Destructive Dural Ectasia of Dorsal and Lumbar Spine with Cauda Equina Syndrome in a Patient with Ankylosing Spondylitis~!2010-06-04~!2010-06-24~!2010-08-26~!

Abstract

We present a patient with longstanding ankylosing spondylitis complicated with cauda equina syndrome. The patient suffered from increasing pain in the leg with reduced sensitivity and extremely cold feet associated with incontinence. Diagnostic workup revealed dural ectasia, arachnoiditis and a spinal inflammatory mass leading to extensive vertebral bone destruction. Of interest, this was not only found in the lumbar spine region (which is typical in cases of cauda equina syndrome associated with ankylosing spondylitis) but also in the lower cervical spine (C7) and upper dorsal spine. Moreover, the bone destructive phenotype of this complication of long-standing AS contrasts with the usual characteristics of new bone formation and ankylosis. As initial treatment with anti-inflammatory drugs was not sufficiently successful, infliximab therapy was started which resulted in manifest clinical improvement as chronic pain, incontinence and laboratory signs of inflammation progressively disappeared.

Horse's tail in bamboo spine: the ‘cauda equina syndrome in ankylosing spondylitis’

“…Nevertheless, both procedures risk significant complications in patients with ankylosing spondylitis 2. There are two case reports describing the successful treatment of the syndrome using the tumour necrosis factor-α antagonist, infliximab,5 6 with resolution of faecal incontinence in one5 and partial relief of radicular pain and faecal incontinence in the other 6. These two patients reported only subjective benefits without improvement in objective neurological signs (unlike in this case).…”

Intravertebral pseudomeningocele: an unusual complication after disc surgery

“…Dural ectasias are large dilatations of the normal spinal sac and generally form large cysts around the nerve roots. These ectasias are common in patients suffering from collagen tissue disorders such as Marfan syndrome and Ehler-Danlos syndrome [6], but can also be encountered in neurofibromatosis and ankylosing spondylitis [7,8]. When they induce posterior vertebral scalloping, meningoceles and dural ectasias are typically associated with large intracanalar cystic component.…”

Neurologic Disorders Associated with Bone and Joint Disease

“…116 A detailed description of treatments for ankylosing spondylitis is summarized elsewhere. 117,118 They include radiculopathy from foraminal stenosis or inflammation and myelopathy resulting from fracture-dislocation, atlantoaxial subluxation, pseudoarthritis, ossified intraspinal ligaments, or granulation tissue. 117,118 They include radiculopathy from foraminal stenosis or inflammation and myelopathy resulting from fracture-dislocation, atlantoaxial subluxation, pseudoarthritis, ossified intraspinal ligaments, or granulation tissue.…”