J Korean Neurosurg Soc.  2014 Dec;56(6):517-520. 10.3340/jkns.2014.56.6.517.

Cauda Equina Syndrome Associated with Dural Ectasia in Chronic Anlylosing Spondylitis

• Ha SW
• Son BC

• KMID: 2191150
• DOI: http://doi.org/10.3340/jkns.2014.56.6.517

Abstract

Cauda equina syndrome (CES) associated with dural ectasia is a rare neurologic complication in patients with longstanding ankylosing spondylitis (AS). We report a 68-year-old male with a 30-year history of AS who presented a typical symptom and signs of progressive CES, urinary incontinence and neuropathic pain of the lumbosacral radiculopathy. Computed tomography (CT) and magnetic resonance imaging (MRI) findings showed the unique appearances of dural ectasia, multiple dural diverticula, erosion of posterior element of the lumbar spine, tethering of the conus medullaris and adhesion of the lumbosacral nerve roots to the posterior aspect of the dural ectasia. Considering the progressive worsening of the clinical signs, detethering of the conus medullaris through resection of the filum terminale was performed through a limited laminectomy. However, the urinary incontinence did not improve and there was a partial relief of the neuropathic leg pain only. The possible pathogenetic mechanism of CES-AS and the dural ectasia in this patient with longstanding AS are discussed with a literature review.

Keyword

Ankylosing spondylitis; Cauda equina syndrome; Dural ectasia; Filum terminale

MeSH Terms

Aged
Cauda Equina
Conus Snail
Dilatation, Pathologic*
Diverticulum
Humans
Laminectomy
Leg
Magnetic Resonance Imaging
Male
Neuralgia
Polyradiculopathy*
Radiculopathy
Spine
Spondylitis*
Spondylitis, Ankylosing
Urinary Incontinence

Figure

• 

  Fig. 1 A : A three-dimensional (3D) reconstructed computed tomography (CT) showing a typical appearance of 'bamboo spine' of ankylosing spondylitis in the anterior view. B : A posterior view on a 3D CT scan showing the fusion of sacroiliac joints, syndesmophyte formation and also multiple erosions of the roof of an enlarged spinal canal. An axial (C) and sagittal CT (D) scan images showing a widened spinal canal, multiple erosions on laminae and spinous process, and a subarachnoid diverticulum protruded through the right intervertebral foramen.

• 

  Fig. 2 A : A sagittal T2-weighted magnetic resonance (MR) image showing the low-lying conus medullaris at the level of L2 and an adhesion of the lumbosacral nerve root to the dural ectasia. B : An axial T2-weighted MR image showing multiple dural diverticulas and an adhesion of the nerve root to the posterior wall of the dural diverticula.

• 

  Fig. 3 A : An intraoperative photograph showing the filum terminale through a L2 laminectomy. Note the characteristic fatty infiltration in the filum terminale (arrow). B : An interoperative photography showing the dethetering of the filum terminale after coagulation and cutting (the arrow indicates the cut edge of the filum).

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