Primary Diagnosis

Adhesive arachnoiditis.

Secondary Diagnosis

N/A

Diagnosis Discussion

One of the causes of the so called "failed-back syndrome" is the condition of adhesive arachnoiditis. This iatrogenic condition was more frequent with the use of the intrathecal contrast agent known as Pantopaque. This material, when mixed with a small of amount of the patients blood (from a traumatic lumbar puncture) would frequently produce an inflammatory reaction which resulted in scarring and tethering of the intradural contents resulting in aggregation of nerve roots. In more severe cases, the matted cauda equina adheres to the inner surface of the thecal sac, resulting in the "empty sac" sign on myelography and MRI. While Pantopaque is no longer in use, arachnoiditis is still a potential complication of lumbar laminectomy and diskectomy, especially when the thecal sac is inadvertantly violated. There are no successful methods to treat arachnoiditis. It is important to recognize the pattern of arachnoiditis to exclude other potential causes of chronic back pain.

General Anatomic Area:

Skull Base

Secondary Anatomic Area:

N/A

Disease Category:

Iatrogenic

Contributor:

AE Flanders, MD

Date:

11/01/2003

Difficulty Level:

Easy

Pathology Confirmed?:

No
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ACR Category Number:

N/A

Keywords:

scarring, granulation tissue, failed back syndrome.,dwarfism, short stature, atlanto-axial instability.,intraspinal cysts