Diploma of Specialised Bowen Therapy 22006IVC __________________________ Katherin Phillips

Assessment for Professional Skills

Assessment Task 1: Research task on traditional, alternative and scientific practices in medicine.

USING THE BOWEN TECHNIQUE TO TREAT SYMPTOMS OF

ADHESIVE ARACHNOIDITIS.

2. General Description, beliefs, evolution of this treatment and relevant condition.

History, beliefs and evolution of the Bowen Technique: It states in the Bowtech brochure ‘State of the Art

Healing Technique” that the Bowen Technique was developed in the 1950’s by the late Tom Bowen from

Geelong Australia.

Bowen became a celebrated therapist, regularly treating over 13,000 patients each year. In 1974, he invited

Oswald Rentsch and his wife Elaine to study with him and document his work. Honouring their promise to

Bowen, they began to teach the technique in 1986.

Since then, over 25,000 therapists worldwide have taken Bowen Training. This is where it all started, all Bowen

training is based on Bowtech, who introduced and continue to bring the Bowen Technique to the world.

Dedicated to preserving the technique and ensuring that it is taught in its original form, they founded the

Bowen Therapy Academy of Australia in 1987. (‘State of the Art Healing Technique’ Information Brochure

presented by the Bowen Therapy Academy of Australia).

The Bowen Technique is a gentle form of body work in which subtle moves performed over the muscles and

connective tissue send messages deep into the body, retrieving cellular memory of a preferred, relaxed,

balanced way of wellbeing.

There are frequent but very essential pauses throughout the session that allows the body time to respond and

begin the healing process. The practitioner can target a specific problem or address the body as a whole.

The technique addresses not only the musculoskeletal framework, but also the fascia, nerves and internal

organs. The body's integrated response improves circulation and lymphatic drainage and aids assimilation of

nutrients and elimination of toxins.

Relevant condition - Adhesive Arachnoiditis: Adhesive Arachnoiditis is a condition which begins with the

inflammation of the Arachnoid Membrane covering the spinal canal and brain, this can cause a gradual

buildup of fibrotic scar tissue which disrupts the flow of cerebral spinal fluid (CSF) around the nerves and

deprives them of nutrition. (Burton, C. 2013)

For a greater understanding I have included information and diagrams on the anatomy of Adhesive

Arachnoiditis which was obtained from The Burton Report – see attachment 1.

http://www.burtonreport.com/InfSpine/AdhesArachAnatomy.htm

Symptoms of Adhesive Arachnoiditis: The early symptoms of this condition can be all or some of the following:

Severe low back and leg pain

numbness and chronic pain in leg(s) and feet

burning sensation, especially in the legs and feet

bladder and bowel dysfunction

severe headaches.

Many patients with this condition complain of the feeling of walking on broken glass. Often there are no

outward signs of the condition and the sufferers look deceptively normal; as the condition progress’s the

symptoms may increase and become more permanent. Some patients use wheel chairs and walking aids, and

most patients with Arachnoiditis have to give up work completely which leads to a feeling of uselessness and

loneliness at also losing the strength to keep up a social life.

Causes of Adhesive Arachnoiditis: Known causes of the condition are

Tuberculosis

Meningitis

Spinal Tumor’s

Abscesses

Spinal Surgery or Trauma

Radiculargrams

Epidurals (Steroids) and Lumbar Punctures

Cortisone Injections into the spinal canal.

BUT BY FAR THE LARGEST SINGLE CAUSE: is medical intervention such as Myelograms using Myodil Dye,

(supplied and marketed by Glaxo Smith Kline between 1945 and 1988), which is now known not to be

safe.

(GROVES,P. http://www.aasansw.org.au/ accessed 3/8/2013.)

Over many decades, some of the sufferers of Adhesive Arachnoiditis have been fighting an uphill battle

against Governments and multi-million dollar pharmaceutical companies, to have their concerns and

condition recognised and to raise awareness. While in the sidelines, many more victims have suffered in silence

and have spent the majority of their progressively incapacitated lives trying to get answers and diagnosis from

renowned health specialist, with no avail and with countless misdiagnosis.

