Cauda equina syndrome complicating ankylosing spondylitis: use of electromyography and computerised tomography in diagnosis.

Young, A. Byron; Dixon, Anne-Marie; Getty, John M.; Renton, P.; Vacher, Henri

doi:10.1136/ard.40.3.317

Cited by 28 publications

(7 citation statements)

References 16 publications

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“…Consequently, the lower spinal canal is extended dorsally in an irregular, lobulated manner. The erosions of the laminae are rarely seen on plain spine roentgenograms [23, 301 but have been noted postmortem [lo, 191, at operation C13, 261, and on computed tomographic scan [14,26,30). The dorsal arachnoid diverticula and contiguous bony erosions are shown particularly well by computed tomographic scanning of the lumbosacral spine (Figure).…”

Section: Discussionmentioning

confidence: 99%

Cauda equina syndrome secondary to long‐standing ankylosing spondylitis

Bartleson

Cohen

Harrington

et al. 1983

Annals of Neurology

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Fourteen patients with cauda equina syndrome secondary to long-standing ankylosing spondylitis are described. The roughly symmetrical neurological deficits were very slowly progressive and began long after the onset of the spondylitis, usually well after the rheumatological symptoms had stopped. Eventually every patient had cutaneous sensory loss in the fifth lumbar and sacral dermatomes. All patients developed urinary sphincter disturbances of a lower motor neuron type. There was prominent loss of rectal sphincter tone, and all but 2 patients had bowel complaints, including incontinence and severe constipation. Seven patients had mild to moderate weakness in the lumbosacral myotomes. Seven patients had pain in the rectum or lower limbs. Electromyographic abnormalities were consistent with multiple lumbosacral radiculopathies. Myelography and computed tomographic scanning of the lumbosacral spine showed characteristic enlargement of the caudal sac and dorsal arachnoid diverticula that had eroded the laminae and spinous processes. Recognition of this syndrome, coupled with computed tomographic scanning of the lower spinal canal, allows one to omit myelography, a procedure that is difficult because of the associated spine abnormalities. Surgical intervention should be avoided.

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Section: Discussionmentioning

confidence: 99%

Cauda equina syndrome secondary to long‐standing ankylosing spondylitis

Bartleson

Cohen

Harrington

et al. 1983

Annals of Neurology

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“…Proximal weakness and atrophy, sometimes with mild elevations of creatinine kinase values, often occur in advanced cases of AS suggesting an inflammatory myopathy 5 6. Although the natural history of the disease remains poorly understood, spinal complications include: (1) the involvement of atlantoaxial joint subluxation;7 (2) spinal fractures and pseudoarthroses;7 (3) discovertebral destruction; (4) spinal canal stenosis; and (5) cauda equina syndrome caused by lumbar arachnoid diverticula 8 – 10…”

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confidence: 99%

Ankylosing spondylitis in sub-Saharan Africa

Belachew

Sandu

Schaller

et al. 2009

Postgraduate Medical Journal

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Ankylosing spondylitis (AS) represents a chronic inflammatory bone disease of the axial skeleton that manifests as chronic back pain and progressive stiffness of the spine. It characteristically affects young adults with a peak age of onset between 20-30 years. In contrast to Western Europe and North America, the disease is rare in Sub-Saharan Africa where the majority of the population is HLA-B27 negative. Even in some African populations where HLA-B27 is prevalent (for example, in Gambia and Senegal, where 3-6% of the general population has HLA-B27), the disease is also said to be rare. However, some other genetic markers may be involved in the causation of AS in the HLA-B27 negative population, and when it occurs in this subgroup of patients it has a similar manifestation with HLA-B27 negative white patients and these patients rarely develop anterior uveitis. The clinical presentation of the disease in Africa is generally milder; most affected individuals do not have a family history of AS, the patients are older at onset of the disease, and the majority of them lack extra-articular manifestations such as anterior uveitis compared with the situation in Western Europe and North America. In conclusion, AS in sub-Saharan Africa seems to represent a subgroup of the disease, which may open the window to a greater understanding of the pathophysiology of the condition.

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“…These findings do not always point to a lesion at the cauda equina level and one should remember that other causes of cauda equina syndrome, e.g., compression by a tumour, must be excluded. The electromyogram may demonstrate more widespread involvement than clinically suspected (1,8).…”

Section: Discussionmentioning

confidence: 96%

Cauda equina syndrome complicating ankylosing spondylitis: Role of computed tomography and magnetic resonance imaging

et al. 1994

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We present two cases of cauda equina syndrome in ankylosing spondylitis. Cauda equina syndrome is a rare complication of ankylosing spondylitis, the pathogenesis of which is not well understood. The onset is insidious with pain and sensory symptoms; sphincter disturbances are common. After a period of increasing neurological symptoms, the condition tends to stabilize. The degree of nerve involvement is variable and can be accurately defined by electromyography. The diagnosis has to be confirmed by computed tomography (CT) or magnetic resonance imaging (MRI); myelography must be avoided. There is no specific treatment, except for pain control. The different clinical presentations and the role of new imaging techniques, CT and MRI, are demonstrated.

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Cauda equina syndrome complicating ankylosing spondylitis: use of electromyography and computerised tomography in diagnosis.

Abstract: SUMMARY A case of the cauda equina syndrome complicating ankylosing spondylitis (AS) is described. An

Cited by 28 publications

References 16 publications

Cauda equina syndrome secondary to long‐standing ankylosing spondylitis

Cauda equina syndrome secondary to long‐standing ankylosing spondylitis

Ankylosing spondylitis in sub-Saharan Africa

Cauda equina syndrome complicating ankylosing spondylitis: Role of computed tomography and magnetic resonance imaging

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