2020 Volume 34 Issue 3 Pages 292-296
Cauda equina syndrome (CES) is a rare complication of long-standing ankylosing spondylitis (AS). Cerebrospinal fluid (CSF) circulation disorder occurs because of chronic inflammation, and it affects the cauda equina nerve root. Based on this mechanism, there are some reports of lumboperitoneal (LP) shunt performed for preventing the development of CES symptoms by improving the CSF flow circulation. We report two cases of CES in AS treated with an LP shunt.
A 71-year-old woman developed pain in the lumbar area and lower extremities, followed by bilateral lower extremity dysesthesia and urinary disturbance. Magnetic resonance imaging (MRI) and computed tomography myelography (CTM) revealed arachnoid cysts in the dura mater and dural ectasia. CTM also revealed communication between the cyst and the subarachnoid space. We performed an LP shunt with the aim of decompression by the cyst. After the operation, the patient's pain subsided.
A 54-year-old man developed left lower extremity dysesthesia, followed by bowel and urinary disturbance. MRI revealed dural ectasia, but no obvious mass lesion was observed in the dura mater. We performed lumbar CSF drainage to evaluate whether an LP shunt would be effective. After CSF drainage, the patient's symptoms slightly improved; therefore, we performed an LP shunt. After the operation, the patient's symptoms improved slightly.
The mechanism underlying the effectiveness of LP shunt is unknown. It may normalize CSF flow circulation, leading to normalized CSF pressure in the dura mater, and decrease nerve root compression. LP shunt for CES in AS is beneficial in halting the progression of symptoms.