Adhesive Arachnoiditis may be diagnoses as:

Failed back surgery syndrome

Epidural (peridural, post-surgical) fibrosis (scarring)

Multiple Sclerosis

Fibromyalgia

Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome CRPS)

Chronic Pain Syndrome

Lupus-like disorder

Depression

Psychosomatic disorder

Compensation neurosis / Malingering (Burton,C. 2013)

Treatment for Adhesive Arachnoiditis: Adhesive Arachnoiditis is difficult to treat. Treatment is limited to

alleviation of pain and other symptoms. Surgical intervention generally has a poor outcome, and only provides

temporary relief. Steroid injections, administered either intrathecally or epidurally have been linked as a cause

of the disease, therefore they are generally discouraged as a treatment and may even worsen the condition.

(Burton,C. 2013)

As stated in an article written by( Mullen, 2013)which was presented on the Medical Observer website;

(Radiologist and emeritus professor Michael Sage, from Flinders University ), said “Diagnosis was difficult

because there was a wide variation in neurological symptoms”.

Many doctors are unfamiliar with Arachnoiditis and, mistaking it for a common disc or nerve impingement

problem, order treatments that worsen the condition. Patients may be wise to see a physician with specific

experience in this area, though many doctors consider themselves a specialist while aware of the disastrous

outcomes even routine procedures can cause. Patient education is important. (Burton,C. 2013)

How Bowen Therapy addresses the symptoms of Adhesive Arachnoiditis:

Given that the symptoms of Adhesive Arachnoiditis are many and varied, I believe overall, and from the results

of my client, that the Bowen Technique addresses

neurological pain

muscular tension

distortion and wasting of soft tissue

increases circulation and resolved lower limb oedema

initiates lymphatic release

encourages an overall sense of wellbeing

alleviates mental stress

This is achieved by which Bowen moves are transmitted throughout the body by facia. This enables treatments

to be effective as the damaged nerves are not a barrier.

3. Demographic statistics

It is easy for the general community of the Moreton Bay Region to access Bowen Therapy. There are

approximately 15 qualified and registered Bowtech therapists within a 15klm radius. Over the past 2 years I

have found that when talking to others in the community there would be about 50:50 knowledge of the Bowen

Technique. The people that know of Bowen Therapy and have experienced it, love it and it is their preferred

natural therapy. On the other hand the ones that had never heard about it were intrigued with the

explanation and would consider trying it in the future.

The Moreton Bay Regional Council demographic profile, based on results obtained from the 2011 Census of

population and housing, states a population of over 400,000 people in the region.

http://profile.id.com.au/moreton-bay/service-age-groups accessed 25/8/2013.

My research shows there was and increased in use of spinal surgery and imagery investigation since back in

the early 1940’s. This would indicate that the main age group affected by Adhesive Arachnoiditis is from the

ages of 50 to 85 and over. This marries up with populating statistic in the Moreton Bay region of 117,638 people

which is a total of approximately 29% of the local community.

It is unknown of the exact number of suffers of Adhesive Arachnoiditis, due to misdiagnosis and suffers who

have actively been seeking recognition of the initial cause of their symptoms and have not been formally

diagnosed as having Adhesive Arachnoiditis by medical professionals.

It is estimated that approximately over 100,000 people in Australia have had a myelogram between 1945 and

1988. Not to mention others who have been affected by this disease through other causes.

4. Aims and Objectives of the Project

1. To bring awareness to the Bowen Therapy community: With varying views and the unfamiliarity of this

often misdiagnosed, debilitating and incurable disease by medical practitioners, most patients seek alternative

or complementary therapies to assist in reducing their symptoms. My decision to research this disease and the

positive outcomes that the Bowen Technique has had on the presented symptoms of Adhesive Arachnoiditis

will bring awareness to the greater Bowtech community.

