Cauda equina syndrome in ankylosing spondylitis: successful treatment with lumboperitoneal shunting.
Spine (Phila Pa 1976)
; 35(24): E1423-9, 2010 Nov 15.
Article
en En
| MEDLINE
| ID: mdl-21030893
ABSTRACT
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Polirradiculopatía
/
Espondilitis Anquilosante
/
Derivaciones del Líquido Cefalorraquídeo
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
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Female
/
Humans
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Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Spine (Phila Pa 1976)
Año:
2010
Tipo del documento:
Article
País de afiliación:
Francia