Lumboperitoneal shunt for treatment of dural ectasia in ankylosing spondylitis

Neurological complications of ankylosing spondylitis (AS) are reported in 2.1% of patients. Cauda equina syndrome (CES) is rare and occurs at the ankylosing stage. MRI and CT of the lumbar spine show a cauda equina deformation with dural ectasia and bony erosion. We report three patients with AS presenting with progressive CES. These patients underwent lumboperitoneal shunting (LPS) surgery. The motor deficit improved in all cases. We suggest that CES develops from arterial pulsation of the CSF on a dural sac with reduced elasticity and that LPS reduces these intradural pressure shock waves. A meta-analysis by Ahn et al. [Ahn NU, Ahn UM, Nallamshetty L, et al. Cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome): meta-analysis of outcomes after medical and surgical treatments. J Spinal Disord 2001;14:427-33] concludes that surgical treatment has a better outcome than conservative or no treatment. Adding our 3 patients to this analysis, it appears that LPS for CES in AS is more efficient than laminectomy. LPS is a routine procedure for a rare indication, which promises improvement or atleast a stabilization of this disabling evolution of the disease.     

Post-convulsive spinal epidural haematoma in ankylosing spondylitis.

A case of post-convulsive spinal spidural haematoma in a patient with ankylosing spondylitis is presented. As acute tetraplegia developed, surgery was performed with finding of blood clots in the extradural space from C6 to D8. Lethal evolution due to late referral to medical care stresses the need for prompt decompression of the injured spine.     

Radiculopathy as a complication of ankylosing spondylitis.

A cauda equina syndrome in association with ankylosing spondylitis is well recorded. We report the occurrence of an upper limb radiculopathy which progressed to a cauda equina syndrome in association with ankylosing spondylitis.     

Cognitive-behavioral therapy in patients with ankylosing spondylitis in a German self-help organization.

A cognitive-behavioral treatment program for pain control was administered to 22 subjects with a diagnosis of ankylosing spondylitis (AS) in a self-help setting of the German Rheumatism League. A sample of 17 AS subjects from the same setting served as waiting-list controls. The program consisted of training in progressive muscle relaxation, cognitive restructuring, attention related techniques and pleasant activity scheduling, and was aimed at an improvement of self-control strategies. Ratings of pain severity, anxiety, depression, psychophysiological complaints, and sleep disturbances were used to evaluate the outcome. Follow-up assessments were conducted six months post treatment. A significant interaction between treatment condition and assessment period was demonstrated. Further analyses indicate a beneficial effect of the treatment in all outcome measures apart from general symptoms during pain attacks at the follow-up assessment. Reductions of pain intensity, anxiety, and psychophysiological symptoms were maintained at 12 month follow-up. Although pain reduction was statistically significant, it did not exceed 14% in the pain diary. The more important aspect of the treatment appears to be emotional stabilization and increased feelings of well-being.     

Lumbar radiculopathy after spinal fusion for scoliosis

In 184 patients with no preoperative neurologic deficit who underwent operation for idiopathic scoliosis, somatosensory evoked potential monitoring was used. Four patients had neurologic deficits postoperatively. Two patients developed mild signs of intraspinal lesions involving upper motor neurons at high lumbar levels that resolved over 3-5 months. These patients and two others developed evidence of unilateral, moderate, lower motor neuron damage that was confirmed on electromyography. No changes in somatosensory evoked potentials occurred in these patients. Lumbar root damage may be difficult to recognize after operation and should be considered in patients with neurologic deficit after scoliosis surgery.     

Coexistence of ankylosing spondylitis and multiple sclerosis

Ankylosing spondylitis is reported to involve not only the joints but neurologic systems as well. The association of MS and AS has rarely been reported in the literature and epidemiological studies did not prove a definite relationship between these two conditions at present. We here describe a HLA-B 27 positive AS patient with MS symptoms and review the literature on the association of two diseases.     

Cervical spinal cord injury complicating ankylosing spondylitis

Within a period of 12 years 466 patients with acute spinal cord injury were admitted to our Centre, seven of these having ankylosing spondylitis (AS). A history of alcohol consumption preceding the accident was present in five patients, and in four there was a history of neurological deterioration before their admission. An epidural hematoma was found in one patient and four expired within 3 months of their injury. The incidence of ankylosing spondylitis in cervical cord injury was 1.5%, and an associated epidural hematoma was present in some 14% of the patients. The mortality rate was 57%. There was a high incidence of alcoholic use before the accident. Neurological deterioration commonly occurred before admission.     

Bulbar symptoms and episodic aphonia associated with atlanto-occipital subluxation in ankylosing spondylitis

A patient with intermittent aphonia associated with atlanto-occipital subluxation due to ankylosing spondylitis is presented and discussed. The only other case from the literature is reviewed and compared with our patient, where symptoms and signs of episodic low bulbar disease, presumably due to intermittent vascular insufficiency, were relieved by external bracing.     