2. To evaluate the effectiveness of the Bowen Technique on symptoms of Adhesive Arachnoiditis.

Overall the effectiveness of using the Bowen Technique in treating symptoms of Adhesive Arachnoiditis has

been a slow but positive result. Since first treating this client in June 2012 to present, there has been significant

improvements in my clients overall wellbeing, improved sleep, increased mobility, reduction in lumbar and

lower limb pain, tension and swelling and a vast improvement in medial leg rotation at the hips and a 9o%

reduction of severe oedema to the ankles and feet.

3. To introduce Bowen Therapy to sufferers of Adhesive Arachnoiditis.

One of the aims of this research project is to introduce to sufferers of Adhesive Arachnoiditis, to the prospect of

a modality which has a holistic benefit that supports traditional treatments, and to promote the effectiveness

of the Bowen Technique in improving their quality of life. This can be done by contacting Associations and

promoting to their members through website information links.

4. To compare the perception of the client pre and post treatment.

My client’s pre-treatment perception of the Bowen Technique, and its ability to relieve pain and improve or

reduce symptoms of his disease, was very sceptical.

However, post initial Bowen treatment, my client was pleasantly surprised at just how relaxed, balanced, and

how a reduction in overall pain and muscular tension was achieved after one consultation. These feelings

triggered an increased interest in how the Bowen Technique worked, and the client proceeded to do a little

research himself. The client’s acceptance and perception of the Bowen Technique had relinquished some of

the doubts of success, which was reinforced with continued improvement highlighted in future Bowen sessions.

This client was diligent in following through with my requests for him to increase hydration, gentle

stretches/exercises and to address his diet. Furthermore, the client’s perspective of the treatments and results

will be determined by regular questioning and addressing his needs as time progresses.

5. Research Method / Strategies

As I only have use this one presenting client with this medically diagnosed condition, I felt that a quantitative

method was best used in this research project. The client was interviewed at length with respect to

signs and symptoms, pain levels, quality of life and effectiveness of traditional treatments. This study utilised

many assessments and observations recorded over a period of 17 months. This research is ongoing.

6. The Study Sample / Stakeholders

My study sample was a 65 year old male with medically diagnosed Adhesive Arachnoiditis. Over the past 20

years he has slowly become physical incapacitated, to a point where he now uses a mobility walker. This client

presented for Bowen therapy treatment for relief of lumber and lower limb pain.

After several Bowen therapy treatments provided to this client, I felt that through many discussions he was

happy for me to provide him with any knowledge I had gathered on his condition. An exceptional

client/therapist rapport was developed and when asked, he was extremely happy for me to use his presenting

condition, clinical notes and discuss his history in this research assignment.

This client reports a very healthy childhood with no significant illness, nor did he require hospitalisation or

specialist medical consultation. He led an active life as a young adult, married early with a young family.

At the age of approximately 30 he was suffering with recurrent lumbar pain, which was caused from several

falls while working as a fireman and heavy labouring type work as a concreter, on his days off. The client

obtained treatments from chiropractors, physiotherapists and acupuncturists over many years, with little or no

resolve. In September 1980, as requested by his consulting physician, he underwent a Myelogram to see if that

could shed some light into the cause of his lower back pain. The Myelogram results showed congenital

narrowing of the cervical spinal cord at C1 to C3, with no other abnormalities or skeletal degeneration or

damage. His doctor’s recommendations were to continue with complementary therapies like massage,

physiotherapy etc. (Please note: this client has had no symptoms relating to the congenital narrowing of the

cervical spine).

My client continued to experience significant lumbar and sciatic pain, and as the years went on he became

increasing unable to lead an active life. He had “given up” on all physical therapy treatments and resorted to

taking pain relief medications when symptoms were intolerable. He has now learnt to live with his pain and

copes with his restricted mobility and muscular degeneration and flare up of pain at time to time.

