Arachnoiditis - All About Epidural


Date: October 3rd, 2013

“Last week a woman who signed her name as Dawn Marie G posted the following on the Facebook page of All About Epidural.”

Next month is my 5th anniversary. I cannot it has been this long already. I first got arach from a botched epidural for childbirth. I came home from the hospital with TWO gifts that day. A precious, beautiful, perfect baby girl.. And a lifelong disability and curse of the worst pain possibly imaginable. Shattered dreams. Plans for mine and my husband’s future GONE.. Unless they could involve a wheelchair. Then I was given 3 epidural steroid injections. I lost my bladder function, bowel function, bladder and bowel control. I couldn’t lift my feet or even walk to the bathroom any longer. I was DESTROYED. From trusting my doctors. These procedures were supposed to give me pain relief. They left me absolutely wrecked, and a shell of a human being. I was never warned of these possibilities. They pass a long sheet of teeny tiny warnings and give you a few seconds to go over it, while they assure you they’ve never had ANY problems before, and it will never happen to you. Guess what. It does. There are thousands of us out here. It’s not reported or tracked, so we don’t know how many. Many of the sufferers of Arachnoiditis have no idea! They are told something funky and vague, like “failed back syndrome”, or fibromyalgia. That they are getting older, or are overweight. But it NEEDS to end!!

Do NOT Let anybody near your back with ANY kind of needle or scalpel. Nothing. Even if they tell you it will “go nowhere near your spine”. It goes close enough to wreck your life. Many of us are proof of that. You may be desperate for relief, but if you are given this monstrosity, you will go back to wishing “ONLY” for the pain you had before.

I have a support group on Facebook. And an awareness page. Please, like us, join us, and help us warn everyone you know. I wouldn’t wish this on my worst enemy. Please, don’t allow your friends to get it!! WARN THEM! ”

This is undoubtedly a horrifying story. One day in the hospital turns a healthy young woman into an invalid with the serious disability. It is a nightmare for the patient. Believe me, this is also a nightmare for the anesthetist involved. Cases like these makes us doubt if we chose right profession.

Chronic Adhesive Arachnoidits (or CAA), the condition that afflicted this unfortunate woman, is a rare (probably extremely rare), but debilitating condition that has received increased media attention at the beginning of 2000s.

On April 15, 2001, British newspaper, The Sunday Express ran a double page article entitled ‘Birth Jabs Cripple Women’, outlining what they described as ‘the scandal of epidurals that have wrecked lives’. They claimed that epidurals for labor have left thousands of women disabled or paralyzed; and that this ‘fact’ was one of the NHS’s most closely guarded secrets. A week later, they ran two articles: one entitled ‘Time to acknowledge this danger’ implied a reluctance of the medical profession to acknowledge the iatrogenic causes of arachnoiditis; and the other including an alleged quote, about epidurals in labor, from a former director of women and children’s health at WHO: ‘They are being told they are safe. This is a lie’.

What is CAA

A review published in the British Journal of Anaesthesia in 2004 summarized the data relevant to CCA available at the time.

Arachnoid is one membranes surrounding the spinal cord. In order to have their effect, drugs placed in the epidural space have to pass through the arachnoid.

Inflammation of the arachnoid, arachnoiditis (CAA), was recognized as the separate disease in 1909. Since then this disease has been described by many authors under different names. More recently, CAA has been used to describe clinically significant non-specific inflammation of the arachnoid and intrathecal neural elements.

Symptoms of CAA vary considerably from patient to patient, making the diagnosis difficult. Also, there is no precise correlation between symptoms and findings of special investigations, such as CT or MRI scans.

Most frequently symptoms and signs are back pain increased by activity, leg pain, often bilateral, decreased peripheral reflexes, decreased range of movement of the trunk, impaired sensation in the affected parts of the body, and urinary sphincter dysfunction. In up to one third of patients the disease is progressive. In other words, once it starts it gets worse with time.

Causes of CAA

What causes CAA? In the 19th century it was mostly caused by infections, such as syphilis, gonorrhea and tuberculosis. In the 1940, since the implementation of antibiotics, blood in the cerebro-spinal fluid – for example after hemorrhagic stroke or surgery – became the most important cause. More recently, other factors have been implicated in CAA: contrast media, epidural steroids, trauma, blood, preservatives, contaminants, vasoconstrictors, and local anesthetics.

