Factors affecting neurological outcome in traumatic conus medullaris and cauda equina injuries

Abstract

<jats:p>The purpose of this review was to describe the relevant factors that influence neurological outcomes in patients who sustain traumatic conus medullaris injuries (CMIs) and cauda equina injuries (CEIs). Despite the propensity for spinal trauma to affect the thoracolumbar spine, few studies have adequately characterized the outcomes of CMIs and CEIs. Typically the level of neural axis injury is inferred from the spinal level of injury or the presenting neurological picture because no study from the spinal literature has specifically evaluated the location of the conus medullaris with respect to the level of greatest canal compromise. Furthermore, the conus medullaris is known to have a small but important variable location based on the spinal level. Patients with a CMI will typically present with variable lowerextremity weakness, absent lower-limb reflexes, and saddle anesthesia. The development of a mixed upper motor neuron and lower motor neuron syndrome may occur in patients with CMIs, whereas a CEI is a pure lower motor neuron injury. Many treatment options exist and should be individualized. Posterior decompression and stabilization offers at least equivalent neurological outcomes as nonoperative or anterior approaches and has the additional benefits of surgeon familiarity, shorter hospital stays, earlier rehabilitation, and ease of nursing care. Overall, CEIs and CMIs have similar outcomes, which include ambulatory motor function and a variable persistence of bowel, bladder, and potentially sexual dysfunctions.</jats:p>

Conus medullaris syndrome due to spinal cord iscemia: case report

“…Spinal kord iskemilerinin net bir veri olmamakla birlikte tüm inmelerin yaklaşık %1,2'si ve akut myelopatilerin %14'ü oranında olduğu kabul edilmektedir. Daha çok ateroskleroz zemininde geliştiği göz önünde bulundurulduğunda ileri yaşlarda daha sık görülmektedir (2 (8,9). Konus bölgesinin beslenmesi ASA ve iki PSA tarafından oluşturulan anastomoz ansı ve özellikli iki arter olan T8'den conus medullarise kadar uzanan Adamkiewicz arteri ve internal iliak arterin dalı olan Desproges-Gotteron arteri tarafından sağlanır (6).…”

Improvement in chronic low back pain in an aviation crash survivor with adjacent segment disease following flexion distraction therapy: a case study

“…Spinal fusion surgery for the purpose of managing destructive pathology or severe spinal trauma may be necessary to prevent lifelong disability or paralysis. 13,14 In cases such as these, ASD is likely to be a nonissue in the surgical decision-making process.…”

Sexual dysfunction in cauda equina syndrome

“…Les 5 % restant se situent entre l'espace intervertébral T11-T12 et la vertèbre L4. Ainsi, en pratique, une fracture ou, plus généralement, une lésion neurologique du segment T12-L1 peut s'exprimer de façon différente selon l'anatomie du sujet [4]. Nous connaissons l'importance de cette région sur le contrôle moteur et sensitif de la vessie, la région anorectale et de toute la fonction sexuelle.…”

“…Le système sympathique lombaire et le parasympathique sacré en plus du contrôle somatique sacré sont assurés par les racines nerveuses de la queue-decheval. Le mécanisme physiopathologique des troubles sensitivomoteurs est une compression mécanique, un phénomène inflammatoire ou une ischémie [4,5].…”

“…À noter cependant que les SQC sont plus souvent asymétriques que les lésions du cône médullaire [4,14].…”