Cauda equina syndrome is caused by any narrowing of the spinal canal that compresses the nerve roots below the level of the spinal cord. A 49yearold woman presented with chronic sciatica, mild bladder dysfunction, and paresthesia in. Incomplete spinal cord syndromes are caused by lesions of the ascending or descending spinal tracts that result from trauma, spinal compression, or occlusion of spinal arteries. The most distal bulbous part of the spinal cord is called the conus medullaris, and. Any malfunction that occurs in the conus medullaris results to what they call the conus medullaris syndrome.
Cauda equina and conus medullaris syndromes statpearls. Injuries at the level of t12 to l2 vertebrae are most likely to result in conus medullaris syndrome. Conus medullaris typically produces sudden symptoms on both sides of the body, while cauda equina syndrome usually develops over time, producing uneven symptoms concentrated on one side of the body. Attachments may occur congenitally at the base of the spinal cord conus medullaris or they may develop near the site of an injury to the spinal cord. We provide differential imaging characteristics for conus medullaris lesions on mri and demonstrate various examples from our institution with illustration of differentiating features. Twenty percent of all spinal tumors affect this area. Cauda equina syndrome and conus medullaris syndrome result from compression of the spinal cord and nervesnerve roots arising from l1l5 levels. Cramer, in clinical anatomy of the spine, spinal cord, and ans third edition, 2014. Here, a 12yearold boy with acute myeloblastic leukemia, maxillary mass, and conus medullaris syndrome is reported.
These symptoms include low back pain, sciatica unilateral or. Conus medullaris syndrome is a secondary form of spinal cord damage resulting from injuries. The cauda equina latin for horses tail begins at the 2nd lumbar space extending down to the beginning of the sacral nerves. Jun 14, 2018 cauda equina syndrome refers to a characteristic pattern of neuromuscular and urogenital symptoms resulting from the simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris see the image below.
Venous congestion, ischemia from vascular steal, hemorrhage, and mass effect can all contribute to the symptomatic presentation of these avms. Conus medullaris syndrome is a constellation of signs and symptoms indicating underlying injury to the lower end of the spinal cord at the level of first or second lumbar vertebra in adults conus medullaris conus terminalis. Cauda equina syndrome neurologic disorders msd manual. Conus medullaris syndrome radiology reference article. Conus medullaris surgery for lumbar spine pain spine. The most common symptoms of disc disease are radicular pain in the dermatome of the compressed. Conus medullaris and cauda equina syndromes online. It is a clinical subset of spinal cord injury syndromes.
After the cord terminates, the nerve roots descend within the spinal canal as individual rootlets, collectively termed the cauda equina. Jun 14, 2018 patients can present with symptoms of isolated cauda equina syndrome, isolated conus medullaris syndrome, or a combination. Consequently, problems with the conus medullaris often affect the cauda equina. Conus medullaris medical definition merriamwebster. Mar 27, 2019 tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. The spinal cord is composed of long tracts of myelinated nerve fibres known as white matter arranged around the periphery of a symmetrical butterflyshaped cellular matrix of gray matter. Conus medullaris syndrome is caused by an injury or insult to the conus medullaris and lumbar nerve roots. The cauda equina is a set of 10 paired dorsal and ventral nerve roots 20 nerve roots in total, corresponding to four lumbar second to fifth, five sacral, and one coccygeal segments that originate from the conus medullaris.
Often very prominent and severe, asymmetrical, radicular motor findings. Lesions of the epiconus will affect the lower lumbar roots supplying muscles of the lower part of the leg and foot, with sparing of reflex function of sacral segments. Conus medullaris and cauda equina syndromes nervous. The spinal cord tapers and ends at the level between the first and second lumbar vertebrae in an average adult. These symptoms include low back pain, sciatica unilateral or, usually, bilateral, saddle sensory. It is distal to the tapered end of the spinal cord, or conus medularis. Conus medullaris syndrome inspired spinal cord injury. Magnetic resonance imaging in the differential diagnosis. Cauda equina and conus medullaris syndromes are classified as clinical syndromes of the spinal cord. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Apr 21, 2012 conus medullaris syndrome definitions historically i. Conus medullaris surgery for lumbar spine pain spine surgery mn. Outline of discussion introduction anatomical overview conus medullaris syndrome trauma as an etiology cauda equina syndrome questions.
