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
Risk Factors
  • 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
Aetiology
  • 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
    • Diskitis
    • Tumour (either metastatic or a primary CNS cancer)
    • Trauma
Pathophysiology
  1. Compression of the nerves
  2. Reduced afferent and efferent signals
  3. 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
Clinical Presentation
  • 5 characteristic features:
    • Bilateral neurogenic sciatica
    • Reduced perineal sensation
    • Altered bladder function leading to painless retention,
    • Loss of anal tone
    • Loss of sexual function
Investigations
  • Gold standard investigation – MRI imaging with sagittal and axial T1 and T2 sequences
Management
  • Surgical decompression via laminectomy with or without subsequent discectomy
Complications
  • 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

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