Advertisement

Cauda Equina Injuries

  • Hyun-Yoon Ko
Chapter

Abstract

Injuries of cauda equina and conus medullaris are generally clinically not clearly distinguishable and are often described together because they often occur as combined injuries. Anatomically, the cauda equina is defined as a bundle of the spinal roots located below the tip of the conus medullaris around the filum terminale. Unlikely the cervical and thoracic spinal cord and the corresponding surround spine, the conus medullaris is condensed to less than two vertebral heights. The conus medullaris is located from the T12/L1 intervertebral disc space to the L1/L2 intervertebral disc space. Within this short distance, approximately ten spinal cord segments, L1–S5, are concentrated in the conus medullaris and are not in close spatial relationship to the respective vertebrae.

References

  1. American Spinal Injury Association (ASIA). International standards to document remaining autonomic function after spinal cord injury, 1st edn. American Spinal Injury Association, Atlanta; 2012.Google Scholar
  2. Bagley CA, Gokaslan ZL. Cauda equina syndrome caused by primary and metastatic neoplasms. Neurosurg Focus. 2004;16:E3.CrossRefGoogle Scholar
  3. Brouwers E, van de Meent H, Curt A, et al. Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review. Spinal Cord. 2017;55:886–90.CrossRefGoogle Scholar
  4. Chau AM, Xu LL, Pelzer NR, et al. Timing of surgical intervention in cauda equina syndrome: a systematic critical review. World Neurosurg. 2014;81:640–50.CrossRefGoogle Scholar
  5. Chuang TY, Cheng H, Chan RC, et al. Neurourologic findings in patients with traumatic thoracolumbar vertebra junction lesions. Arch Phys Med Rehabil. 2001;82:375–9.CrossRefGoogle Scholar
  6. Cohen MS, Wall EJ, Kerber CW, et al. The anatomy of the cauda equina on CT scans and MRI. J Bone Joint Surg Br. 1991;73:381–4.CrossRefGoogle Scholar
  7. De Vloo P, Monea AG, Sciot R, et al. The filum terminale: a cadaver study of anatomy, histology, and elastic properties. World Neurosurg. 2016;90:565–73.CrossRefGoogle Scholar
  8. Findlay G, Macfarlane R. Cauda equina syndrome. J Neurosurg Spine. 2009;11:90–1.CrossRefGoogle Scholar
  9. Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil. 2009;90:1964–8.CrossRefGoogle Scholar
  10. Goodman BP. Disorders of the cauda equina. Continuum (Minneap Minn). 2018;24:584–602.Google Scholar
  11. Harrop JS, Hunt GE Jr, Vaccaro AR. Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles. Neurosurg Focus. 2004;16:E4.CrossRefGoogle Scholar
  12. Hertzler DA 2nd, DePowell JJ, Stevenson CB, et al. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29:E1.CrossRefGoogle Scholar
  13. Hoang TX, Havton LA. Novel repair strategies to restore bladder function following cauda equina/conus medullaris injuries. Prog Brain Res. 2006;152:195–204.CrossRefGoogle Scholar
  14. Jensen RL. Cauda equina syndrome as a postoperative complication of lumbar spine surgery. Neurosurg Focus. 2004;16:E7.CrossRefGoogle Scholar
  15. Kapetanakis S, Chaniotakis C, Kazakos C, et al. Cauda equina syndrome due to lumbar disc herniation: a review of literature. Folia Med (Plovdiv). 2017;59:377–86.CrossRefGoogle Scholar
  16. Kennedy JG, Soffe KE, McGrath A, et al. Predictors of outcome in cauda equina syndrome. Eur Spine J. 1999;8:317–22.CrossRefGoogle Scholar
  17. Kingwell SP, Curt A, Dvorak MF. Factors affecting neurological outcome in traumatic conus medullaris and cauda equina injuries. Neurosurg Focus. 2008;25(5):E7.CrossRefGoogle Scholar
  18. Kostuik JP. Medicolegal consequences of cauda equina syndrome: an overview. Neurosurg Focus. 2004;16:E8.CrossRefGoogle Scholar
  19. Lavy C, James A, Wilson-MacDonald J, et al. Cauda equina syndrome. BMJ. 2009;338:b936.CrossRefGoogle Scholar
  20. Lawson BK, Jenne JW, Koebbe CJ. Cauda equina and conus medullaris avulsion with herniation after midlumbar chance fracture. Spine J. 2014;14:1060–2.CrossRefGoogle Scholar
  21. Mauffrey C, Randhawa K, Lewis C, et al. Cauda equina syndrome: an anatomically driven review. Br J Hosp Med (Lond). 2008;69:344–7.CrossRefGoogle Scholar
  22. McCarthy MJ, Aylott CE, Grevitt MP, et al. Cauda equina syndrome: factors affecting long-term functional and sphincteric outcome. Spine (Phila Pa 1976). 2007;32:207–16.CrossRefGoogle Scholar
  23. McKinley W, Graham S, Lee K, et al. Cervical and lumbar spinal stenosis associated with myelopathy and cauda equina syndrome. Top Spinal Cord Inj Rehabil. 2008;14:10–8.CrossRefGoogle Scholar
  24. McNamee J, Flynn P, O'Leary S, et al. Imaging in cauda equina syndrome—a pictorial review. Ulster Med J. 2013;82:100–8.PubMedPubMedCentralGoogle Scholar
  25. Monajati A, Wayne WS, Rauschning W, et al. MR of the cauda equina. AJNR Am J Neuroradiol. 1987;8:893–900.PubMedGoogle Scholar
  26. Namba K. Vascular anatomy of the cauda equina and its implication on the vascular lesions in the caudal spinal structure. Neurol Med Chir (Tokyo). 2016;56:310–6.CrossRefGoogle Scholar
  27. New PW. Cauda equina syndrome. Specialist rehabilitation BMJ. 2009;338:b1725.PubMedGoogle Scholar
  28. Özgen S, Baykan N, Dogan IV, et al. Cauda equina syndrome after induction of spinal anesthesia. Neurosurg Focus. 2004;16:e5.CrossRefGoogle Scholar
  29. Orendácová J, Cízková D, Kafka J, et al. Cauda equina syndrome. Prog Neurobiol. 2001;64:613–37.CrossRefGoogle Scholar
  30. Parke WW, Gammell K, Rothman RH. Arterial vascularization of the cauda equina. J Bone Joint Surg Am. 1981;63:53–62.CrossRefGoogle Scholar
  31. Pavlakis AJ, Siroky MB, Goldstein I, et al. Neurourologic findings in conus medullaris and cauda equina injury. Arch Neurol. 1983;40:570–3.CrossRefGoogle Scholar
  32. Podnar S. Epidemiology of cauda equina and conus medullaris lesions. Muscle Nerve. 2007a;35:529–31.CrossRefGoogle Scholar
  33. Podnar S. Saddle sensation is preserved in a few patients with cauda equina or conus medullaris lesions. Eur J Neurol. 2007b;14:48–53.CrossRefGoogle Scholar
  34. Ridley LJ, Han J, Ridley WE, et al. Cauda equina: normal anatomy. J Med Imaging Radiat Oncol. 2018;62(Suppl 1):123.CrossRefGoogle Scholar
  35. Spector LR, Madigan L, Rhyne A, et al. Cauda equina syndrome. J Am Acad Orthop Surg. 2008;16:471–9.CrossRefGoogle Scholar
  36. Tarulli AW. Disorders of the cauda equina. Continuum (Minneap Minn). 2015;21:146–58.Google Scholar
  37. Wall EJ, Cohen MS, Massie JB, et al. Cauda equina anatomy. I: Intrathecal nerve root organization Spine (Phila Pa 1976). 1990;15:1244–7.Google Scholar
  38. Wostrack M, Shiban E, Obermueller T, et al. Conus medullaris and cauda equina tumors: clinical presentation, prognosis, and outcome after surgical treatment: clinical article. J Neurosurg Spine. 2014;20:335–43.CrossRefGoogle Scholar