7. Ethical Considerations

Bowen Therapy, its methodology and its effects on the body were explained in detail and written consent for

treatments and subsequent publishing of the collected results was received from the client participating.

8. Data Collection – Results

Bowen Therapy Treatment Plan.

In June 2012 this client presented with constant, central to left sided lumbar and sciatic pain on a scale of

7/10. Also there were a variety of related symptoms due to inactivity. Due to the extended period that this

client hadn’t had any physical activity or treatments, I introduced him slowly to Bowen Therapy to ensure he

didn’t experience an overload. I continued to add appropriate procedures in following treatments if no

adverse effects or minimal results were achieved after previous sessions.

Initial Observations.

On the initial consultation the client was unable to walk or stand unassisted.

Severe medial rotation of the hips, knees, ankles and feet - (spastic type gait).

Drags feet when walking.

His upper body was noticeably tilted forward from the hips.

Significant wasting of the gastrocnemius muscles.

Moderate to high levels of oedema to both ankles/feet.

Noticeably grey complexion.

Extremely dry skin.

Relevant Client Information

During general discussion of symptoms the client comments that he has regular trips and falls, bowel

dysfunction, leads a very sedentary lifestyle and his diet and water consumption is of a very poor standard. He

has learnt to deal with his continual pain and only when his lower back flares up and pain increases he will rest

more and take panadol or nurofen for relief until symptoms subside.

He mentions that he has a slightly painful cyst posteriorly on the left hip, which he has had scanned and shows

as benign.

He experiences unresolved left knee pain, which scans show no ligament or skeletal damage.

A MRI scan report of the lumbar region indicates there is normal vertebral degeneration and slight disc

narrowing.

He also has difficulty getting out of his lounge chair, finding it necessary to slide down onto the ground getting

on his knees, then turning around and using the chair and his upper body strength to get onto his feet.

He sometimes loses balances easily even when using his walker.

Client feels condition has been exacerbated by:

Untreated/unresolved PTSD from continued exposure to trauma whilst working as a fireman in the QFS

(Queensland Fire Service).

Exposure to high stress job as a senior ranked officer in the QFS.

Exposure to chemicals whilst working in QFS for 30 years.

Stress of taking years to have his condition medically diagnosed / recognised by many leading medical

professionals.

Decline in lifestyle due to his lack of ability to get around unassisted.

Assessments / Observations

Neck, thoracic and upper limb assessment shows:

reduced cervical ROM with mild muscular tension at S1

Trapezius and SCM stiffness on palpation

full active ROM in shoulders - no pain or restrictions

reduced thoracic rotation whilst sitting, slightly increasing left lumbar/sciatic pain

no pain or restrictions in upper limbs

Lumbar assessment shows:

lumbar muscle and skin tension

raised thoracic erector spinae muscle on the right

the client unable to perform lumbar extension

limited balance while standing unassisted and unable to step backwards

flattening of lumbar region

no sacroiliac joint dysfunction.

Pelvic and lower limb assessment shows:

medial rotation of legs

extreme hamstring muscle tension

extreme adductor muscle group tension

unable to abduct legs more than 20° passively, while client supine

left knee joint swelling and reduced ROM to both – no ligament weakness

gastrocnemius wasting

legs and feet cold to touch

severely dry flaky skin

wearing away of toenails from dragging feet while walking with no shoes on.

soft tissue bruising and scaring on knees, shins and ankles… from many trip and falls

no leg length, tibial or femoral length discrepancy

severely reduced ankle and foot ROM due to oedema of ankles and feet. This restriction improved

significantly at the completion of the first 3 treatments as swelling reduced remarkably.

Significant improvement noted with

each passive assessment done.

Client almost has full ROM at end of

17 months.

Special tests

1st Assessment

Slump – a positive result with increased pain and restriction to left leg

Thomas – an extremely positive result with the clients L & R legs off the table by almost 40cms

Straight leg raise – positive with L 30° R 40°

Ober test – positive with left and right illotibial tension

Stork test – negative

Follow up results at end of 17 months of Bowen treatments, and daily stretching and strengthening exercise.

