Arterial vascularization of the cauda equina.

Parke, Wesley W.; Gammell, K; Rothman, Richard H.

doi:10.2106/00004623-198163010-00007

Cited by 130 publications

(51 citation statements)

References 9 publications

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“…Microangiograms showed an abundant vascular network with repeating T-shaped branching throughout the length of the nerve root (Figure 3). This was also present near the watershed region in the radicular artery, and there was no hypovascular region as suggested by Parke et al [26] . Thus, the intraradicular vessels controlled segmentally by radicular arteries have no fixed direction of flow and there appears to be no particular clinical significance in the watershed region of arteries maintaining a high intravascular pressure.…”

Section: Blood Supply Of Cauda Equina Nerve Rootsupporting

confidence: 67%

“…Corbin described anatomic details of radicular arteries and classified them into three groups: artères radiculo-grères, artères radiculo-piemeriennes, and artères radiculo-medullares [25] . The first two arteries were named as distal and proximal radicular arteries by Parke et al [26] and were thought to be nutrient arteries of the nerve roots. They described that each lumbosacral spinal nerve root receives its intrinsic blood supply from both distal and proximal radicular arteries, through which the blood flows toward a mutual anastomosis in the proximal one third of the root.…”

Section: Blood Supply Of Cauda Equina Nerve Rootmentioning

confidence: 99%

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Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Kobayashi

2014

WJO

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Spinal nerve roots have a peculiar structure, different from the arrangements in the peripheral nerve. The nerve roots are devoid of lymphatic vessels but are immersed in the cerebrospinal fluid (CSF) within the subarachnoid space. The blood supply of nerve roots depends on the blood flow from both peripheral direction (ascending) and the spinal cord direction (descending). There is no hypovascular region in the nerve root, although there exists a so-called water-shed of the bloodstream in the radicular artery itself. Increased mechanical compression promotes the disturbance of CSF flow, circulatory disturbance starting from the venous congestion and intraradicular edema formation resulting from the breakdown of the blood-nerve barrier. Although this edema may diffuse into CSF when the subarachnoid space is preserved, the endoneurial fluid pressure may increase when the area is closed by increased compression. On the other hand, the nerve root tissue has already degenerated under the compression and the numerous macrophages releasing various chemical mediators, aggravating radicular symptoms that appear in the area of Wallerian degeneration. Prostaglandin E1 (PGE1) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis. However, investigations in the clinical setting have shown that PGE1 is effective in some patients but not in others, although the reason for this is unclear.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Lumbar canal stenosis; Cauda equine; Nerve root; Prostaglandin E1; Blood flow Core tip: The radicular symptoms associated with degenerative disease of the lumbar spine are reported to be attributable to a combination of mechanical nerve root compression and resultant circulatory disturbance. Disturbance of blood flow in the cauda equina and nerve roots is reported to play an important role in the mechanism of intermittent claudication in patients with lumbar canal stenosis. Prostaglandin E1 (PGE1) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis with intermittent claudication. However, investigations in the clinical setting have shown that lipo-PGE1 is effective in some patients but not in others, although the reason for this is unclear.Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World

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Section: Blood Supply Of Cauda Equina Nerve Rootsupporting

confidence: 67%

Section: Blood Supply Of Cauda Equina Nerve Rootmentioning

confidence: 99%

Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Kobayashi

2014

WJO

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“…The individual fascicles are embedded in the epineurium and surrounded by the perineurium. In addition to its protective mechanical function, the high degree of vascularization of this mantle contributes to the metabolism of the peripheral nerve [29,41,42]. Several authors [9,25] have described deformations of the nerve fascicle and their occurrence in the range of an exerted pressure of 30-50 mmHg, which is consistent with our observations.…”

Section: Discussionsupporting

confidence: 92%

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation

2001

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“…10,19 This seems plausible in our patient's case as the cauda equina, compared with other peripheral nerve roots, has a poorly developed epineurium and lacks a segmental blood supply, making it highly susceptible to injury. 17,20,21 The appearance of the cauda equina in our patient was unlikely to be a result of his 2004 pelvic radiation owing to the location of the nerve roots involved.…”

Section: Discussionmentioning

confidence: 76%

A case of indirect cauda equina syndrome from metastatic prostate cancer

Lefresne

Fairchild

Bistritz

et al. 2013

CUAJ

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We report the case of a patient with metastatic hormone refractory prostate cancer in whom "indirect" cauda equina syndrome developed concurrent with multilevel spinal cord compression (SCC). Three months after his first positive bone scan, a 65-yearold otherwise healthy man presented with severe back pain, bilateral lower extremity paresthesias, leg weakness and urinary retention. Magnetic resonance imaging (MRI) showed a dural-based mass causing SCC at the T9, T10 and T11 vertebrae, with a normal cauda equina. He received corticosteroids and palliative external beam radiotherapy, resulting in good pain control and gradual improvement in his neurological symptoms. He did well for 8 months, at which time his residual bilateral leg weakness abruptly worsened and he experienced numbness, paresthesias, urinary incontinence and constipation. Repeat MRI showed progression of epidural metastatic disease compressing the spinal cord or thecal sac at 7 thoracic vertebral levels. The cauda equina was also distorted and flattened without evidence of direct solid tumour impingement. We hypothesized that the etiology was increased intrathecal pressure due to disrupted cerebrospinal fluid flow resulting from multiple levels of upstream thecal sac compression. It is essential to image the entire spinal cord and cauda equina when patients with metastatic bone disease present with neurological symptoms to institute correct treatment and preserve function and mobility.Can Urol Assoc J 2009;3(4):E31-E35 pathological fracture, an intramedullary lesion or a combination of these factors.5 Both oncological emergencies require early diagnosis and treatment to prevent the development of devastating and potentially irreversible neurological complications. We present a unique case of CES secondary to increased cerebrospinal fluid (CSF) pressure as a result of multilevel upstream malignant SCC in a patient with prostate cancer.

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Arterial vascularization of the cauda equina.

Cited by 130 publications

References 9 publications

Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation

A case of indirect cauda equina syndrome from metastatic prostate cancer

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