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Arachnoiditis: the silent epidemic
  1. J Van Dellen

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    Edited by J Antonio Aldrete (Pp 339, US$110.00). Published by Futuremed Publishers, Denver, and the Arachnoiditis Foundation Inc, Seaside, 2000. ISBN 968-7860-56-1

    This book provides a comprehensive analysis, and comments on a condition we hope will be significantly reduced in incidence with new imaging modalities. It provides an extensive bibliography providing reference on the views expressed, the likely multifactorial aetiological factors responsible for the development of a very disabling combination of signs and symptoms, and management strategies. The earlier chapters provide a historical perspective together with relevant anatomical, pathological, and physiological information, which will be useful to the reader while reading the later chapters. Although the book discusses predominantly the spinal arachnoid, it also covers important cranial subdivisions of the condition, in addition to associated conditions such as syringomyelia. There is an interesting section on questionable causes of arachnoiditis, which are very relevant because the previously predominant causes—namely, injection of foreign materials into the intrathecal compartment of the spine for diagnostic and therapeutic purposes—are no longer used or are regarded with circumspection. The final sections relate to the thorny question of diagnosis, which is extremely difficult, and to the limited treatment options available. Arachnoiditis is a condition that would be better prevented than treated. Unfortunately, the prognosis remains bleak for these patients but the management strategies in dealing with multiple concerns faced by such patients are well described. The senior author is to be congratulated on producing a single volume, based on some eight thousand references, and his undoubted unique experience of dealing with hundreds of such cases, which is a unique contribution to our body of knowledge.

    It is salutary reading for some of the more senior members of our profession and will provide guidance to the younger members. It is a useful book for anyone treating patients with this awful affliction and it can provide guidance to those involved in dealing with patient complaints or litigation. The book provides both philosophical and scientific viewpoints.