Paralytic bladder incontinence bowel incontinence impotence perineal sensory changes absence of lower extremity weakness presently, a constellation of signs and symptoms including. Injuries to the spinal cord commonly result from motor vehicle accidents, traumatic falls, diving, surfing, skiing, and snowboarding accidents, other forms of sports injuries, as well as from gunshot injuries in victims of violent crimes. Conus medullaris avms tend to be diffuse and classically have multiple feeding vessels that originate from the posterior and the anterior spinal arteries fig. Most spinal cord injuries involve the cervical or midthoracic spinal cord. Mar 06, 20 the spinal cord tapers and ends at the level between the first and second lumbar vertebrae in an average adult. Conus medullaris syndrome is less severe than above, but they tend to have back pain with a minimal radicular component. A 49yearold woman presented with chronic sciatica, mild bladder dysfunction, and paresthesia in the buttocks. Conus lesions affecting neural segments s2 and below will present with lower motor neuron lmn deficits of the anal sphincter and bladder due to damage of the anterior horn cells of s2s4. However, it mimics conus medullaris syndrome, causing similar symptoms. The conus medullaris, which is the terminal segment of the adult spinal cord, lies at the inferior aspect of the l1 vertebrae. Developed for nice by the national collaborating centre for cancer. At the request of several members, i am writing a summary of conus medullaris injuries, its clinical manifestations and what potential therapies are being developed to restore function in such injuries. Cases of neoplastic and vascular etiologies may present similar clinical signs.
The most common symptoms of disc disease are radicular pain in the. Surgical outcomes in thoracolumbar fractures with pure conus. Definitions of traumatic conus medullaris and cauda equina. Conus medullaris syndrome is a constellation of signs and symptoms indicating underlying injury to the lower end of the spinal cord at the level of. It typically causes back pain and bowel and bladder dysfunction, spastic or flaccid weakness depending on the level of the lesion, and bilateral sensory loss. The conus medullaris extends further inferiorly than normal in a condition known as tethered cord syndrome. The condition usually develops when the nerves in the conus medullaris find it unable to function correctly as a result of constriction of the lower part of the spinal column or undue pressure. Diagnosis and management of patients at risk of or with metastatic spinal cord compression. Conus medullaris syndrome is a type of incomplete spinal cord injury that is less likely to cause paralysis than many other types of spinal cord injuries.
The conus medullaris is the bundled, tapered end of the spinal cord nerves. Brown sequard syndrome central cord syndrome anterior cord syndrome posterior cord syndrome conus medullaris syndrome cauda equina syndrome incomplete cord syndromes powerpoint presentation. The conus medullaris most commonly terminates at the l12 intervertebral disc level in children and adults. Six months ago cms conus medullaris syndrome was diagnosed. Thank you for your interest in spreading the word about the bmj. However, about a third of spinal cord injuries affect the lower thoracic spinal segments where. Mri of conus medullaris, cauda equina, and filum terminale. Jul 19, 2019 definition of conus medullaris and cauda equina syndromes.
Intradural schwannoma of the conus medullaris is a rare form of spinal neoplasm, which commonly occurs in the lumbar region. Bladder and rectal reflexes are diminished or absent, depending on the exact level and extent of the lesion. Nov 24, 2016 cauda equina vs conus medullaris syndrome 1. Pdf incidence of conus medullaris and cauda equina. Conus medullaris definition of conus medullaris by. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Conus medullaris and cauda equina syndrome as a result of. Oftentimes the conus medullaris is wedged between the end of the thoracic vertebrae and the beginning of the lumbar vertebrae, but sometimes its found between the l1 and l2 vertebrae.
Conus medullaris and cauda equina syndromes online medical. Apr 27, 2016 the conus medullaris is the coneshaped structure at the base of the spinal cord. The nerve that passes through the conus medullaris is the one that controls the legs, genitals, bowels and the bladder. It refers to a collection of symptoms that arise due to damage to the conus medullaris.
It is assumed that these syndromes are different regarding neurological and functional prognosis. Degenerative disc disease results in mechanical compression on either the spinal cord or a nerve root. A person with conus medullaris syndrome has symptoms that occur when the nerves in the conus medullaris malfunction. Compounding any attempts to accurately characterize the outcomes of these injuries, it is often assumed that the conus medullaris terminates at l12 despite its known variable location. Ependymoma is the most common spinal intramedullary neoplasm in adults. Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. In childhood, the conus medullaris syndrome owing to leukemia is rare. Choose from 19 different sets of conus medullaris flashcards on quizlet. The pathophysiology underlying neurologic decline includes venous hypertension, ischemia, hemorrhage, and mass effect from hugely dilated venous structures. Introduction conus medullaris and cauda equina syndromes are clinical entities diagnosis based on clinical. Mri of conus medullaris, cauda equina, and filum terminale l. Conus medullaris syndrome is a collection of signs and symptoms associated with injury to the conus medullaris. Herniated nucleus pulposus cause of 26% of cases of cauda equina syndrome neoplasm, including metastases, astrocytoma, neurofibroma, and meningioma.
