Dural ectasia or dural dysplasia is defined as widening or ballooning of the spinal canal, scalloping of the posterior vertebral body, increased thinning of the cortex of the pedicles and lamina, widening of the neural foramina, or the presence of a meningocele [1].

The etiology of dural ectasia is not well known, but it is usually observed in patients with connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis 1, and ankylosing spondylitis [1–4]. In contrast, some studies suggest that dural ectasia can originate from vertebral fractures, spine surgeries, scoliosis, and traumas [5,6].

Some studies report that patients with dural ectasia suffer from low back pain and sciatica symptoms, but some patients do not [7].

Many cases of low back pain and sciatica with lumbar disc herniation or spinal stenosis, has been treated with integrative Korean medical treatment, which has not been the case for dural ectasia. This study presents the outcome of a patient with suspected dural ectasia, low back pain, and sciatica that was treated with integrative Korean medical treatment.

The patient had low back pain and right leg sciatica that was caused by a suspected dural ectasia. The patient’s symptoms improved considerably with integrative Korean medical treatment that included pharmacopuncture, acupuncture, herbal medicine, Chuna therapy, cupping therapy and physiotherapy. The patient was hospitalized for 45 days. After inpatient treatment, the NRS scores for low back pain and right leg sciatica decreased from 7 to 3 and 7 to 2, respectively. The ODI score decreased from 40 to 31.11. The EQ-5D score increased from 0.67 to 0.70. As a result, the patient’s pain relieved, and she could sleep without nyctalgia. The patient’s symptoms markedly improved, allowing her to increase the period she could walk without any breaks.

The etiology of dural ectasia has not been clearly identified and connective tissue disorders and ankylosing spondylitis are typically thought to be the most likely cause of low back pain and leg sciatica. It has been suggested that the defective fibrillin leading to abnormally weak connective tissues cause weakness and dilatation of the dural sac [11]. On the one hand, it has also been proposed that chronic peridural inflammation due to ankylosing spondylitis, could weaken the dural sac and result in dural ectasia [3]. Studies have reported that dural ectasia could occur after spinal surgery (if patients had no medical history of connective tissue disorders or ankylosing spondylitis) [5,12]. It was suggested that prolonged and repetitive peridural inflammation due to spinal surgery, could be the cause of dural ectasia, which is similar to the condition of ankylosing spondylitis. Considering the patient’s past medical history, the cause of dural ectasia, although unclear, could be spinal surgery.

It is uncertain whether the pathology of dural ectasia is symptomatic or asymptomatic. It may cause postural headaches, low back pain, sciatica, and rectal pain [7]. If meningeal cysts are present, compression of the lumbosacral nerve roots can lead to neurological deficits such as the cauda equina syndrome [11,13]. The patient’s magnetic resonance imaging showed lumbar disc herniation and spinal stenosis, in addition to dural ectasia. Therefore, the cause of the patient’s symptoms are multiple.

Since conservative treatment of low back pain or sciatica with dural ectasia has not been previously reported, integrative Korean medical treatment, similar to the lumbar disc herniation and spinal stenosis treatment from previous studies, was used, focusing on the patient’s symptoms [14,15].

The main treatment for relieving the patient’s symptoms was injection of GCSB-5 contained in Shinbaro pharmacopuncture at EX-B2. It has been reported to have an anti-inflammatory activity correlated with the inhibition of inducible nitric oxide synthetase and cyclooxygenase-2 expression [16], and alleviates neuropathic pain by downregulating neuroglial activity in the spinal dorsal horn, and the dorsal root ganglion, through expression of calcitonin gene-related peptide and transient receptor potential cation channel subfamily V member 1 [17]. Besides, it could advance the nerve regeneration and stimulate the motor functional recovery by reducing oxidative stress [18]. It is thought that these chemical mechanisms had an effect on suppressing the inflammatory response, which occurred around the dura or nerve roots, due to expansion of the dural sac, reducing low back pain or sciatica, and promoting the recovery of muscular activities.

Since this study describes only 1 case, more patients are needed to substantiate the observations in this study. Moreover, the cause of low back pain and sciatica cannot be described as only being attributable to dural ectasia. Despite these limitations, this study is meaningful in that there have been no reports in Korea that have improved the symptoms of dural ectasia with conservative treatment relieving severe low back pain and sciatica using integrative Korean medical treatment. Thus, this case supports that integrative Korean medical treatment may be considered to relieve low back pain or sciatica, even when the cause of the pain is uncertain. Further studies are needed to investigate the pathology of dural ectasia, and substantiate the findings reported in this study.