A Case Report of Rapidly Progressing Cauda Equina Symptoms due to Rheumatoid Arthritis

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.

Multiple Vertebral Involvement of Rheumatoid Arthritis in Thoracolumbar Spine: A Case Report

“…Although the cervical spine is more commonly involved in RA, and atlantoaxial subluxation is well known, there are some reports of thoracolumbar spine involvement in a few patients with RA (1-3, 6-9). With regard to the disease incidence, Heywood and Meyers reported a frequency of 0.94% (seven cases in 746 patients satisfying the criteria of definite rheumatoid arthritis) (2).…”

“…The surgical treatment of the thoracolumbar lesions affected by RA are quite rare, and they need to be tailored to each patient according to the location of the lesion within the vertebra and the patient's symptoms (2, 6, 8, 9). A laminectomy may allow adequate decompression in selected cases, particularly those with an epidural rheumatoid nodule or spinal stenosis (2, 6).…”

Neuropsychiatric manifestations in rheumatoid arthritis

“…Vertebral collapse and rheumatoid synovitis can result in progressive degenerative changes and pain or compression syndromes [78,79]. Rheumatoid nodes and enthesitis are potentially involved in the mechanism of intervertebral disc destruction [79].…”

“…Poor bone quality secondary to corticosteroids use can also result in an increased risk for osteoporosis fractures. In some cases, with severe degenerative disease, patients can present with neurological deficits due to root compressions and even cauda equine syndrome [79] , .…”

Atteinte radiologique du rachis lombaire au cours de la polyarthrite rhumatoïde

“…L'érosion des plateaux vertébraux et la destruction discale peuvent être les conséquences d'une synovite des AIAP[5] ou de granulomes rhumatoïdes présents dans le corps vertébral et provenant soit de la plaque cartilagineuse, soit des articulations costoverté-brales ou costotranversaires adjacentes[13,14]. Ces spondylodiscites peuvent être responsables de troubles neurologiques ; Kawaji et al ont décrit, chez une patiente suivie pour PR, un syndrome de la queue-de-cheval secondaire à une destruction du disque et des plateaux vertébraux de L2 et L3 associée à un latérolisthésis de L2[15]. Nous n'avons pas observé de corrélation entre l'existence et/ou la sévérité des lésions radiologiques du rachis lombaire et les facteurs cliniques liés à la PR, notamment la durée d'évolution, la classe fonctionnelle selon Steinbrocker et al et le HAQ, ce qui concorde également avec les données de la littérature[5].…”