Repair of conus medullariscauda equina injury using human. Conus medullaris syndrome due to an intradural disc. Degenerative disc disease knowledge for medical students. Cauda equina and conus medullaris syndromes clinical. Other articles where conus medullaris is discussed. Cauda equina syndrome is not a spinal cord syndrome. A conus medullaris syndrome due to extradural compression from a herniated d12l1 disc was diagnosed and an urgent decompression was done at 16 hrs after presentation. Cauda equina syndrome, on the other hand, is a type of. Patients can present with symptoms of isolated cauda equina syndrome, isolated conus medullaris syndrome, or a combination. Do the spinal pathologies that accompany lumbar disc disease. Conus medullaris and cauda equina syndromes nervous system. Conus medullaris syndrome is a constellation of signs and symptoms indicating underlying injury to the lower end of the spinal cord at the level of first or second lumbar vertebra in adults conus medullarisconus terminalis.
Conus medullaris syndrome cms and cauda equina syndrome ces are wellknown neurological entities. The most common cause of compression in 45% of ces is a herniated lumbar intervertebral disc. Tethered spinal cord syndrome information page national. After the cord terminates, the nerve roots descend within the spinal canal as individual rootlets, collectively termed the cauda equina the conus medullaris most commonly terminates at the l12 intervertebral disc level in children and adults extending from the conus is a delicate. Conus medullaris syndrome in spinal contusion the bmj. The conus medullaris is the terminal end of the spinal cord. T2w mri sagittal a and axial images b and c showing disc herniation at d12l1.
Situated near the first two lumbar vertebrae, the conus medullaris ends at the cauda equina, a bundle of spinal nerves and nerve roots. Conus medullaris syndrome cms and cauda equina syndrome ces are complex neurological disorders that can be manifested through a variety of symptoms. Cauda equina is the latin name for horses tail because the cauda equina resembles a horse tail. Some symptoms are similar to ces but not identical. Epidemiology of cauda equina and conus medullaris lesions. The conus medullaris is a site of frequent involvement by lesions of inflammatory or infectious etiology, generally established by hematogenous spread, but also disseminated through the cerebrospinal fluid or by meningeal or vertebral extension. Conus medullaris definition of conus medullaris by medical. Conus medullaris syndrome is a condition of the terminal end of the spinal cord, at the lower backbuttocks area from traumatic injury or from birth congenital. Cauda equina syndrome refers to a characteristic pattern of neuromuscular and urogenital symptoms resulting from the simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris see the image below. Conus medullaris definition,syndrome,symptoms and more. Isolated neurological symptoms are estimated to be less than 30% in cns ivlbcl. Degenerative disc disease refers to a variety of pathologies with displacement of disc material into the spinal canal, such as protrusion, herniation, and sequestration. Cystic dilatation of the fifth ventricle on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain.
Strange or jarring sensations in the back, such as buzzing, tingling, or numbness. However, literature concerning spinal trauma is ambiguous about the exact definition of the syndromes. The conus medullaris is the terminal end of the spinal cord gross anatomy. This has frequently led to many unusual complications.
The conus medullaris is the end of the spinal cord, which is located in the lower back. Conus medullaris syndrome manifest symptoms that are similar to cauda equina syndrome, but the two conditions require different treatment. The conus medullaris is the coneshaped structure at the base of the spinal cord. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal andor urinary incontinence or dysfunction. Conus medullaris syndrome definitions historically i. Brown sequard syndrome hemisection of the spinal cord caused by extramedullary lesions usually caused by penetrating trauma or. The symptoms and signs of cauda equina syndrome tend to be mostly lower motor neuron lmn in nature, while those of conus medullaris syndrome are a combination of lmn and upper motor neuron umn effects see table 1, below. This condition can cause pain and neurological deficits i. Cauda equinaconus medullaris syndrome as an isolated presenting symptom of intravascular large. Learn conus medullaris with free interactive flashcards. Incomplete spinal cord syndromes knowledge for medical. Conus medullaris syndrome is a secondary form of spinal cord damage resulting from injuries to the lumber vertebrae. Conus medullaris syndrome spinal decompression machines. The segment above the conus is termed the epiconus, consisting of spinal cord segments l4s1.
Repair of conus medullariscauda equina injury using human es cellderived motor neurons public abstract. Conus medullaris is actually at the end part of the spinal cord located at the lower back. Cauda equinaconus medullaris syndrome as an isolated. These nerve roots are contained by the thecal sac, which. In the fully developed spine this condition is caused by either a thickened filum terminale or adhesions connecting the filum terminale to adjacent. There is a subset of spinal cord injuries referred to as spinal cord injury syndromes, to which conus medullaris syndrome belongs, that are grouped by their respective symptomatology, including central cord syndrome, brownsequard syndrome, anterior cord syndrome, posterior cord syndrome, and cauda equina syndrome.
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