Show Summary Details
Page of

Chapter 88 

Chapter 88
Chapter 88

Philip Dougherty

and Kathleen R. Fink

Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2022. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 26 May 2022

Arachnoiditis is an inflammatory process involving the nerve roots of the cauda equina. Inflammation rich in a fibrinous exudate covers the nerve roots causing them to stick to each other and the thecal sac. With time, collagenous scar tissue is laid down by fibroblasts, compartmentalizing the intradural space. The causes of arachnoiditis are diverse, but typically fall into three main categories: infection (meningitis), trauma/surgical (particularly complex surgeries, intraoperative durotomies, or multiple bloody lumbar punctures), and chemical (myelograms and intrathecal steroid injections). Pantopaque, an oily intrathecal contrast agent, is also notorious for causing arachnoiditis, but is no longer in use. Cases of Pantopaque-induced arachnoiditis may still be encountered, however, due to a long latency period for the development of symptoms. Modern water-soluble intrathecal contrast has an improved safety profile, but is not completely devoid of risk. Clinical manifestations of arachnoiditis are variable and imprecise. Typical pain is poorly localized, burning, and constant with minimal relief from analgesics. Distribution includes the inner aspects of knees, insteps, and lumbosacroiliac areas. Patients have also reported genitourinary, gastrointestinal, and other systemic symptoms. It is important to note that not all patients with imaging findings of arachnoiditis will be symptomatic.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.