Document Detail


Cauda equina syndrome in ankylosing spondylitis: successful treatment with lumboperitoneal shunting.
MedLine Citation:
PMID:  21030893     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
STUDY DESIGN: Retrospective study.
OBJECTIVE: To assess outcomes after lumboperitoneal shunting for CES with dural sac dilation and multiple arachnoid diverticula in patients with long-standing AS.
SUMMARY OF BACKGROUND DATA: Cauda equina syndrome (CES) is a rare complication of long-standing ankylosing spondylitis (AS). Neurologic symptoms occur insidiously and have a poor prognosis without effective treatment.
METHODS: We retrospectively studied cases seen between 1997 and 2009 at our university-hospital rheumatology department.
RESULTS: We identified 9 patients with AS and dural sac dilation (mean age: 64, range: 38-75), of whom 8 experienced CES 29.1 years on average (range: 10-51) after AS onset. Presenting symptoms were urinary abnormalities (n = 4), sensory abnormalities (n = 6), or radicular or low back pain (n = 4). The symptoms worsened progressively, with mild (n = 3) to severe (n = 1) motor deficiency, sphincter dysfunction (urinary [n = 6] and/or anal [n = 4] sphincter), and impotence (n = 3). Magnetic resonance imaging showed dural sac dilation (n = 9), multiple lumbar arachnoid diverticula (n = 6), erosions of the laminae and spinous processes (n = 6), and nerve-root tethering (n = 6) with adhesion to the dura mater and vertebrae (n = 7). Cerebrospinal fluid (CSF) flow study by magnetic resonance imaging was performed in 2 patients and showed communication of the diverticula with the CSF. Lumboperitoneal shunting, performed in 5 patients, was followed by improvements in sensation (n = 4), urinary symptoms (n = 2), anal continence (n = 3), and pain. Full recovery of muscle strength was noted in 3 patients. Improvements persisted after a mean of 49 months (range: 18-96).
CONCLUSION: Lumboperitoneal shunting induced substantial improvements in all 5 patients treated with this procedure. This result suggests that AS-related CES may be due to chronic arachnoiditis and dural fibrosis leading to diminished CSF resorption with dural sac dilation and diverticula formation.
Authors:
Hang-Korng Ea; Frédéric Lioté; Guillaume Lot; Thomas Bardin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  35     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E1423-9     Citation Subset:  IM    
Affiliation:
Fédération de Rhumatologie, Pôle Appareil Locomoteur, Hôpital Lariboisière, (Assistance Publique-Hôpitaux de Paris), 75010 Paris, France. korngea@yahoo.fr
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