CASE REPORT - Rapidly progressing cauda equina symptoms due to RA

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Journal of Nippon Medical School

Vol. 72 (2005) , No. 5 pp.290-294

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A Case Report of Rapidly Progressing Cauda Equina Symptoms due to

Rheumatoid Arthritis

Hidemi Kawaji1), Masabumi Miyamoto1), Yoshikazu Gembun1)

and Hiromoto Ito1)

1) Department of Orthopaedic Surgery, Nippon Medical

School

Abstract

Although rheumatoid involvement of the lumbar spine is

relatively rare, we report a patient with rapidly progressing cauda equina

symptoms due to rheumatoid diskitis. A 72-year-old woman was admitted to our

hospital because of motor weakness below the iliopsoas muscle and sensory

disturbance beneath the level of L2. Plain X-ray films, computed tomography,

and magnetic resonance imaging demonstrated destruction of the L2/3

intervertebral disc and endplates with subluxation of the facet joints. The

dural sac was compressed. Based on a diagnosis of spinal canal stenosis due

to rheumatoid diskitis, we performed partial laminectomy and posterolateral

fusion with pedicle screws. The neurological deficits improved immediately.

The mechanism of intervertebral disc destruction in this case is thought to

be rheumatoid nodes or enthesitis. Destruction of the facet joints and the

intervertebral disc might have led to severe instability and spinal canal

stenosis.

http://www.jstage.jst.go.jp/article/jnms/72/5/72_290/_article

http://www.jstage.jst.go.jp/article/jnms/72/5/290/_pdf

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