Slump – continued to show significant improvement with reduced pain and restriction to left leg. At last

assessment client reported general neural sensation.

Thomas – This test has been the biggest indicator with improvement progressing slowly over each

assessment performed. Client now only has a 2 inch space between back of knee and table.

Straight leg raise – L 75° R 85°

Ober test - negative

Please note: - After the first 3 treatments one week apart, this client continued to have approximately 2 to 3

treatments per month.

ACTIVE

MOVEMENT

1st

Consultation

2nd week

Consultation

3rd week

Consultation

After 2

months

After 6

months

After 12

months

End of 17th

month with

2 sessions

/month

Neck Sitting

Rot L 30° R 30°

Lat Flex L30°

R30°

Rot L 40° R 40°

Lat Flex L 35°

R 35°

Rot L 60° R 60°

Lat Flex L 40°

R 40°

continued to

maintain full

ROM in

cervical spine

continued to

maintain full

ROM in

cervical spine

continued to

maintain full

ROM in

cervical spine

continued to

maintain full

ROM in

cervical spine

Lumbar

standing

Flexion 45°

Extension 0°

Flexion 45°

Extension 0°

Flexion 45°

Extension 5°

Flexion 45°

Extension 10°

Flexion 45°

Extension 10°

Flexion 45°

Extension 15°

Flexion 45°

Extension 15°

Sitting

Lumbar Rot

L 20 - 30°

R 15 - 20°

L 20 - 30°

R 20°

L 20 - 30°

R 20 - 30°

L 30 - 40°

R 30 - 40°

L 30 - 40°

R 30 - 40°

L 30 - 40°

R 30 - 40°

L 30 - 40°

R 30 - 40°

Sitting

Lumbar &

Thor Flexion

L 20° R 10° L 20° R 15° L 25° R 15° L 25° R 20° L 25° R 20° L 25° R 20° L 25° R 20°

Procedures

Initial treatment – BRM 1 , 2 , 3 & Head.

Other procedures used and introduced slowly were hamstring, pelvic, knee, ankle, hammer toe, bunion,

sacral, kidney, respiratory, coccyx, sciatic, gracilis, psoas, coccyx oblique, knee reflex and straight up the leg.

Rehabilitation

The client was given the pelvic and hamstring Bowen specific exercises, with hamstring and adductor group

stretches in the first few months, in the last approximately 12 months the client has had increased motivation to

expand his stretch and strengthening regime on a daily basis.

9. Data Analysis – Conclusion

Through thorough assessments it shows that the symptoms of the Adhesive Arachnoiditis have impacted the

neural and muscular ability of this client. Therefore Bowen therapy treatments have addressed the main areas

of the body affected by the symptoms of Adhesive Arachnoiditis i.e. Lumbar/sciatic pain, extreme lumbar,

pelvic, and leg muscular tension, medial rotation of the legs, causing abnormal gait, restricted movement and

ankle / feet deformity and oedema.

Due to the severity of this client symptoms and the long period of a sedentary lifestyle, and that he had gone

many years without any health professional’s consultations, I felt it was important to introduce Bowtech

procedures in measured amounts in order to prevent an overload of reaction.

The client feels that his symptoms have significantly improved with each session and will continue with regular

Bowen therapy treatments to maintain his quality of life. With a daily stretching routine and improved diet his

metal attitude has improved. He has also taken it upon himself to purchase a rowing machine and a stationary

bike to increase his fitness and strength.

10. Sharing Knowledge

The Sufferers of Adhesive Arachnoiditis Associations here in Australia, have put in many hard years of work, as

they endeavour to have this condition acknowledged with the government and medical professions. Also with

discussions amongst fellow Bowtech practitioners, mainstream professionals and, indeed, those suffering from

the condition, will help to increase knowledge and hopefully encourage others to look into the causes and

effects of lumbar and lower limb pain more thoroughly. I firmly believe that Bowtech practitioners have a

place in the successful treatment of the symptoms of Adhesive Arachnoiditis and at the very least in the

improvement of the sufferers’ quality of life. This shows the unique means by which Bowen Therapy assists the

body to utilize its own innate healing ability.

