Arachnoiditis has been known since the 19th century when its major cause was infections, mainly tuberculosis and syphilis. The notorious and fearful label of arachnoiditis stems from the inability to treat or improve the condition once it is established. In the past and with no treatment available, this disorder caused excruciating pain, paralysis, immobility, incontinence, adrenal failure, and early death. Hence, its reputation as both “hopeless and untreatable”. During the 20th century the major cause of arachnoiditis was the use of insoluble oil-based dyes that were injected into spinal fluid to enhance x-ray vision, called myelograms, for diagnostic purposes. In this century adhesive arachnoiditis (AA) is the condition of most concern. It is caused by the adherence or “gluing” of the cauda equina nerve roots to the arachnoid spinal canal lining by adhesions. The major causes of AA are anatomic abnormalities, and genetic, autoimmune, and traumatic injuries.
Most recently, the scientific understandings of both neuroinflammation and neuroregeneration has led to the development of treatment protocols for AA. While formerly viewed as an untreatable disease, this reputation is no longer true. Thanks to multiple recent scientific discoveries, a medical treatment process or protocol has been developed consisting of 3 basic components: (1) suppression of neuroinflammation; (2) promotion of neuroregeneration; and (3) pain control. Although it is in its first generation, this process is spreading in medical practice and has been receiving a most positive, albeit anecdotal, response. The process will undoubtedly improve with controlled studies and more widespread clinical experience.