An evidence-based assessment and treatment plan for arachnoiditis

Arachnoiditis is a relatively rare and under-diagnosed condition that can affect many patients differently. Most cases are incidentally discovered on radiologic imaging.¹ After treating a patient in our institution with lumbar arachnoiditis, we performed a literature review to determine the epidemiology and the most optimal treatment plan for arachnoiditis. The term "arachnoiditis" was used as the search subject, and no distinction was given for cervical, thoracic, or lumbosacral anatomic location. The following medical search databases were utilized: Pubmed, Cochrane Library, United States National Library of Medicine, MDConsult, Medscape, Google and Google Scholar, Merck Manual, Web Directory of Medical Education, and UpToDate. After examination of the resulting papers and reports, 30 publications were found that the abstract's authors felt were of clinical relevance towards our case patient. Due to the relatively rare prevalence of arachnoiditis, randomized clinical trials are not available to formulate a recommended treatment algorithm.² Multiple etiologies were suggested in our literature review including, but not limited to, prior spinal surgery, neuraxial anesthesia or steroid injections, infection, lumbar puncture, subarachnoid hemorrhage, and syringomyelia. Magnetic resonance imaging is currently the recommended imaging modality of choice.^1,3,4 Treatment options include non-steroidal anti-inflammatory drugs, narcotics, steroids, spinal cord stimulators, and microsurgery. Arachnoiditis is a rare condition, and treatment often needs to be individualized for each patient. Further research on arachnoiditis will likely be beneficial in determining optimal treatment plans for these patients. (1. Koerts G, et al., Clin Neurol Neurosurg, 2007; 2. Rice I, et al., Br J Anaesth, 2004; 3. Kalina J, J Pain Palliat Care Pharmacother, 2012; 4. Thakkar RS, et al., Radiol Clin North Am, 2012.)