Cauda equina syndrome in ankylosing spondylitis: a report of six cases.

Six patients with ankylosing spondylitis and features of a cauda equina syndrome are described. The myelographic findings are discussed in relation to the pathogenesis of the disorder and its natural history. Present experience suggests that the cauda equina syndrome is a more common complication of ankylosing spondylitis than is usually thought.     

全髋关节置换治疗强直性脊柱炎24例

背景：全髋关节置换已经成为改善严重强直性脊柱炎髋关节病变患者关节功能和生活质量的有效选择,但与其他病因的全髋关节置换相比,存在较高的危险因素。 目的：观察全髋关节置换治疗强直性脊柱炎髋关节病变的效果。 方法：对24例(33髋)强直性脊柱炎髋关节病变患者行人工全髋关节置换,置换前患者日常活动均明显受限,其中拄拐9例,轮椅1例;严重疼痛22例;10例(15髋)关节强直。置换前Harris评分平均41.9分,髋关节活动度平均45.4°。所用假体包括生物型18例(24髋)、骨水泥型3例(5髋)、混合型3例(4髋),均为金属合金股骨柄对高分子聚乙烯内衬(摩擦界面)。 结果与结论：全部病例获得随访,随访时间平均23.3个月。最后一次随访,28髋(84.9%)疼痛完全消失;仅有1例仍需单拐辅助行走,其余患者均可不扶拐自由行走,步态正常。Harris评分平均80.1分,其中优10髋,良18髋,可4髋,差1髋,优良率84.8%;髋关节活动度平均159.6°;髋关节Harris评分及关节活动度均显著高于置换前(P < 0.05)。患者的主观满意度为87.5 %。2髋(6.1%)出现异位骨化,分别为Brooker分级Ⅰ,Ⅲ级。无脱位、感染、骨折、神经损伤及假体松动下沉,尚无患者进行翻修。提示全髋关节置换是治疗强直性脊柱炎髋关节病变的有效手段,可以缓解关节疼痛,恢复关节功能,改善患者生活质量。     

Cauda equina syndrome secondary to long-standing ankylosing spondylitis

Fourteen patients with cauda equina syndrome secondary to long-standing ankylosing spondylitis are described. The roughly symmetrical neurological deficits were very slowly progressive and began long after the onset of the spondylitis, usually well after the rheumatological symptoms had stopped. Eventually every patient had cutaneous sensory loss in the fifth lumbar and sacral dermatomes. All patients developed urinary sphincter disturbances of a lower motor neuron type. There was prominent loss of rectal sphincter tone, and all but 2 patients had bowel complaints, including incontinence and severe constipation. Seven patients had mild to moderate weakness in the lumbosacral myotomes. Seven patients had pain in the rectum or lower limbs. Electromyographic abnormalities were consistent with multiple lumbosacral radiculopathies. Myelography and computed tomographic scanning of the lumbosacral spine showed characteristic enlargement of the caudal sac and dorsal arachnoid diverticula that had eroded the laminae and spinous processes. Recognition of this syndrome, coupled with computed tomographic scanning of the lower spinal canal, allows one to omit myelography, a procedure that is difficult because of the associated spine abnormalities. Surgical intervention should be avoided.     

Surgical management of cervical fractures in ankylosing spondylitis using a combined posterior-anterior approach.

The management of cervical fractures in ankylosing spondylitis patients is controversial. In the present article, a literature review is conducted, and the author's experience with four consecutive cases, operated on using a combined approach, is reported. One patient was operated on using the combined approach after developing progressive deformity in a halo fixator, one patient after early redislocation of an anterior monosegmental fixation, and two patients were operated on primarily using the combined approach. All four patients achieved good alignment and immediate stability and no dislocation or deformity was observed during the mean observation period of 11 months.     

强直性脊柱炎非骨水泥型全髋关节置换27例

探讨强直性脊柱炎患者行人工非骨水泥型全髋关节置换的手术时机、手术方法及疗效分析。 方法：选择2000/2005湘雅医院收治强直性脊柱炎后髋关节强直患者27例33髋，均经Gibson入路行人工非骨水泥型全髋关节置换，全部采用Link公司Ribbed非骨水泥型人工全髋关节。比较髋关节置换前后Merle D’Aubigne评分及髋关节活动范围。 结果：27例33髋均获得随访，随访时间≥5个月，平均21个月。X射线平片示假体位置良好，无脱位，髋关节疼痛消失。各向运动良好。患者术后Merle D'Aubigne评分平均17.3分(16~18分)。 结论：对强直性脊柱炎进行人工非骨水泥型全髋关节置换可放宽手术年龄限制，根据患者的不同情况，在术中采取恰当的关节置换技术，均可恢复髋关节功能。