Acknowledgements and Bibliography

‘State of the Art Healing Technique’ Information Brochure presented by the Bowen Therapy Academy of

Australia.

The Bowen Technique, Training and Instruction Manual, Modules 1 and 2, Introduction pages vii to ix, 2007.

MAY, Gil 2006 “Arachnoiditis – A toxic Chemical Tragedy” Nexus Magazine, pages 33-37 August/September

edition 2006.

Websites

http://www.bowen.org.au/

(GROVES, P. President of the Australian Arachnoiditis Sufferers Association NSW) ‘The purpose of this site is to

inform the public, sufferers and their families about Adhesive Arachnoiditis’ the author states that most of this

definition was posted on Gateway to Neurology of Massachusetts General Hospital.

http://www.aasansw.org.au/

Burton, C. August 2013 Edition Volume XIII http://www.burtonreport.com/ accessed 1 September 2013.

http://en.wikipedia.org/wiki/Arachnoiditis

http://www.burtonreport.com/InfSpine/AdhesArachAnatomy.htm

http://www.webmd.com/pain-management/guide/pain-management-arachnoiditis

Mullen 12 February 2013, ‘Report on the Public Roundtable into Adhesive Arachnoiditis’ presented on the

Medical Observer website. Accessed - 20 March 2013. http://www.medicalobserver.com.au/news/govt-seeks-to-raise-profile-of-adhesive-arachnoiditis

Books

Manocchia, P. 2009, Anatomy of Exercise. Hinkler Books Pty Ltd, Victoria Australia.

Kendall, FP. 2005, Muscles Testing and Function with Posture and Pain, Fifth Edition. Lipincott Williams & Wilkins.

Baltimore, USA.

Myers, T W. 2009, Anatomy Trains. Second Edition. Churchill Livingstone Elsevier. United Kingdom.

Marieb, EN. 2012, Essentials fo Human Anatomy and Physiology. Tenth Edition. Pearson Education.

San Francisco CA.

Wilks, J. 2007. The Bowen Technique – The Inside Story. CYMA Ltd. Dorset UK.

Attachment 1

The Anatomy of

Adhesive Arachnoiditis

This illustration (from Noback CR: The Human Nervous System, McGraw-Hill, Inc., 1967) illustrates the human

subarachnoid space surrounding the brain and spinal cord. 60% of spinal fluid is produced within the brain

and 40% from the spinal subarachnoid space. It flows, as shown, and is absorbed by the venous arachnoid

granulations. This spinal fluid is produced at the rate of 0.35cc/min, or 500-750cc/day. Turnover rate is 3-

5 times/day. A normal adult has a ventricular volume of about 30cc and about 100+cc in the surrounding

subarachnoid space. The subarachnoid space serves to be a hydraulic cushion for the floating brain, a

source of nutrition as well neurotransmitters. This space is the most fragile and sensitive area of the

human body.

When the subarachnoid space is subject to insult or inflammatory change damage and scarring occur. One

of the primary difficulties in addressing the subject of neuropathologic change, particularly that of

adhesive arachnoiditis is the great amount of confusion regarding nomenclature. Adhesive arachnoiditis is

an advanced form of arachnoiditis and is most often confused with the latter. Some of the other terms by

adhesive arachnoiditis has been referred to have been:

Serosa Circumscripta Spinalis

Intraspinal Granulomatosis

Obliterative Arachnoiditis

Chronic Arachnoiditis

Spinal Meningitis

Chronic Spinal Meningitis

Chemical Meningitis

Sterile Meningitis

Granulomatous Meningitis

There has been a "Tower of Babel" in regard to the terminology used

to define the normal anatomy of the lumbar spinal column, the dural

membranes, and the subarachnoid space. In the image, to the left,

the nerve rootlets of the cauda equina, which are in motor and

sensory pairs (shown as single nerves for simplification). If a lumbar

puncture were to be performed the needle would simply push the

nerve roots, floating in cerebrospinal fluid, out of the way. If a similar

procedure were attempted in a patient with Class III Adhesive

Arachnoiditis, where the nerve roots were fixed to each other and to

the dura mater, the needle could easily injure or sever the nerves.

