Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles

Abstract

<jats:p>Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common. Unfortunately, a precise understanding of the pathophysiology and optimal treatments, including the best timing of surgery, has yet to be elucidated for either traumatic CES or CMS. In this paper the authors review the current literature on traumatic conus medullaris and cauda equina injuries and available treatment options.</jats:p>

Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature

“…Finally, at intervertebral level of L2-L3, the thecal sac consists mostly of roots, with the motor roots being located anterior in regards to the sensory ones. 1,2,7,29 The anterior and posterior roots include fi ve individual strands. At the level of the S1, the largest anterior and posterior roots are found.…”

“…4). 1,2,7,26,29 PHARMACOLOGY AND TREATMENT OF CES There are three methods which lead to the treatment of CES. The fi rst method is related to surgical methods.…”

“…In the spinal canal, the nucleus pulposus causes the pressure of the nerves. 2,20 The most common levels for the creation of an LDH are L4-L5 and L5-S1. 20 …”

“…The cauda equina is located in an enclosed cavity, which is called thecal sac and is fi lled with cerebrospinal fl uid in the subarachnoid space. [1][2][3]7,29 EMBRYOLOGICAL DEVELOPMENT OF THE CAUDA EQUINA The cauda equina in the human embryo starts developing at the beginning of the third month, when its spinal cord extends the whole length of its body. After the fi rst three months, a disproportion in the rate of growth of the bones and the cartilages of the vertebral column, and the spinal cord is observed.…”

“…Specifi cally, the cauda equina consists of the second through fi fth lumbar nerve pairs, all of the fi ve sacral nerve pairs and the coccygeal nerve. [1][2][3] One of the most common disorders of the cauda equina is presented as CES. Cauda equina syndrome is a rare and serious neurological disease due to the pressure of the cauda equina.…”