What happened to cauda equina fibers? Adhesive arachnoiditis

Abstract

Spinal arachnoiditis may present with low back pain, foot pain, loss of sensation and motor weakness. In addition, some people may have syringomyelia due to impaired flow of cerebrospinal fluid. In the etiology, there are infections, intrathecal steroid or anesthetic injection, trauma, subarachnoid hemorrhage, myelographic contrast media, multiple spinal surgery and lumbar puncture history. The patient’s past treatment history, clinical and MRI examination are important in diagnosis. In this case, we aimed to discuss postoperative adhesive arachnoiditis which caused low back pain, and imaging findings in the light of literature.
 Key words: Adhesive arachnoiditis; Cauda equina; Pain; Anesthesia; Surgery; Imaging; MRI
 Citation: Kara T, Davulcu O, Ates F, Arslan FZ, Sara HI, Akin A. What happened to cauda equina fibers? Adhesive arachnoiditis. Anaesth. pain intensive care 2020;24(5):
 Received: 29 April 2020, Reviewed: 17 June 2020, Accepted: 18 June 2020

Spinal Adhesive Arachnoiditis: A Literature Review

“…The diagnosis is based on thorough anamnesis, clinical presentation, and imaging evaluation [ 30 ]. The site of injury may be associated with clinical and imaging findings, and as the lumbar is the most affected area, the characteristic triad represented by back pain, neurological deficits, and MRI representing adhesions is often present in symptomatic patients [ 7 ].…”

“…In terms of imaging, myelography was used to diagnose AA; however, the intrathecal iodinated contrast given was precipitating the disorder [ 12 ]. Nowadays, MRI is the gold standard, having 92% sensitivity and 100% specificity [ 27 , 30 ], and is usually performed with contrast to elucidate inflammation [ 7 ]. In MRI, AA may be presented as pseudocysts with adherent and narrow nerve roots toward the center of the dural sac or peripherally cluster and narrow nerve roots with empty thecal sac [ 6 , 30 ].…”

“…Nowadays, MRI is the gold standard, having 92% sensitivity and 100% specificity [ 27 , 30 ], and is usually performed with contrast to elucidate inflammation [ 7 ]. In MRI, AA may be presented as pseudocysts with adherent and narrow nerve roots toward the center of the dural sac or peripherally cluster and narrow nerve roots with empty thecal sac [ 6 , 30 ]. The cysts may also show as uni or multilocular with septa [ 29 ].…”

“…Frequently, the treatment is initiated with pharmacologic management [ 27 ]. Medical remedies such as nonsteroidal anti-inflammatory drugs [ 2 , 12 ] and pulse steroid therapy, most commonly methylprednisolone [ 8 , 10 , 12 ], have been described to treat inflammation, although only a few studies show its effectiveness in preventing scar tissue [ 30 ]. In cases of pain, the pharmacologic therapy may include naltrexone, gabapentin [ 1 , 3 , 18 ], pregabalin [ 2 , 12 ], tricyclic antidepressants [ 2 , 12 ], muscle relaxants such as baclofen [ 2 ], local anesthetics [ 12 ], opioid analgesics [ 2 , 10 ], non-opioids [ 10 ], and narcotics [ 8 ].…”

“…In general, the surgical treatment pursues to release the cicatricial adhesions and repair CSF flow, albeit its efficacy is uncertain, as surgery increases the inflammatory process and is scar-forming [ 27 ]. Therefore, in the short term, surgery may relieve symptoms; however, in the long term, it is inefficient [ 26 , 30 ].…”