Adhesive Arachnoiditis comes about as a progression of inflammatory change secondary to insult or

injury occurring over a period of time. This progression involves:

Acute Inflammatory Phase (Class I)

Beginning of Chronic Phase (Class II)

Chronic Scar Phase (Class III)

Arachnoiditis Ossificans

Adhesive Arachnoiditis: Acute Inflammatory Phase (Class I)

In the illustrations of the first, or acute inflammatory phase, shown above, the nerve roots are swollen and

hyperemic (vascular dilatation). Pathologic specimens show acute inflammatory cells predominating.

Adhesive Arachnoiditis: Beginning of Chronic Phase (Class II)

In the illustrations of the second phase, shown above, the nerve root swelling has progressively

decreased (the nerves are beginning to be encased in collagenous scar tissue). Pathologic specimens

show a mix of acute and chronic inflammatory cells.

Adhesive Arachnoiditis: Chronic Scar Phase (Class III)

By the time the process has reached the chronic phase there is prominent collagenous scar deposition. The

nerve roots are adherent to each other and to the meninges. Surgically opening the dura often shows

what appears to be an empty sac because the nerves are now actually part of the dural membrane. By the

Class III stage the inflammatory cells seen document a chronic process. The nerves themselves have been

progressively deprived of nourishment as the nutrient blood vessels have atrophied and the "percolating"

nourishment derived from the cerebrospinal fluid has markedly decreased. It is, in fact, a tribute to the

human nervous system that in the face of such adversity, in can, in the great majority of cases, continue to

maintain "normal" function. The only way this can happen is if the adverse process occurs slowly enough

to allow the system to adapt and acclimate. The acclimization is, however, fragile. Because function is

maintained precariously any additional insult (i.e. trauma, surgery, myelography, etc.) can tip the balance

and cause onset of clinical disability and incapacitation.

By far the greatest number of cases of adhesive arachnoiditis which have occurred throughout the world

during the 20th century resulted from oil myelography with either Pantopaque® or Myodil®. Because

these substances are hyperbaric once they were placed in the subarachnoid space they would migrate to

the distal portion, where they remained, producing progressive scarring.

The patterns of adhesive arachnoiditis scar are typically quite variable in their patterns. Shown above are

drawings of variable scar patterns in three actual cases. These are patterns reflecting diffuse, multi-level

involvement, characteristic of the introduction of a toxic foreign body substance into the sub-arachnoid

space. The last illustrations to the right shows how residual droplets of foreign body substance (in this

case Pantopaque®) are surrounded by encapsulating scar reflecting the body's defense against foreign

body substances.

The illustrations to the left

demonstrate an example of focal

adhesive arachnoiditis. In this case

it is due to the local inflammatory

effect of a hypertrophic facet joint

intruding into the central spinal

canal. Focal inflammation is also

typical following segmental spinal

trauma or focal spinal surgery.

Adhesive Arachnoiditis: Arachnoiditis Ossificans

The image to the left is a year 2000 CT scan performed on a 71 year old

woman who developed clinically significant adhesive arachnoiditis

following a 1971 Pantopaque® myelogram. Control of her constant pain

required implantation of a spinal cord neurostimulator which provided

good pain control allowing the patient return to normal function. In 1990

she began to experience progressive bowel and bladder dysfunction. The

CT scan shows classic arachnoiditis ossificans where the scar tissue has

calcified.

The red dots represent the spaces occupied by the nerve roots. These nerves are being progressively

strangled by the progression of scar calcification.