Cauda equina syndrome and dural ectasia: rare manifestations in chronic ankylosing spondylitis

Abstract

Cauda equina syndrome (CES) is a rare manifestation in patients with long-standing ankylosing spondylitis (AS). We report a 57-year-old male patient with a 30-year history of AS who developed CES in the past 4 years. The CT and MRI examinations showed unique appearances of dural ectasia, multiple dorsal dural diverticula, erosion of the vertebral posterior elements, tethering of the conus medullaris to the dorsal aspect of the spinal canal and adhesion of the nerve roots of the cauda equina to the wall of the dural sac. A large dural defect was found at surgery. De-adhesion of the tethered conus medullaris was performed but without significant clinical improvement. The possible aetiologies of CES and dural ectasia in patients with chronic AS are discussed and the literature is reviewed.

Regional Anesthesia in Patients With Preexisting Neurologic Disease

“…127,128 Dural ectasia is also known to occur in patients with Patau syndrome (trisomy 13), 129 Ehlers-Danlos syndrome, neurofibromatosis type I, and ankylosing spondylitis. 130 Several case reports have described inadvertent dural puncture during caudal anesthesia 129,131,132 and incomplete spinal anesthesia 133 in patients with dural ectasia.…”

Physical Therapy and Surgery

“…Case series and meta-analyses confirm cauda equina to be a rare complication of AS, in which dural sac enlargement and arachnoid diverticulae lead to progressive neurological impairment 38, 39 . Lumbo--peritoneal decompression and infliximab have both been reported to be effective treatments 40, 41 .…”

Neurologic Disorders Associated with Bone and Joint Disease

“…117 In most patients, there are no inflammatory markers in the blood. 123 Nerve roots appear to deviate toward the diverticula and may be displaced posteriorly; they appear to be adherent to the arachnoid membrane and to each other, suggesting arachnoiditis. Bladder symptoms include decreased awareness of bladder sensation, decreased ability to empty the bladder, hesitancy, decreased force of urinary stream, urgency, and frequency.…”

“…118,123 The typical presentation includes insidious onset and progression of bowel and bladder symptoms, sensory loss (often asymmetric) in an L5-S4 distribution, pain radiating into the lower limbs or the rectal area, and minimal weakness in muscles innervated by the L5-S2 segments. 123 Infrequently, erosion of the posterior portion of the vertebral body is found or involvement is unilateral or confined to one level. Radiography of the lumbar spine may show erosions of the lamina.…”