Maria, I'm relatively new to the arach world. I hope that Claudine will be along to clarify things. My understanding is that it is visible on MRI. I hope that someone will post some sample images soon.
I have come to trust Dr. Warnke's opinion. As I understand him, arach is activated by blood, contrast, medications or other foreign substances introduced intradural. Most people will not have a horrible reaction (or they could not do epidural anesthesia, myelography, intrathecal pumps, etc...) Some people will have a highly elevated immune or inflammatory response that kicks off formation of adhesions between nerve rootlets or between rootleds and the arachnoid layer of the cauda equina. This tethering of the nerve rootles creates a constant irritation that generates the neuropathic pain. That process is also responsible for forming the Tarlov or neuroforaminal cysts.
As I understand Dr. Warnke, the inflammatory response can cool down. I don't know if that allows the symptoms to subside. (Claudine?) However, in the patients that have the elevated response (proven by the formation of arach), further spine surgery risking more assults on the dura, can cause more of the elevated response an make things much, much worse.
More as I learn it.
Mark
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