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Surgery for Arachnoiditis
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TOPIC: Surgery for Arachnoiditis

Surgery for Arachnoiditis 10 years, 11 months ago #511

  • Kim
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Hi to all
Ann had sent me links to a site where successful treatment - surgery, had been tried in Portugal. I sent everything to the Doc and got her reply today.
DocSarah replies:

I had actually run across this paper and filed it to include in the Cochrane Review (which incidentally I don't think is worth doing there is so little evidence to look at).

There are points for and against the study. It is low level of evidence, as a case series, but compared with many other similar studies the numbers are quite reasonable. The surgical technique seems OK and the ASIA scoring system fairly well validated. MRI results for follow-up don't necessarily correlate with clinical status, and there is no record of the patients' physical level of functioning, pain, cauda equina symptoms etc. etc. so I do not feel ASIA scores are that helpful clinically.

The fact remains that many studies show that despite early improvement, recurrence of inflammation and scar tissue leads long-term to either no change or perhaps exacerbation of symptoms.

The issues with surgical treatment of arachnoiditis are:

1.safe removal of scar tissue (i.e. without damage during surgery)
2.prevention of inflammation and hence
3.prevention of recurrence of scarring
4.the underlying condition e.g. degenerative disc disease, stenosis etc. may still be a problem
5.permanent damage from the scarred nerve roots, not responsive to surgery
6.secondary musculoskeletal problems often due to altered postural dynamics etc. which are worse the longer the condition has persisted

Whilst this study suggests that it may be possible to tackle issues 1-3, it fails to completely back this up with evidence and it certainly does not address the other issues 4-6.

Overall I would still counsel considerable caution regarding any spinal surgical procedure with arachnoiditis: generally the evidence to date shows that problems recur, and may even be exacerbated by surgery.


Not sure this is what people want to hear!

End of her reply!

Can't say I am surprised knowing the Doc as well as I do. I actually spoke with DocSarah tonight, a rare but welcome opportunity. I needed to get her permission to post this reply, as I know she can't do it herself at the moment. Like she said she was concerned it wasn't what people wanted to hear (me included) but that's why we have her helping us. At least we get the truth.
Please feel free to post her answer to other forums or groups. I am hoping Ann can do it for me and give us feedback on what people think and feel about it
Sadly KIm
NEMESIS - goddess of indignation against and retribution for, evil deeds. Apparently regarded as an avenging or punishing divinity - I wish.
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