The central nervous system – the brain and spinal column – are surrounded by fluid contained in a membrane called the dura, which is primarily made up of connective tissue. The enlargement of this membrane is referred to as “dural ectasia.” Dural ectasia also includes perineural cysts and meningocele cysts.
Dural ectasia is present in more than 60 percent of people affected with Marfan syndrome. Research suggests that the presence of dural ectasia does not always cause problems, although it sometimes causes back, abdominal and leg pain and headaches in some affected persons.
Dural ectasia is best identified through MRI imaging, particularly of the lower spine with a person standing upright. A mylogram, CT scan, or plain spinal films might also reveal the presence of dural ectasia.
Does dural ectasia occur only in the lower spine?
No, dural ectasia can occur in the neck or in the upper torso, but it is very rare. In 99 percent of patients with dural ectasia, it occurs in the lowest part of the spine because this is where the fluid pressure is greatest when standing.
Can dural ectasia present itself following trauma, such as an automobile accident, since people with Marfan syndrome are predisposed?
Dural ecastia can present itself following trauma, but it doesn’t commonly occur this way.
What are the symptoms associated with dural ectasia? What do the pain, weakness and numbness of dural ectasia feel like and where does it occur?
The symptoms of dural ectasia vary. They include aching in the very low back, almost in the tailbone, abdominal pain, headaches and leg pain. Perineal pain and numbness can also occur because of the lowest sacral nerve roots. Unfortunately, there is a significant overlap with the low back pain that anyone in the general population can develop. The difference may be one of age and degree.
What kind of symptoms may suggest that there is dural ectasia for which an evlauation is needed?
The need for an evaluation depends on the degree of symptoms and disability. If the symptoms are tolerated, there is no urgency to be evaluated.
Are there other problems in the spine that are the result of, or associated with, dural ectasia?
Dural ectasia does thin the spinal vertebrae. It can have implications for a person having surgery on the spine for any reason.
At what point does it become a possible benefit to offer more aggressive treatment of dural ectasia than just pharmacological pain management and what are those interventions?
Currently, pain management is the mainstay of treatment. Unfortunately, it is not possible to replace the dura like it is the aorta. Some surgical treatment of "sacs" of dural ectasia or extreme cases may be undertaken on a case-by-case basis.
Can one safely have an MRI of the spine if there already are titanium rods in place due to scoliosis?
One can have an MRI with any kind of spinal rod. The implications involve a "halo" or invisible area on the MRI in the immediate area around the rod. Titanium creates the smallest halo.