Spinal adhesive arachnoiditis

Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

RH No. 74 of 2020 · BoP No. 75 of 202059 factors

Meaning of spinal adhesive arachnoiditis: For the purposes of this Statement of Principles, spinal adhesive arachnoiditis: (a) means: (i) chronic inflammation of the arachnoid membrane of the spinal cord, with fibrosis and nerve root adhesions in the arachnoid and subarachnoid space that have been demonstrated by imaging or surgery; and (ii) neurological symptoms and signs that are consistent with the observed spinal pathology; and (b) includes arachnoiditis ossificans; and (c) excludes asymptomatic transient inflammation of the arachnoid membrane and arachnoid inflammation involving the brain and cranial nerves.

Reasonable Hypothesis (RH) — Statement of Principles No. 74 of 2020

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting spinal adhesive arachnoiditis or death from spinal adhesive arachnoiditis with the circumstances of a person's relevant service:

(1)
having severe spinal trauma involving the affected site within the ten years before the clinical onset of spinal adhesive arachnoiditis;
Note: severe spinal trauma is defined in the Schedule 1 - Dictionary.
(2)
undergoing spinal surgery involving the affected site within the ten years before the clinical onset of spinal adhesive arachnoiditis;
Note: Examples of spinal surgery include spinal fusion, laminectomy and discectomy.
(3)
having a lumboperitoneal shunt at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;
(4)
having an epidural blood patch within the three months before the clinical onset of spinal adhesive arachnoiditis;
(5)
having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical onset of spinal adhesive arachnoiditis;
(6)
having a myelogram involving an injection of water-soluble intrathecal radiological contrast agent from the specified list of radiological contrast agents within the ten years before the clinical onset of spinal adhesive arachnoiditis;
Note: specified list of radiological contrast agents is defined in the Schedule 1 - Dictionary.
(7)
having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical onset of spinal adhesive arachnoiditis;
(8)
having intrathecal injection of methylprednisolone acetate (Depo- Medrol) within the two years before the clinical onset of spinal adhesive arachnoiditis;
(9)
having an in situ intrathecal drug delivery system at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;
(10)
having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical onset of spinal adhesive arachnoiditis;
(11)
having intrathecal injection of radioactive gold at the affected site before the clinical onset of spinal adhesive arachnoiditis;
(12)
having an infection from the specified list of infections before the clinical onset of spinal adhesive arachnoiditis;
Note: specified list of infections is defined in the Schedule 1 - Dictionary.
(13)
having a subarachnoid haemorrhage within the ten years before the clinical onset of spinal adhesive arachnoiditis;
(14)
having a spinal subdural haematoma at the affected site within the two years before the clinical onset of spinal adhesive arachnoiditis;
(15)
having ankylosing spondylitis involving the affected site before the clinical onset of spinal adhesive arachnoiditis;
(16)
having an intervertebral disc prolapse causing spinal stenosis at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;
(17)
having sarcoidosis before the clinical onset of spinal adhesive arachnoiditis;
(18)
having severe spinal trauma involving the affected site within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
Note: severe spinal trauma is defined in the Schedule 1 - Dictionary.
(19)
undergoing spinal surgery involving the affected site within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
Note: Examples of spinal surgery include spinal fusion, laminectomy and discectomy.
(20)
having a lumboperitoneal shunt at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;
(21)
having an epidural blood patch within the three months before the clinical worsening of spinal adhesive arachnoiditis;
(22)
having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical worsening of spinal adhesive arachnoiditis;
(23)
having a myelogram involving an injection of water-soluble intrathecal radiological contrast agent from the specified list of radiological contrast agents within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
Note: specified list of radiological contrast agents is defined in the Schedule 1 - Dictionary.
(24)
having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical worsening of spinal adhesive arachnoiditis;
(25)
having an in situ intrathecal drug delivery system at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;
(26)
having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical worsening of spinal adhesive arachnoiditis;
(27)
having intrathecal injection of radioactive gold at the affected site before the clinical worsening of spinal adhesive arachnoiditis;
(28)
having an infection from the specified list of infections before the clinical worsening of spinal adhesive arachnoiditis;
Note: specified list of infections is defined in the Schedule 1 - Dictionary.
(29)
having a subarachnoid haemorrhage within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
(30)
having a spinal subdural haematoma at the affected site within the two years before the clinical worsening of spinal adhesive arachnoiditis;
(31)
having ankylosing spondylitis involving the affected site before the clinical worsening of spinal adhesive arachnoiditis;
(32)
having an intervertebral disc prolapse causing spinal stenosis at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;
(33)
having sarcoidosis before the clinical worsening of spinal adhesive arachnoiditis;
(34)
inability to obtain appropriate clinical management for spinal adhesive arachnoiditis;

