These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Cauda equina syndrome in ankylosing spondylitis: successful treatment with lumboperitoneal shunting.
    Author: Ea HK, Lioté F, Lot G, Bardin T.
    Journal: Spine (Phila Pa 1976); 2010 Nov 15; 35(24):E1423-9. PubMed ID: 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.
    [Abstract] [Full Text] [Related] [New Search]