". Anaesthesia. 67 (12): 1386–1394. doi: 10.1111/anae.12017 . ISSN   0003-2409. PMID   23061983.
  18. 1 2 Cornelson, Stacey M.; Johnnie, Edward D.; Kettner, Norman W. (2018-12-01). "Neural Mobilization in a 54-Year-Old Woman With Postoperative Spinal Adhesive Arachnoiditis". Journal of Chiropractic Medicine. 17 (4): 283–288. doi:10.1016/j.jcm.2018.07.004. ISSN   1556-3707. PMC   6391232 . PMID   30846922.
  19. ↑ Krätzig, Theresa; Dreimann, Marc; Mende, Klaus Christian; Königs, Ingo; Westphal, Manfred; Eicker, Sven Oliver (2018-08-01). "Extensive Spinal Adhesive Arachnoiditis After Extradural Spinal Infection–Spinal Dura Mater Is No Barrier to Inflammation". World Neurosurgery. 116: e1194–e1203. doi:10.1016/j.wneu.2018.05.219. ISSN   1878-8750. PMID   29883820. S2CID   47002240.
  20. ↑ Morisako, Hiroki; Takami, Toshihiro; Yamagata, Toru; Chokyu, Isao; Tsuyuguchi, Naohiro; Ohata, Kenji (2010). "Focal adhesive arachnoiditis of the spinal cord: Imaging diagnosis and surgical resolution". Journal of Craniovertebral Junction and Spine. 1 (2): 100–106. doi: 10.4103/0974-8237.77673 . ISSN   0974-8237. PMC   3075825 . PMID   21572630.
  21. ↑ Kara T, Davulcu Ö, Ateş F, Arslan FZ, Sara HI, Akin A (2020-10-06). "What happened to cauda equina fibers? Adhesive arachnoiditis". Anaesthesia, Pain & Intensive Care. 24 (5). doi: 10.35975/apic.v24i5.1364 . ISSN   2220-5799. S2CID   226319113.
  22. ↑ Parenti V, Huda F, Richardson PK, Brown D, Aulakh M, Taheri MR (May 2020). "Lumbar arachnoiditis: Does imaging associate with clinical features?". Clinical Neurology and Neurosurgery. 192: 105717. doi:10.1016/j.clineuro.2020.105717. PMID   32062307. S2CID   211019420.
  23. 1 2 Steel CJ, Abrames EL, O'Brien WT (2015). "Arachnoiditis Ossificans - A Rare Cause of Progressive Myelopathy". The Open Neuroimaging Journal. 9 (1): 13–20. doi: 10.2174/1874440001509010013 . PMC   4578143 . PMID   26401174.
  24. ↑ Maulucci CM, Ghobrial GM, Oppenlander ME, Flanders AE, Vaccaro AR, Harrop JS (September 2014). "Arachnoiditis ossificans: clinical series and review of the literature". Clinical Neurology and Neurosurgery. 124: 16–20. doi:10.1016/j.clineuro.2014.06.024. PMID   24999276. S2CID   12593117.
  25. 1 2 3 4 "Arachnoiditis Information Page". National Institute of Neurological Disorders and Stroke, National Institutes of Health . Archived from the original on 2016-12-09. Retrieved 2015-10-23.
  26. 1 2 Gonzalez CE, Enriquez LE, Cruz CA (May 2012). "Arachnoiditis Following Spinal Anesthesia for Cesarean Section". Colombian Journal of Anesthesiology. 40 (2): 150–152. doi: 10.1016/S2256-2087(12)70031-7 .
  27. ↑ Jurga S, Szymańska-Adamcewicz O, Wierzchołowski W, Pilchowska-Ujma E, Urbaniak Ł (February 2021). "Spinal adhesive arachnoiditis: three case reports and review of literature". Acta Neurologica Belgica. 121 (1): 47–53. doi:10.1007/s13760-020-01431-1. PMC   7937595 . PMID   32833147.
  28. ↑ Tachibana T, Moriyama T, Maruo K, Inoue S, Arizumi F, Yoshiya S (November 2014). "Subarachnoid-subarachnoid bypass for spinal adhesive arachnoiditis". Journal of Neurosurgery. Spine. 21 (5): 817–820. doi:10.3171/2014.7.SPINE131082. PMID   25170651.
  29. ↑ Nelson DA, Landau WM (April 2001). "Intraspinal steroids: history, efficacy, accidentality, and controversy with review of United States Food and Drug Administration reports". Journal of Neurology, Neurosurgery, and Psychiatry. 70 (4): 433–443. doi: 10.1136/jnnp.70.4.433 . PMC   1737322 . PMID   11254764.
  30. ↑ Shaw MD, Russell JA, Grossart KW (February 1978). "The changing pattern of spinal arachnoiditis". Journal of Neurology, Neurosurgery, and Psychiatry. 41 (2): 97–107. doi:10.1136/jnnp.41.2.97. PMC   492975 . PMID   632824.
  31. ↑ Neal JM, Kopp SL, Pasternak JJ, Lanier WL, Rathmell JP (2015). "Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine: 2015 Update". Regional Anesthesia and Pain Medicine. 40 (5): 506–525. doi:10.1097/AAP.0000000000000297. PMID   26263076. S2CID   10759432.
  32. ↑ Brammah TB, Jayson MI (November 1994). "Syringomyelia as a complication of spinal arachnoiditis". Spine. 19 (22): 2603–2605. doi: 10.1097/00007632-199411001-00019 . PMID   7855688. S2CID   34679325.
  33. ↑ Ibrahim GM, Kamali-Nejad T, Fehlings MG (August 2010). "Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy". Evidence-Based Spine-Care Journal. 1 (2): 46–51. doi:10.1055/s-0028-1100914. PMC   3623106 . PMID   23637667.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.