MRI and CT of ankylosing spondylitis with vertebral scalloping

Abello, Ricardo; Rovira, M; Sanz, M. P.; Gili, Jaume; Capdevila, Antoni; Escalada, Javier; Peri, J.

doi:10.1007/bf00341843

Cited by 33 publications

(9 citation statements)

References 9 publications

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“…This anomaly is assumed to arise from a congenital or acquired weakening of the dura mater and has been described in patients with NF1, Marfan syndrome, Ehlers-Danlos syndrome, ankylosing spondylitis, and traumatic injuries. 1,10,22,43 Progressive bone defects often arise near these areas of malformed dura. In patients with NF1, dural ectasia is most commonly seen in the thoracic and lumbar spine 15 although involvement of the optic foramen, 11 internal auditory canal, 12,34 and calvaria 5,24 also have been observed.…”

Section: Discussionmentioning

confidence: 99%

Calvarial defects associated with neurofibromatosis Type 1

Mislow¹,

Proctor²,

McNeely³

et al. 2007

Journal of Neurosurgery: Pediatrics

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Calvarial osteolysis is a relatively rare finding in patients with neurofibromatosis. The authors describe two patients with neurofibromatosis Type 1 (NF1) and extensive cranial defects associated with underlying dural ectasia. Cranioplasties were performed in both patients with mixed results. One patient underwent cranioplasty using titanium mesh and methylmethacrylate. The other patient underwent an extensive cranioplasty with autogenous iliac crest grafting, and after initial healing has since had further bone resorption. In conclusion, the results of cranial reconstruction in patients with NF1 and dural ectasia are unpredictable because of the tendency for further bone resorption; techniques that protect the graft material from cerebrospinal fluid pulsations via a rigid mesh should be considered.

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Section: Discussionmentioning

confidence: 99%

Calvarial defects associated with neurofibromatosis Type 1

Mislow¹,

Proctor²,

McNeely³

et al. 2007

Journal of Neurosurgery: Pediatrics

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“…7 Dural ectasia has also been reported in patients with neurofibromatosis type 1, Ehler-Danlos syndrome, ankylosing spondylitis, trauma, tumours, and scoliosis. [12][13][14] The severity of DE can be evaluated by computed tomography or MRI using either quantitative (actual dural sac measurements) or qualitative (evaluating the prevalence of different features of DE, i.e., scalloping) criteria. There are no universally accepted quantitative criteria for diagnosing DE, and various methods have been used, including evaluation of dural sac ratio, 15 assessment of dural sac diameter at S1 and L4 levels, nerve root sleeve diameter, 16 and lumbar pedicle width.…”

Section: Discussionmentioning

confidence: 99%

Regional anesthesia in Marfan syndrome, not all dural ectasias are the same: a report of two cases

