Cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome): Meta-analysis of outcomes after medical and surgical treatments

The cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome) i s marked by slow, insidious progression and a high incidence of dural ectas ia in the lumbosacral spine. A high index of suspicion for this problem mus t be maintained when evaluating the patient with ankylosing spondylitis wit h a history of incontinence and neurologic deficit on examination. There ha s been disagreement in the literature as to whether surgical treatment is w arranted for this condition. A meta-analysis was thus performed comparing o utcomes with treatment regimens. Our results suggest that leaving these pat ients untreated or treating with steroids alone is inappropriate. Nonsteroi dal antiinflammatory drugs may improve back pain but do not improve neurolo gic deficit. Surgical treatment of the dural ectasia, either by lumboperito neal shunting or laminectomy, may improve neurologic dysfunction or halt th e progression of neurologic deficit.