Unfortunately (or fortunately!), because of the rarity of this disease there are no randomized controlled trials available, and the only data we have on the subject comes from case reports in medical literature.

Contrast media

Contrast is injected into the epidural or intrathecal space in order to make neural structures visible on the X-Ray. These agents have been implicated in CAA since 1970s, and apparently they can cause this condition in up to 1% of patients. Older preparations had very long elimination time from the cerebro-spinal fluid, up to 1 year! Appearance of blood in the needle during the procedure increased the incidence of CAA. Modern contrast agent, Metrizamide, is thought to be the safest, as it is cleared from the CSF within hours, and there have been no reported cases of arachnoiditis after its use in humans.

Epidural steroids

Injection of steroid preparations into the epidural space is commonly used for the treatment of back pain. There have been reports of CAA after intrathecal injection of one of the preparations, methylprednisolone acetate (MPA). It is possible that the preservative in this preparation causes CAA.


It has been suggested that blood in the CSF can lead to an inflammatory reaction. This is very relevant to obstetric anesthetic practice, as the treatment for the post dural puncture headache is the injection of patient’s blood into the epidural space. Bleeding into the epidural space can also occur during the placement of the epidural catheter, so called “bloody tap” that occurs in up to 20% of epidurals.

In the review of 2004 one case of CAA is mentioned that has been caused by the epidural blood patch. However, the technique of the blood patch in that particular case is somewhat doubtful, and it is likely that the blood patch has been deposited into the subdural rather than epidural space.


It is well known that CAA occurs after spinal surgery, particularly if it is. Some authors believe that so called Failed Back Syndrome, which is consists of persistent pain and various neurologic abnormalities, is, in fact, CAA caused by multiple trauma.

It has been suggested that the epidural catheter may cause an inflammatory reaction in the epidural space, particularly if left in the epidural space long‐term. In animal experiments some inflammatory reaction is evident after the epidural catheter has been left in place for several days. This is not common practice in labor epidurals, however, where the catheter is left in place for less than one day. There was one case reported from Tokyo, where traumatic epidural led to the development of CAA. However the patient also had several epidural steroid injections and myelography with contrast, so the cause of that particular case is not clear-cut.

Detergents and contaminants

Detergents, the substances used to disinfect the skin and accidental contaminants in the epidural mixture may cause CAA.

A case of CAA caused by accidental injection of chlorhexidine has been discussed in an earlier article on this site. Some practitioners believe that traces of antiseptics used to clean instruments may play a role in the development of CAA after epidurals. However, there is no strong scientific evidence to support this.


Vasoconstrictors such as adrenaline are commonly used in epidural mixtures. However, currently there is no clear evidence that they may cause CAA. It is possible, however, that in combination with other factors they may contribute to the development of CAA.


Preservatives added to local anesthetics, namely methylparaben, propylparaben and metabisulfite may cause CAA. Sulfur containing preservatives have also been shown to be neurotoxic in animal experiments. Currently these preservatives are banned from use in epidural setting in the developed countries.

Local anesthetics

Local anesthetics are toxic substances, and in animal experiments they have been shown to induce does-dependent inflammation of the neural tissues.

CAA and Cauda Equina syndrome have been documented after spinal anesthesia using a continuous micro‐catheter technique. In these cases CAA is thought to be caused by the accumulation of significant amount of local anesthetic (most commonly lignocaine) around Cauda Equina. Animal studies have demonstrated that neurotoxicity can occur at clinically used concentrations of lignocaine and bupivacaine when continues administration is used.


Opioids are widely used in the epidural and intrathecal space in obstetric epidural practice. Long-term epidural and spinal opioids are also commonly used for the treatment of chronic pain. Unfortunately there are no data from controlled trials investigating the long‐term side effects of neuraxial opioids. Animal studies show no evidence that opioids cause CAA.

True incidence of CAA

The true incidence of neurological complications due to epidural anesthesia is difficult to quantify. Studies of neurological complications after epidural anesthesia are not designed to specifically discover CAA, particularly as MRI scanning is often not undertaken. However, a large survey would be expected to uncover cases of CAA if it were prevalent after epidural anesthesia.

A review of adverse drug reactions in Sweden over 30 years included 21 reports of neurological abnormalities secondary to epidural analgesia. Since 1965, it has been compulsory to report all suspected new or adverse drug reactions to the Swedish Adverse Drug Reactions Advisory Committee. No cases of CAA were reported from this large database. There was only one case of an obstetric epidural leading to neurological deficit.

