A Novel Technique Using Magnetic Resonance Imaging in the Supine and Prone Positions for Diagnosing Lumbar Adhesive Arachnoiditis: A Preliminary Study

Abstract

BackgroundLumbar adhesive arachnoiditis is a debilitating neuropathic condition and is difficult to diagnose owing to lack of definitive diagnostic criteria. By focusing on the intrathecal mobility of nerve roots, we assessed whether useful diagnostic criteria could be established using MRI.MethodsSeventeen patients with a high risk for lumbar adhesive arachnoiditis and 18 no‐risk patients with chronic low back pain and/or leg pain participated in this study. The patients underwent MRI in both the supine and prone positions. Eleven axial T2‐weighted images between the L2 and L5/S levels were obtained, and the proportion of the low‐intensity area in the dorsal half to the total low‐intensity area in the dural sac was calculated for each axial view.ResultsAt some lumbar levels, the low‐intensity area in the dorsal half of the dural sac was relatively larger in patients with a high risk for lumbar adhesive arachnoiditis than in the no‐risk patients. In the no‐risk group, the proportion of the low‐intensity area in the dorsal half in the supine position was significantly higher than that in the prone position at all lumbar levels. However, in the high‐risk group, at some levels, the proportions were not significantly different in the dorsal half of the dural sac between the supine and prone positions.ConclusionIn patients with a known risk for lumbar adhesive arachnoiditis, nerve roots lose their potential to migrate in the dural sac in the gravitational force direction on MRI.

Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review

“…No preference towards a certain level of the spinal column was observed either. Tsuchida et al [ 51 ] searched for new MRI diagnostic criteria that could make it possible to diagnose CSAA in earlier and asymptomatic stages of the disease. Reduced nerve root mobility has been suggested as an early marker for the development of CSAA.…”

“…This leads to the hypothesis, that a high-dose cortisone treatment is most effective in early stages of the disease because it intervenes in the pathomechanism and therefore interrupts the development of the adhesions and all following complications. To make early diagnosis possible, it is necessary to discover diagnostic criteria for the early stages of the disease, such as the reduced mobility of the nerve roots in high-risk patients [ 51 ].…”

Perspective: Early diagnosis and treatment of postoperative recurrent cerebrospinal fluid fistulas/ dural tears to avoid adhesive arachnoiditis

“…with low back pain without AA), those with AA exhibited large, low density, non-mobile, dorsally clumped roots that failed to migrate ventrally [ Table 1 ]. [ 15 ]…”

Editorial for “MRI Findings of Arachnoiditis, Revisited. Is Classification Needed?”

“…It is also important to mention that only a third of patients included in the present study had gadolinium‐based contrast enhancement during imaging. Another recent study found that MRI in supine and prone positions could facilitate the early detection of lumbar adhesive arachnoiditis 9 . Further studies could assess the impact of using contrast agents and multimodal MRI on diagnostic findings.…”

“…Another recent study found that MRI in supine and prone positions could facilitate the early detection of lumbar adhesive arachnoiditis. 9 Further studies could assess the impact of using contrast agents and multimodal MRI on diagnostic findings.…”