Adhesive arachnoiditis

Inflammation and scarring of the arachnoid that may cause nerve-root adhesions and persistent neurological symptoms.

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Understanding the mechanism

Adhesive arachnoiditis involves inflammation and scarring of the arachnoid, a membrane surrounding neural structures within the spinal canal. Nerve roots can adhere to one another or to nearby coverings. It may be associated with previous surgery, infection, bleeding or other irritation. It differs from epidural fibrosis, which occurs outside the dural covering rather than within this compartment.

Symptoms and warning signs

Burning pain, abnormal sensations, weakness or pelvic dysfunction may occur according to the affected structures. Severity and progression vary. New urinary retention, loss of perineal sensation or rapidly developing weakness requires immediate emergency assessment even when a chronic diagnosis already exists. A new complication must not automatically be attributed to the person's usual arachnoiditis symptoms.

Diagnosis and investigations

Diagnosis combines the history, neurological examination and MRI, which may demonstrate root clumping or abnormal distribution of the roots. Imaging and symptoms do not correspond perfectly. Other causes of pain, such as recurrent compression, neuropathy or inflammatory disease, need consideration. Additional investigation depends on the circumstances and specialist assessment rather than the imaging phrase alone.

Treatment and outlook

Management is often multidisciplinary and focuses on pain, independence and neurological complications. Medication, suitable rehabilitation and selected specialist procedures may be considered. Interventions targeting adhesions have uncertain benefits and meaningful risks; no universal method guarantees their removal. A realistic plan includes sleep, mobility and valued daily activities, with progress measured beyond the intensity of pain at a single visit.

The role of TAGMED care

At TAGMED, supportive care should be cautious and coordinated with the medical or pain-management team. Traction, percussion and manipulation cannot be described as separating adhered nerve roots. External laser and shockwave therapy are not established cures for arachnoiditis. Sustained worsening after an intervention requires reassessment rather than increasing the force or assuming that symptoms represent necessary healing.

Practical follow-up

A realistic programme can begin with a short, repeatable activity and adjust progression to the response. Fluctuations should be discussed without automatically adding invasive procedures that lack a clear indication. Goals should remain shared across the patient and the different treating disciplines.

Frequently asked questions

Does it always result from surgery?

No. Several inflammatory or infectious insults can be responsible.

Is it the same as epidural scarring?

No. Different anatomical compartments are involved.

Does imaging predict all the pain?

No. Clinical manifestations cannot be read directly from the radiological appearance.

Can activity continue?

Carefully graded activity can support independence, with monitoring of the response.

Which goals are most useful?

Reducing impact and preserving function without promising to eliminate every adhesion.

Educational information from The Spine Page. This entry does not replace an individual assessment. Documentary version: October 12, 2026. Sylvain Desforges, B.Sc., D.O., N.D., osteopath and naturopath.