Musculoskeletal System >
Conus Medullaris & Corda Equina Syndrome
“Compressive damage to the spinal cord“
- Conus medullaris syndrome (CMS) results when there is compressive damage to the spinal cord from T12-L2.
- Cauda equina syndrome (CES) results from compression and disruption of the L3-L5 nerve roots. Both syndromes are neurosurgical emergencies
- History of back problems (e.g. spinal stenosis)
- Degenerative disc disease
- Birth defects (e.g. a narrow spinal canal or spina bifida)
- Haemorrhages affecting the spinal cord
- Arteriovenous malformation
- Spinal surgery or spinal anaesthesia
- Lesion or tumour affecting the spinal bones, spinal nerve roots, or cerebrospinal fluid (CSF)
- Infection affecting the spine
- CMS and CES result from compression of the spinal cord and nerves/nerve roots arising from L1-L5 levels.
- The most common cause of compression is a herniated lumbar intervertebral disc.
- Other causes include
- Epidural abscess
- Spinal epidural hematoma
- Tumour (either metastatic or a primary CNS cancer)
- Compression of the nerves
- Reduced afferent and efferent signals
- Leads to sensory/motor deficits in the lower limbs, sensory deficits in the saddle area, loss of voluntary control of the external anal and urinary sphincters
- 5 characteristic features:
- Bilateral neurogenic sciatica
- Reduced perineal sensation
- Altered bladder function leading to painless retention,
- Loss of anal tone
- Loss of sexual function
- Gold standard investigation – MRI imaging with sagittal and axial T1 and T2 sequences
- Surgical decompression via laminectomy with or without subsequent discectomy
- Complications occur in a large percentage of those diagnosed irrespective of their time to surgical decompression.
- Examples include micturition deficits such as retention, dysfunction with defecation, sexual dysfunction, persistent saddle anaesthesia, and long-term sciatica