The Patient Injury Act in Finland provides a ‘no fault’ scheme for all patients. Claims are therefore made against the Patient Insurance Association (PIA) rather than the party implicated.

A review from Finland spanning 5 years and based on the claims related to the Patient Injury Act uncovered 38 reports of neurological damage after central nerve block among the 23 500 claims for compensation. It was estimated that 55 000 spinals and 170 000 epidurals were performed during this time. This large study revealed no documented cases of CAA. Two obstetric cases were reported in this review. After epidural analgesia for labor, one patient suffered an L5 lesion whilst the other had an unspecified permanent neurological deficit. There are no details as to the clinical findings or investigations, making it difficult to determine the cause or type of neurological deficit.

A prospective audit in North‐West Thames had 35 notifications of neurological deficits. Of 48,066 deliveries, 13,007 patients had an epidural and 629 had a spinal. An independent neurologist reviewed the notes of the 35 women with neurological deficits. No anesthetic technique could be identified as a contributory factor. However, none of the women were examined or given an MRI scan, and no diagnosis was given to the neurological deficits.

The study published in 1989 reported six cases of arachnoiditis following epidural anesthesia. None of the cases were obstetric. The authors of the report hypothesized that CAA could have been caused by vasoconstrictors, detergents or preservatives in the local anesthetic solution. They suggested that the incidence of CAA might be considerably higher than accepted at the time of publication.

Now what?

At the end of the day the most important question every woman considering an epidural is facing: should I have it?
As I mentioned numerous times, the purpose of this site is to provide you with the truthful information regarding the risks and benefits of labor epidural. Generally safe, epidural is not risk-free. I want to repeat it: LABOR EPIDURAL IS NOT RISK-FREE. It can cause serious complications. On the brighter side, serious complications after labor epidural are rare.

According to the National Vital Statistics System of the Center for Disease Control and Prevention of the United States, in 2010 the total of 2,651,428 of women gave vaginal birth in that country. The study published earlier by the US Department of Health and Human Services and based on the statistics of birth in 27 states reported that 61% of women who gave vaginal births in 2008 received epidural analgesia.

The number of birth and the proportion of women receiving labor epidural seems to stay more or less the same in the last few years. Therefore, in the last five years approximately 7,500,000 women (seven and a half million) in the US received labor epidurals.

European statistics of the use of labor epidurals varies from country to country. In France, for instance, the use of epidural is similar to that in the USA, while in the Netherlands it has traditionally been low. According to Eurostat data there were 9,650,73 live birth in Europe in 2008. Assuming – conservatively – that one fifth of those had epidurals, brings the total numbers of labor epidurals over five year period in the region to 9,500,000. That’s nine and a half million in Europe plus nine and a half million in the USA, the total of 17 million epidurals in the last five years in two major regions of the world.

Millions of epidurals have been performed in the developed countries. And I am only talking about labor epidurals. If you add epidurals done for patients undergoing surgery the numbers will be even larger. Yet there aren’t many reports of arachnoiditis caused by epidurals. The review of 2004 concluded that CAA is an extremely rare condition.

True, many cases of serious complications may not be published. On the other hand, these cases are very likely to have legal implications, and the data from legal databases should present reasonably reliable numbers. Still, even if we assume that the incidence of arachnoiditis is twice what we believe it is, it still remains a rare complication.

To Dawn…

Dawn’s letter was not addressed to me personally; her message is rather directed towards the readers of the Facebook page and the site. Yet, I would like to answer it.

First and foremost, I am very sorry for what has happened to you, Dawn. For people not affected by such horrible condition it is impossible to imagine what it is like to be constantly in pain, not being to move around and control you bowel and the bladder.

From your letter and your Facebook page I understand that first you got radiculitis from labor epidural that was consequently treated by epidural injections. I was not present at the time when epidural was placed, but, having noted that you live in the USA I assume that it was done by properly qualified medical personnel in appropriate conditions. Was your radiculitis caused by epidural? It is difficult to say. Evidence presented in this chapter on the site does not indicate that labor epidural causes back pain. Pregnancy and labor, on the other hand, commonly do. With all fairness I don’t think in your case you can say that your condition was caused by labor epidural. It was one link in the chain of events that lead to it.

Every intervention has its risks. Every known medication can cause severe allergy and result in serious injury or death. However, such reactions are rare. So is arachnoiditis after epidural.

