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Conus medullaris and cauda equina syndrome

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Text of Conus medullaris and cauda equina syndrome

  • 1. Conus Medullaris & Cauda Equina Syndrome By: Ismah Haron 06/08/20141 Leg weakness is flaccid and areflexic not spastic and hyperreflexic

2. 06/08/20142 Source: Walter B. Greene. Netter's Orthopaedics 1st ed. 2006 Source: Keith L. Moore and Anne Agur. Essential Clinical Anatomy, 3rd Edition 3. 06/08/20143 4. 06/08/20144 Etiology Trauma - Fracture, subluxation - Penetrating trauma Herniated disc - 90% at L4-L5 and L5-S1 Spinal stenosis - Developmental abnormality - Degenerative disease Picture from: Walter B. Greene. Netter's Orthopaedics 1st ed. 2006 5. 06/08/20145 Neoplasm - Primary (schwannoma, paraganglioma) - Metastatic (intracranial, lung, breast and renal cell ca) Inflammations and infections - Paget disease, epidural abscess - Pyogenic and non pyogenic Picture from: 6. Iatrogenic - Misplaced pedicle screw, laminar hooks - Continuous spinal anesthesia 06/08/20146Picture from: 7. Conus medullaris syndrome Cauda equina syndrome Vertebral level L1-L2 L2-sacrum Spinal level Sacral cord segment and roots Lumbosacral nerve roots Presentation Sudden and bilateral Gradual and unilateral Radicular pain Less severe More severe Low back pain More Less Motor strength Symmetrical, less marked hyperreflexic distal paresis of LL, fasciculation More marked asymmetric areflexic paraplegia, atrophy more common Reflexes Ankle jerks affected Both knee and ankle jerks affected Sensory Localized numbness to perianal area, symmetrical and bilateral Localized numbness at saddle area, asymmetrical, unilateral Sphincter dysfunction Early urinary and fecal incontinence Tend to present late Impotence Frequent Less frequent 06/08/20147 Conus Medullaris vs. Cauda Equina Syndromes 8. 06/08/20148 Illustration of saddle anesthesia; - The S5, S4, and S3 nerves provide sensory innervation to the rectum, perineum, and inner thigh. Source: Journal of the American Academy of Orthopaedics Surgeons, 9. Radiology MRI Laboratory FBC, ESR Needle electromyography of the bilateral external anal sphincter muscles Lumbar puncture 06/08/20149 Investigation 10. 06/08/201410 Sagittal and axial CT scans of thoracolumbar spine demonstrating an L4 burst fracture with retropulsion of bone into the spinal canal Source: Harrop, J. S., G. E. Hunt Jr, et al. (2004). "Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles." Neurosurgical Focus 16(6): 1-23. 11. 06/08/201411 Source: Harrop, J. S., G. E. Hunt Jr, et al. (2004). "Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles." Neurosurgical Focus 16(6): 1-23. MRI image shows compression of the distal lumbar and sacral nerve rootles 12. 06/08/201412 Sagittal MRI images demonstrating large central disc extrusion at L5-S1 (arrows) with compression on the cauda equina. Source: Levis, J. T. (2009). "Cauda equina syndrome." Western Journal of Emergency Medicine 10(1): 20. 13. Discectomy - 1 2 Laminectomy 06/08/201413 Method to Relieve Cord Compression 14. 06/08/201414 Source: Corpectomy 15. Important predictor of recovery - The extent of perineal or saddle sensory deficit Patients with unilateral deficits have a better prognosis than patients with bilateral deficits Females and patients with bowel dysfunction have been reported to have worse outcomes postoperatively 06/08/201415 Prognosis Source: - Shaw A, Anwar H, Targett J, Lafferty K. Cauda equina syndrome versus saddle embolism. Ann R Coll Surg Engl. Sep 2008;90(6):W6-8. - O'Laughlin SJ, Kokosinski E. Cauda equina syndrome in a pregnant woman referred to physical therapy for low back pain. J Orthop Sports Phys Ther. Nov 2008;38(11):721. 16. THANK YOU Other references: - - Oxford handbook of clinical medicine - Oxford handbook of clinical surgery - Apleys consice system of orthopaedics and fractures 3rd edition 06/08/201416