Aggravation-only factors: the factors in subsections 9(18) to 9(34) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Balance of Probabilities (BoP) — Statement of Principles No. 75 of 2020

25 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, spinal adhesive arachnoiditis or death from spinal adhesive arachnoiditis is connected with the circumstances of a person's relevant service:

(1)
having severe spinal trauma involving the affected site within the ten years before the clinical onset of spinal adhesive arachnoiditis;
Note: severe spinal trauma is defined in the Schedule 1 - Dictionary.
(2)
undergoing spinal surgery involving the affected site within the ten years before the clinical onset of spinal adhesive arachnoiditis;
Note: Examples of spinal surgery include spinal fusion, laminectomy and discectomy.
(3)
having a lumboperitoneal shunt at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;
(4)
having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical onset of spinal adhesive arachnoiditis;
(5)
having a myelogram involving an injection of water-soluble intrathecal radiological contrast agent from the specified list of radiological contrast agents within the ten years before the clinical onset of spinal adhesive arachnoiditis;
Note: specified list of radiological contrast agents is defined in the Schedule 1 - Dictionary.
(6)
having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical onset of spinal adhesive arachnoiditis;
(7)
having an in situ intrathecal drug delivery system at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;
(8)
having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical onset of spinal adhesive arachnoiditis;
(9)
having intrathecal injection of radioactive gold at the affected site before the clinical onset of spinal adhesive arachnoiditis;
(10)
having an infection from the specified list of infections before the clinical onset of spinal adhesive arachnoiditis;
Note: specified list of infections is defined in the Schedule 1 - Dictionary.
(11)
having a subarachnoid haemorrhage within the ten years before the clinical onset of spinal adhesive arachnoiditis;
(12)
having a spinal subdural haematoma at the affected site within the two years before the clinical onset of spinal adhesive arachnoiditis;
(13)
having severe spinal trauma involving the affected site within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
Note: severe spinal trauma is defined in the Schedule 1 - Dictionary.
(14)
undergoing spinal surgery involving the affected site within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
Note: Examples of spinal surgery include spinal fusion, laminectomy and discectomy.
(15)
having a lumboperitoneal shunt at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;
(16)
having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical worsening of spinal adhesive arachnoiditis;
(17)
having a myelogram involving an injection of water-soluble intrathecal radiological contrast agent from the specified list of radiological contrast agents within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
Note: specified list of radiological contrast agents is defined in the Schedule 1 - Dictionary.
(18)
having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical worsening of spinal adhesive arachnoiditis;
(19)
having an in situ intrathecal drug delivery system at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;
(20)
having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical worsening of spinal adhesive arachnoiditis;
(21)
having intrathecal injection of radioactive gold at the affected site before the clinical worsening of spinal adhesive arachnoiditis;
(22)
having an infection from the specified list of infections before the clinical worsening of spinal adhesive arachnoiditis;
Note: specified list of infections is defined in the Schedule 1 - Dictionary.
(23)
having a subarachnoid haemorrhage within the ten years before the clinical worsening of spinal adhesive arachnoiditis;
(24)
having a spinal subdural haematoma at the affected site within the two years before the clinical worsening of spinal adhesive arachnoiditis;
(25)
inability to obtain appropriate clinical management for spinal adhesive arachnoiditis;

Aggravation-only factors: the factors in subsections 9(13) to 9(25) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Spinal adhesive arachnoiditis — DVA SoP factors