As you say on your personal Facebook page, “God gives His hardest battles to His toughest soldiers“. I sincerely hope you get better one day and wish you all the best.

Whose responsibility?

In her letter Dawn mentioned that she was not given proper warnings about the possibility of serious complications. I want this statement to be a warning to all those women who are considering epidural for their labor, as well as the warning to anybody getting any kind of treatment.

Labor is not something that happens out of the blue, and there is time to learn about all the options and complications associated with them. When you fall pregnant there is enough time to search for information and learn about possible side effects and complications. If anything, childbirth information on the Web is dominated by the advocates of natural birth, and epidural complications tend to be over-emphasized and often exaggerated, not concealed. This site also gives you fact-based info about possible problems with labor epidural.

Learn about the option, their risks and then decide if the risk is acceptable to you. It is impossible to tell if a certain complication will happen to you, but you can get an idea of the probability of it happening. Knowledge is power; it gives you the opportunity to make informed decisions regarding your health.



Image source:

Dr. Eugene Smetannikov is a practicing anesthesiologist with the interest in obstetric anesthesia. He is the author of the most comprehensive book on the subject, The Truth About Labor Epidural


So far, 11 people have said: about “Arachnoiditis”:

  1. I have spinal adhesive arachnoiditis in the thoracic and lumbar region caused by a SINGLE injection spinal anesthesia containing 5%lidocaine, epinephrine, and dextrose that I received during a “routine right knee arthroscopy”
    It is confirmed on full spine MRI. I had no history of any back injury or back pain prior to this procedure. If my primary care physician had known what to watch for after that one injection, there may have been a chance to prevent this condition that NOBODY warned me about. By the time anyone realized what was wrong with me it was too late. I was pushed to have the spinal because “it would save time in recovery.” I was told, “it is safer than general anesthesia and we’ve been doing it this way for years.” After the fact, I found out that the label on the package indicates that this drug is not intended for intrethecal use…they used it anyway. Warn patients. Warn your peers. ADD this to your list of causes because the FDA does not approve this concentration of lidocaine for this purpose.BUT YOU AND YOUR PEERS USE IT ANYWAY UNDER THE GUISE OF ACCEPTABLE PRACTICE AND THE AVERAGE STANDARD OF CARE. I have the transcripts from the meeting in which it was decided to warn against this use and additional documentation showing that the manufacturer initiated this warning because of the evidence of nerve injuries reported to them. This has been known since 1994-1996. My procedure was done in 2007 and covered up by a network of 14 specialists until the statute of limitations had passed. Make sure your peers are aware that SINGLE INJECTION SPINAL ANESTHESIA CAUSES ARACHNODITIS. One day, one time, to increase the number of patients they could run through outpatient procedurs that day…and now I am permanently unemployable. The NYS DOH found the hospital in violation of the NYS hospital code regarding patients rights because they failed to disclose the name of the anesthetic or the intent to use it for off-label purposes. No other measures of accountability have been taken.This practice continues. WHAT DO YOU DO TO GUARANTEE THAT THESE TOXIC SUBSTANCES DO NOT EVER ENTER THE INTRETHECAL SPACE DURING THE EPIDURALS YOU ADMINISTER DURING LAVOR AND DELIVERY?

  2. Sheila Kalkbrenner
  3. I have to add that even ONE case of PREVENTABLE adhesive arachnoiditis out of 17 million or even ONE case too many if YOU are that one person. I’d say that the odds of getting arachnoiditis are much, much higher than your estimation…so how many people will fall into that category of ONE before doctors take the time to get educated about arachnoidtis? and before they will take the time to accurately and adequately warn their patients about it? That would be true informed consent. Until then, the patient does not have enough information to “choose the best option” or decide “what is worth the risk” for them. The risks are NOT being accurately presented to them in the first place.

  4. Sheila Kalkbrenner
  5. Sheila

    I appreciate your comment. Of course, when a complication like this happens the numbers of chance and incidence do not matter much to the person affected by it. Unfortunately, everything is a numbers’ game. All I can do before giving someone labor epidural is to inform them about their chances. I cannot predict which complication will occur and to whom. If the incidence of one in 17 million is one too many, then what incidence is be acceptable? For example, annual risk of jogging is about one in 15,000. I would have to try hard to find a person thinking jogging is dangerous, yet its risks are way higher than that of any serious complication of an epidural.