Suggested Reading

  1. Altman J, Bayer SA. Development of the human spinal cord: an interpretation based on experimental studies. 1st ed. New York: Oxford University Press; 2001.Google Scholar
  2. American Spinal Injury Association. International standards for neurological classification of spinal cord injury. Revised 2011. Updated 2015 ed. Atlanta: American Spinal Injury Association; 2015.Google Scholar
  3. Byrne TN, Benzel EC, Waxman SG. Diseases of the spine and spinal cord. Oxford: Oxford University Press; 2000.Google Scholar
  4. Campbell WW. DeJong’s the neurologic examination. 7th ed. New York: Wolters Kluwer Lippincott Williams & Wilkins; 1992.Google Scholar
  5. Eagler GL, Cole J, Merton WL, editors. Spinal cord diseases: diagnosis and treatment. New York: Marcel Dekker Inc.; 1998.Google Scholar
  6. Hattingen E, Klein JC, Weidauer S, Vrionis F, Setzer M, editors. Diseases of the spinal cord. Heidelberg: Springer; 2015.Google Scholar
  7. Holtz A, Levi R. Spinal cord injury. Oxford: Oxford University Press; 2010.Google Scholar
  8. Lin VW, editor. Spinal cord medicine. Principles and practice. 2nd ed. New York: Demos Medical; 2010.Google Scholar
  9. Mai JK, Paxinos G, editors. The human nervous system. 3rd ed. London: Elsevier; 2011.Google Scholar
  10. Mancall E. Gray’s clinical neuroanatomy: the anatomic basis for clinical neuroscience. Philadelphia: Elsevier; 2011.Google Scholar
  11. Mtuid E, Gruener G, Dockery P. Fitzgerald’s clinical neuroanatomy and neuroscience. 7th ed. Philadelphia: Elsevier; 2016.Google Scholar
  12. Patestas MA, Gartner LP. A text book of neuroanatomy. Oxford: Blackwell Publishing; 2006.Google Scholar
  13. Thron AK. Vascular anatomy of the spinal cord. neurological investigations and clinical syndromes. New York: Springer; 1988.CrossRefGoogle Scholar
  14. Vanderah T, Gould DJ. Nolte’s the human brain. Philadelphia: Elsevier; 2016.Google Scholar
  15. Verhaagen J, McDonald JW III. Spinal cord injury. In: Aminoff MJ, Boller F, Swaab DF, editors. Handbook of clinical neurology, 3rd series, vol. 109. London: Elsevier; 2012.Google Scholar
  16. Vinken PJ, Bruyn GW, editors. Injuries of the spine and spinal cord. Part I. Handbook of clinical neurology, vol. 25. Oxford: North-Holland Publishing Company; 1976a.Google Scholar
  17. Vinken PJ, Bruyn GW, editors. Injuries of the spine and spinal cord. Part II. Handbook of clinical neurology, vol. 25. Oxford: North-Holland Publishing Company; 1976b.Google Scholar
  18. Vogel LC, Zebracki K, Betz RR, Mulcahey MJ, editors. Spinal cord injury in the child and young adult. London: Mac Keith Press; 2014.Google Scholar
  19. Weidner N, Rupp R, Taney KE, editors. Neurological aspects of spinal cord injury. Cham: Springer; 2017.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Hyun-Yoon Ko
    • 1
  1. 1.Department of Rehabilitation MedicineRehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of MedicineYangsanSouth Korea

Personalised recommendations