Cauda Equina Syndrome in Ankylosing Spondylitis: Challenges in Diagnosis, Management, and Pathogenesis

Tang, Chengzhou; Moser, Franklin G.; Reveille, John D.; Brückel, J; Weisman, Michael H.

doi:10.3899/jrheum.181259

Cited by 19 publications

(12 citation statements)

References 31 publications

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“…The time interval between the onset of AS and the clinical manifestation of CES averages 35 years (range 17-53 years) [7] . MRI characteristically shows an enlarged caudal thecal sac, bone erosion and dural ectasia [3] . The lesions primarily affect the lumbar region but can also appear in the thoracic region [8] .…”

Section: Discussionmentioning

confidence: 99%

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Anterior dural ectasia associated with cauda equine syndrome in ankylosing spondylitis: a case report

Liu¹,

Chen²,

Liang³

2020

Preprint

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Background: Cauda equina syndrome (CES) is a rare neurologic complication in patients with long-standing ankylosing spondylitis (AS). MRI characteristically shows an enlarged caudal thecal sac, bone erosion and dural ectasia. Dural ectasia is more likely to occur in the posterior elements rather than the vertebral bodies. Methods: We report an uncommon case of CES in AS with formation of anterior dural ectasia. The origin of this rare pathology is analysed and relevant literatures are reviewed. Results: The patient had a 50-year history of AS and presented with weakness of his left leg but without bladder or rectal dysfunction. Radiographs of the full spine showed the classic features of AS with fusion of all spinal ligaments and bilateral sacroiliac joints. CT scanning demonstrated erosion-like lesions with marginal sclerosis in the posterior aspect of the T12 and L1 vertebral bodies. Lumbar MRI revealed anterior dural ectasia into the vertebral body, and ventral herniation of the spinal cord and adhesion to the dural sac. Conclusions: The clinical manifestations of anterior dural ectasia in AS with CES include lower limb numbness and weakness, bladder and rectal dysfunction, impotence, etc. MRI characteristically shows an enlarged caudal thecal sac, bone erosion and anterior dural ectasia at the junction of thoracolumbar and upper lumbar.

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Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) of CES in AS characteristically shows an enlarged caudal thecal sac, bone erosion and dural ectasia [3] . Dural ectasia is more likely to occur in the posterior elements rather than the vertebral bodies [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Anterior dural ectasia associated with cauda equine syndrome in ankylosing spondylitis: a case report

Liu¹,

Chen²,

Liang³

2020

Preprint

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“…According to Tang et al ., (), it is unclear what causes equine tail syndrome, and no effective therapy has been reported so far. However, it is possible that unique characteristics related to spinal and dural anatomy and the distribution of mechanical forces in the thoraco‐lumbar spine that occur over time may have an unrecognized contribution to the etiopathogenesis resulting in the compression of the nerve roots of the cauda equina.…”

Section: Discussionmentioning

confidence: 99%

Vertebromedullary Topography of the Red‐Rumped Agouti (Dasyprocta leporina Linnaeus, 1758)

Júnior

Oliveira

Costa

et al. 2019

The Anatomical Record

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The agouti is a wild rodent located almost throughout the Brazilian territory, with great scientific importance and high reproductive potential when farmed. In the clinical routine, clinical and surgical procedures are performed on the nervous system of these animals, such as epidural anesthesia and cerebrospinal fluid (CSF) collection; however, data available are limited in literature on the main points of these procedures in this species. In this aspect, the objective was to describe the vertebromedullary topography of the agouti in order to identify and quantify it, with the intention of expanding the information regarding the clinical-surgical procedures in this system. Ten animals were incised longitudinally in the dorsal median line, removing the skin, the musculature, and dorsal fascia of the vertebral column; then, removed the vertebral arches and consequent exposure of the spinal cord and meninges. The morphometry of the animals was done by obtaining the total length, body length, and crown-rump length, as well as the total length of the spinal cord and its segments. The cervical intumescence in the agouti is located between C4-T1 and measures 2.45 cm. The lumbar intumescence is between L5-L7 and is 2.52 cm long. The cauda equina arises from S2 and the filum terminale from S3. As for the medullary cone, it is located between L7-S1 and is 2.52 cm long. The suggested localization for epidural anesthesia or CSF puncture for laboratory tests in agoutis is the lumbosacral space, with the insertion of the needle to be carried out at angle of 90 in the sphinx position.

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“…Autoimmune disease as ankylosing spondylitis, lumbosacral plexopathy, demyelinating polyneuropathy, and acute transverse myelitis could occur symptom mimicking CES. These are not an operative conditions but a medical treatment should be performed 10) .…”

Section: Neuro-inflammatory Diseasementioning

confidence: 99%

Guidelines for Cauda Equina Syndrome Management

Hur

Park

Lee

et al. 2019

J Neurointensive Care

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The cauda equina syndrome (CES) is an urgent situation which needs immediate surgery. However, proper diagnosis is often confused. There are some clinical check points; bilateral radiculopathy, impaired perineal sensation, impaired anal tone, and urinary retention. In addition, magnetic resonance image should match the clinical symptom. With these clinical and radiographic evidences, we can classify CES as CES suspected or suspicious (CESS), incomplete CES (CESI), and CES with neurogenic retention of urine (CESR). All these situations may need surgery, however, the timing of surgery and neurologic outcomes are various. Herein we prescribe the guideline for proper treatment strategy of CES.

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Cauda Equina Syndrome in Ankylosing Spondylitis: Challenges in Diagnosis, Management, and Pathogenesis

Cited by 19 publications

References 31 publications

Anterior dural ectasia associated with cauda equine syndrome in ankylosing spondylitis: a case report

Anterior dural ectasia associated with cauda equine syndrome in ankylosing spondylitis: a case report

Vertebromedullary Topography of the Red‐Rumped Agouti (Dasyprocta leporina Linnaeus, 1758)

Guidelines for Cauda Equina Syndrome Management

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