Adhesive Arachnoiditis: A Continuing Challenge
by Sarah Alexandra Andreae-Jones (Smith), MB, BS
 This little known and poorly understood condition has a reputation
amongst medical personnel as a rare entity, or maybe even a non-existent one.1
However, far from being a medical dinosaur, adhesive arachnoiditis, the clinically
significant form of the disease, is a ‘clear and present danger’ that
practitioners need to be aware of since it remains a life sentence of unremitting pain and
disability imposed, in some cases, very early in life.
Historically, adhesive arachnoiditis was first recognized over a hundred years ago and
was originally principally linked with spinal infections such as TB and thoracic
involvement was the typical presentation. However, iatrogenic arachnoiditis, involving the
lumbar region, has since been associated with the use of oil-based myelogram dyes such as
iophendylate (Pantopaque/Myodil).2
Many doctors, if aware of the condition at all, tend to link it with Pantopaque/Myodil
and thus to consider it a past threat rather than a continuing one. This is sadly not the
case. First, one must bear in mind the prolonged usage of the oil-based dyes up until the
late 1980s, and the possibility of considerably delayed onset of symptoms, maybe some
15-20 years later. In fact the delayed onset can lead to a lack of recognition of the true
cause of the symptoms, which may be triggered by a relatively minor event such as a fall
or slight car accident. The ensuing deterioration appears completely out of proportion,
but may in fact be a result of disruption of cysts releasing residual dye to act as a
potent nerve irritant, especially if there is also blood within the subarachnoid space.
It is important to note that the current practice of placing a number of different
chemotherapeutic agents in or near the cerebrospinal fluid space is relatively
commonplace, despite this area being highly vulnerable to damage. In some cases, the
treatment is lifesaving (leukemia) but in others, such as intraspinal steroid injections
for low back pain, the true risks may often be underestimated and preclude an accurate
assessment of risk-benefit.
Please refer to the Mar/Apr 2004 issue for the complete text. In the event you need to order a back issue, please click here.
— Mar/Apr 2004
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