Ankylosing Spondylitis with Cauda Equina Syndrome and Dural Ectasia - A Case Report -

Case Report

J Korean Assoc EMG Electrodiagn Med 2011;13(2):143-147.
Published online December 1, 2011.

Received: 20 September 2011 • Revised: 14 October 2011 • Accepted: 20 October 2011

Abstract

Ankylosing spondylitis is characterized by inflammation of multiple articular and para-articular structures, frequently resulting in bony ankylosis. The most common presenting symptom is chronic pain and stiffness in the lower part of the spine. Neurological complications such as cauda equina syndrome are very uncommon but can be caused by fibrosis following arachnoiditis, direct compression by arachnoid cyst, or root damage by dural ectasia. We describe a case of a 41-year-old male patient diagnosed with ankylosing spondylitis 11 years ago complaining of recent voiding and defecation problems. Lumbosacral spine MRI and CT imaging revealed dural ectasia with bony erosion of the posterior wall of L3 to S1 vertebral bodies. The electrodiagnostic study was compatible with bilateral lumbosacral polyradiculopathy and the urodynamic study showed underactive detrusor activity during the voiding phase. At 15 month follow-up the patient’s symptoms showed little improvement and he still complained of voiding problems and decreased defecation sense. We report a patient of ankylosing spondylitis with cauda equine syndrome in whom MRI disclosed dural ectasia, and discuss the role of MRI in revealing pathogenesis.

Key Words: Ankylosing spondylitis, Cauda equina syndrome, Dural ectasia