Disclosures: Annette Grotheer, MD, MPH: No financial relationships or conflicts of interest

Case Diagnosis: Dural Ectasia from Ankylosing Spondylitis (AS) causing Cauda Equine Syndrome (CES).

Case Description: A 74-year-old male with past medical history significant for ankylosing spondylitis and bladder cancer presented for initial evaluation of left shoulder pain. The patient was diagnosed with AS at age 20. He incidentally reported sudden onset urinary retention for one year with associated difficulty defecating. Since developing retention, he has utilized intermittent catheterization as recommended by his urologist. His bladder cancer was treated with Transurethral Resection of a Bladder Tumor and had been in remission for over three years with no previous urinary retention reported. Subjectively he denied any changes in low back pain or radicular symptoms. On exam, he had full lower extremity strength and sensation, limited lumbar spine flexion range of motion with mild pain associated with movement and normal achilles and patellar reflexes bilaterally.

Setting: Academic Outpatient Spine Clinic

Assessment/Results: Magnetic resonance imaging of the lumbar spine demonstrated dural ectasia causing cauda equina nerve root deviation posteriorly. The patient was referred to a neurosurgeon, but was managed conservatively with neurogenic bowel and bladder training, pelvic floor physical therapy and referral to a spinal cord injury physiatrist for education and management. Treatment resulted in reduced episodes of overflow incontinence and improved ability to clear his bowels, significantly improving social participation.

Discussion: Ankylosing spondylitis is a chronic inflammatory disease that primarily involves spine and sacroiliac joints. Neurological complications of AS are uncommon and infrequently develop dural ectasia. However, dural ectasia resulting in CES is extremely rare.

Conclusion: Dural ectasia resulting in CES is an extremely rare complication of chronic AS. In this case, the patient’s urinary incontinence was initially attributed to sequalae from bladder cancer treatment. It is important to prioritize neurologic work up for bowel and bladder incontinence. Furthermore, conservative management may significantly improve quality of life in these patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dural-ectasia-as-a-cause-of-cauda-equina-in-chronic-ankylosing-spondylitis/