Baghirzada

Krings

Carvalho

2012

Can J Anesth/J Can Anesth

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Background The anesthetic management of women with Marfan syndrome and dural ectasia undergoing Cesarean delivery remains controversial. We present two cases of patients with Marfan syndrome and dural ectasia where neuraxial anesthesia was used successfully. Case 1 A 31-yr-old G1P0 female with Marfan syndrome presented for elective Cesarean delivery at 35 3/7 weeks' gestation. The magnetic resonance imaging of her spine revealed significant dural ectasia in the lumbosacral area with a mean lumbar dural sac area of 4.71 cm 2 . Intrathecal administration of 0.75% hyperbaric bupivacaine 9 mg produced only limited perineal analgesia. The epidural catheter was titrated, and 0.5% bupivacaine 150 mg were required to achieve a T4 sensory level. Case 2 A 34-yr-old G1P0 female with Marfan syndrome presented for elective Cesarean delivery at 37 weeks' gestation. The intrathecal administration of 0.75% hyperbaric bupivacaine 13.5 mg produced a T5 sensory level. Magnetic resonance imaging of her spine prior to discharge confirmed the diagnosis of moderate dural ectasia with a mean lumbar dural sac area of 3.61 cm 2 . Discussion The two patients described in this report responded differently to spinal anesthesia, most likely based on the severity of their dural ectasia. Although preoperative magnetic resonance imaging may help to identify patients at risk for a failed spinal, we suggest considering a combined spinal-epidural technique in cases of dural ectasia. RésuméContexte La prise en charge anesthe´sique de femmes ayant un syndrome de Marfan et une ectasie de la dure-me`re au cours d'un accouchement par ce´sarienne reste un sujet controverse´. Nous pre´sentons le cas de deux patientes ayant un syndrome de Marfan et une ectasie de la dure-me`re chez qui une anesthe´sie neuraxiale a e´te´re´alise´e avec succe`s. Cas n8 1 Une femme de 31 ans, G1P0, ayant un syndrome de Marfan a e´te´admise pour accouchement par ce´sarienne programme´a`35 semaines et 3 jours de grossesse. L'imagerie par re´sonance magne´tique de la colonne verte´brale a re´ve´le´une ectasie significative de la dure-me`re dans la re´gion lombosacre´e avec une surface moyenne du sac dural lombaire de 4,71 cm 2 . L'administration intrathe´cale de 9 mg de bupivacaı¨ne hyperbare a`0,75 % n'a procure´qu'une analge´sie pe´rine´ale limite´e. La dose du cathe´ter pe´ridural a e´te´titre´e et 150 mg de bupivacaı¨ne 0,5 % ont e´te´ne´cessaires pour atteindre le niveau sensitif D4. Cas n8 2 Une femme de 34 ans, G1P0, ayant un syndrome de Marfan a e´te´admise pour accouchement par ce´sarienne programme´a`37 semaines de grossesse. L'administration intrathe´cale de 13,5 mg de bupivacaı¨ne Author contributions Leyla Baghirzada and Jose C.A. Carvalho cared for patients, reviewed the literature, and wrote the manuscript. Jose C.A. Carvalho and Timo Krings revised the manuscript, and Leyla Baghirzada submitted the final version of the manuscript. Timo Krings interpreted the magnetic resonance imagings for both patients.

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“…Often, the AS itself appears relatively inactive by the time CES symptoms appear. 70 Clinically, patients experience cutaneous sensory disturbances in the L5 and sacral dermatomes, urinary and rectal sphincter disturbances, variable weakness in the lower extremities, and occasionally lower extremity or perineal pain. 46,71 The pathophysiology of CES developing in patients with AS remains unknown.…”

Section: Ossification Of Paraspinal Ligamentsmentioning

confidence: 99%

“…It has been speculated that inflammation of the posterior facet joints may induce a mild arachnoiditis, which may lead to adhesions within the thecal sac, with subsequent development of progressive dural ectasia and/ or arachnoid diverticulae, which may cause symptoms by exerting pressure on the nerve roots. 70 Plain radiographs and CT may show asymmetric erosions of the pedicles, laminae, or spinous processes of the lumbosacral spine, with widening of the neural canal at one or more levels. 72 CT alone, without myelography, cannot totally exclude intradural mass or disc fragment, causing nerve root compression, as a cause of symptoms.…”

Section: Ossification Of Paraspinal Ligamentsmentioning

confidence: 99%

MR Imaging of Ankylosing Spondylitis

2003

Semin Musculoskelet Radiol

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Ankylosing spondylitis (AS) is one of a group of disorders characterized by association with HLA-B27 histocompatibility complex, seronegativity for rheumatoid factor, and propensity for inflammation at entheses, synovial articulations, and cartilaginous articulations. The radiographic hallmark of the disease is ankylosis, and the principle sites of involvement are the sacroiliac joints and spine, with less frequent involvement of other joints, including the pubic symphysis, hips, shoulders, knees, hands, feet, and sternoclavicular, acromioclavicular, sternomanubrial, and temporomandibular joints. Following a brief discussion of the basic pathophysiology and typical clinical findings of AS, we describe the typical magnetic resonance imaging features of the disease as it is manifests in the axial skeleton. Finally, a brief mention of special considerations in the radiographic evaluation of the AS patient in the setting of trauma is made.

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MRI and CT of ankylosing spondylitis with vertebral scalloping

Cited by 33 publications

References 9 publications

Calvarial defects associated with neurofibromatosis Type 1

Calvarial defects associated with neurofibromatosis Type 1

Regional anesthesia in Marfan syndrome, not all dural ectasias are the same: a report of two cases

MR Imaging of Ankylosing Spondylitis

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