    I don’t want to comment on the circumstances of your particular case, but the fact that the hospital was found guilty is the testimony of substandard practice Learning about cases like yours many of us, doctors, question if we have chosen the right occupation. It is the reality of medical practice that whenever a needle or a scalpel is involved, things can go wrong.

    It is possible that the incidence of Arachnoidits as the result of neuraxial block is underestimated. Still, I say it is very low.

    As to what I am doing to prevent what happened to you – this website. I am not trying to “sell” labor and hide its dangers. To the contrary, I welcome all kind of comments so that the readers can get informed and decide if the risks are acceptable to them.

    I wish you all the best and hope your condition will improve with time.

  6. Dr Smetannikov
  7. I have an online support group that is getting at LEAST 2 or 3 new, young mothers diagnosed a WEEK. It has grown 300% in a year. Granted, the MAJORITY of these sufferers are from Epidural Steroid Injections, or surgery. But me and the other 100 or so women and I ALL have the same experience.. We are assured that the “risks” are a HEADACHE… Or it “JUST WON’T WORK”. Period. We NEED informed consent! I’m reaching out because we need help. I represent a rapidly growing number here. We are told these epidurals are “done all the time with no bad results”. They’re being used for surgery now WITH general anesthesia, and doctors are told to PUSH them, by management, at many hospitals because they can CHARGE MORE. I was scared into it, as well as many other women. Told we are risking our babies’ lives if we don’t. “These few extra minutes count”. Labor is called labor for a reason. It’s not a Holiday Inn. And there’s a REAL problem with these things MAIMING people! The symptoms don’t always develop right away.. Sometimes years later. It’s not being connected, or tracked. I wrote to ask for help, and awareness. Maybe that’s how things are at your hospital. But it’s a whole different story on the other end of things. Young, young women damaged for life, with Cauda Equina Syndrome and other injuries. It is SO out of hand. Please, help. We are crying out for somebody to stop ruining young lives. It’s way more common than anybody realizes.

  8. Dawn Marie G
  9. According to the US General Accounting Office (2000) the FDA receives only 1 to 10 percent of all Adverse Drug Events. There are no mandatory reporting requirements and certainly no incentive for the pain management industry to report complications to the FDA.

    Arachnoiditis is grossly under-reported to the FDA and often mis-diagnosed with garbage diagnoses such as Fibromyalgia, Complex Regional Pain Syndrome and Failed Back Surgery Syndrome. It is not rare from my vantage point as I am watching an epidemic unfold in social media networks.

    Thank you for this article on arachnoditis. It is basically a life sentence of experiencing Hell on Earth.

  10. Terri Anderson
  11. Dawn

    I hope this discussion does not deteriorate to doctor bashing. Vast majority of doctors believe in what they do, and I personally would not hesitate to administer labor epidural to my own daughter. In fact, I gave my wife a spinal block for the cesarean section for our second child; this is pretty strong evidence of my integrity (yes, she is still married to me!) For one, where I work epidurals are not “pushed”. Currently accepted consensus is that epidural prolong labor, so I am not sure where “These extra minutes count” fits the reasoning. Adding epidural to general anesthesia for abdominal, thoracic and other types of surgery has quite a few positive physiological effects and strong advantages for certain groups of patients, and is superior for controlling pain after the operation. Its use in this context has declined considerably in the last decade, partly because of increased litigation, partly because other, technically easier and potentially safer alternatives have been developed.

    I understand that arachnoiditis support group will have considerable amount of members. However, taking into account huge number of labor epidurals performed each year, the chance of getting arachnoiditis is very low. I have practiced anesthesiology for more than twenty years, obstetric anesthesia has been large part of my practice for many years, and personally I know of one case of arachnoiditis, that discussed in the post on . Yet, I am the first to state that the incidence of a complication is only one side of the equation: the severity is the other, not less important.

    I strongly agree that nobody should be forced to have an epidural. In addition, health care must not be driven by profit and hospitals should not benefit from doing extra procedures. But I urge everyone: do not rely on someone else for information. Do not wait until the last minute to learn about epidurals. Judgement and objectivity will be challenged when you’re in severe pain. Find out about you options, their complications and side-efects and decide on what is suitable to you in advance. Websites, books, Internet forums – the resources are endless. I am doing my best to promote truthful information about obstetric epidurals, that’s why comments like yours are welcome here. If I can be useful for your group – let me know, I will help with whatever I can.

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  13. Terri

    I agree that arachnoiditis is under-reported to the FDA. However, other sources of data, such as Closed Claims Project, Patient Insurance Association in Finland, published reviews and clinical audits give a good idea of the incidence. I think large proportion with CAA are missed, but not because of reporting, but because its clinical presentation is complex and can be mixed with other conditions. Fibromyalgia and CRPS – not “rubbish” diagnoses by any means – are two examples that can be erroneously diagnosed in patients with CAA.

    The project you are running, A.S.A.P., is a very important undertaking. Are you planning to publish the results of your poll? I would like to know what proportion of arachnoiditis sufferers got it from labor epidural.

  14. admin
  15. To Admin and other interested readers. The biggest problem with Arachnoiditis is the many causes! Historically Arachnoiditis was caused by infection or trauma. Since the inception of modern medicines like antibiotics and antivirals, Arachnoiditis has graduated from a rare and Orphan Disease to a epidemic and fully Iatrogenic disease. Spinal surgery, epidural injections of all kinds, Spinal taps and the accompanied blood patches, Myleograms with and without oil based contrast media, Intrathecal Chemo, to name a few are the new causes. What this means is that anytime the sacred intrathecal space is violated contracting arachnoiditis is a likely event.Injecting any foreign substance into the spinal fluid is a bad idea as most contain preservatives and other chemicals toxic to the neural structures. This being said, the fault lies with doctors of all types. we need to graduate from the informed consent that protects doctors for litigation and move to true informed consent that protects patients. All doctors need to remember the oath all doctors took is to do no harm, not avoid getting sued after a mistake! The ASAP poll on arachnoiditis is painting a very good picture. It is giving us a look at a time period whee more cases have happened, and the leading causes. It is also telling of the practices of pain management and the often unethical practices used to get people in and out while maximizing profits with unapproved medicines. At the last tally of the results, Spinal anesthesia as a cause of arachnoiditis is the third leading cause, The number one cause is spinal surgery followed by epidural steroid injctions. There are so many people living with arachnoiditis as a result of spinal blocks to call it a rare occurrence. This is not to say that the practice is outwardly dangerous, it is meant to serve as a reminder that the more you do to more failures you will have, and that utmost care is needed to ensure that EVERY patient under your care needs to be protected by all means available to avoid a fate far worse than death itself. And every Doctor that inserts a needle into the spine has a duty bound by Oath to inform the patient of the real risk. ASAP will continue to run the Poll through 2013 , and then publish the results soon after. If you would like to see the end results email your contact information. I think the results will be a big eye opener, and hopefully you will gain the understanding that doctors of ll types are involved in a epidemic of harm and steps need to be taken to prevent every single one of them… Thank you
    Walt D.

  16. Walt
  17. In order for this discussion to be credible we need numbers. I probably agree that most causes of CAA these days are iatrogenic. However, in order to state that arachnoiditis is a likely complication we need numbers. Because all I can tell my patients before giving them epidural is numbers.

    I will wait for the results of your poll. Then it will be possible to estimate the approximate incidence of this horrible complication after every intervention.

  18. admin
  19. Thank you Doctor for your open mind and interest. We are not looking to doctor bash and understand that Arachnoiditis is not something that is commonly known. Which is why we are trying to spread the word. If there IS a bloody tap or wet tap, a course of IV steroids and other medications can be administered to lessen or completely prevent this complication, but the information is not out there. In my case, I walked in to have a baby, and left in a wheelchair. And my MRI after the obstetric epidural alone showed extensive adhesive Arachnoiditis. Yet the neurosurgeon I consulted with still recommended the Epidural Steroids. The biggest problem is it not being recognized and people being sent for procedure after procedure. Each assault worsens us considerably. The Arachnoiditis scarring causes the epidural space to disappear and the medications end up being administered intrathecally. So many of us wish we could go back to the pain we had after our first procedure. Thank you so much for the information and interest. Dr. Aldrete from Birmingham University has published several books and hundreds of articles on the subject. If you are interested in his latest book I would gladly mail you a copy.

    Thanks again,

  20. Dawn Marie G
  21. Dawn, thanks for the comment. CAA is a serious complication and has to be discussed in the open. I am already teaching my registrars about CAA in order to raise awareness of this condition. I will get the book you mentioned and will look articles by Dr.Aldrette. Thanks again. Eugene Smetannikov.

  22. admin

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