Conus medullaris syndrome
Updates to Article Attributes
Conus medullaris syndrome is caused by an injury or insult to the conus medullaris and and lumbar nerve roots. It is a clinical subset of spinal cord injury syndromes. Injuries at the level of T12 to L2 vertebrae are most likely to result in conus medullaris syndrome.
Clinical presentation
Patients present with a combination of severe back pain and upper and lower motor neurone deficits, similar to cauda equina syndrome, which include 1-3:
saddle anaesthesia
loss of bladder reflex: urinary retention
loss of bowel reflex: incontinence
lower limb motor weakness
, paraesthesia and numbness(mixed upper and lower motor neurone pattern)
Unlike cauda equina syndrome which which will only have lower motor neurone deficits, conus medullaris will have a combination of upper and lower motor neurone involvement 3.
Pathology
The conus medullaris lies in close proximity to nerve roots and injury to this region results in combined upper motor neurone and lower motor neurone features.
Aetiology
Conus medullaris injury can result most commonly from:
lumbar canal stenosis due to herniation of intervertebral disc(s)
-
trauma
vertebral body fractures (e.g. burst fractures)
traumatic spondylolysis and spondylolisthesis
-
tumours
vertebral body tumours (e.g. vertebral body metastases)
intrathecal-extramedullary tumours (e.g. spinal meningioma, myxopapillary ependymoma etc.
..)intramedullary tumours (e.g. spinal cord metastases)
-
vascular lesions
-
infection
Radiographic features
Depending on the suspected aetiology in addition to MRI that is almost invariably indicated, CT and catheter angiography may also be required. The features will vary according to the causative pathology and are therefore discussed separately.
Treatment and prognosis
The prognosis depends on upon the timing of patient presentation, the severity of deficits and underlying pathology. Early diagnosis and treatment may facilitate improvement in symptoms. Approximately 10% of patients may regain functional recovery.
-<p><strong>Conus medullaris syndrome </strong>is caused by an injury or insult to the <a href="/articles/conus-medullaris">conus medullaris</a> and lumbar nerve roots. It is a clinical subset of <a href="/articles/spinal-cord-injury">spinal cord injury</a> syndromes. Injuries at the level of T12 to L2 vertebrae are most likely to result in conus medullaris syndrome.</p><h4>Clinical presentation</h4><p>Patients present with a combination of severe back pain and upper and lower motor neurone deficits, similar to <a href="/articles/cauda-equina-syndrome">cauda equina syndrome</a>, which include <sup>1-3</sup>:</p><ul>-<li>saddle anaesthesia</li>-<li>loss of bladder reflex: urinary retention</li>-<li>loss of bowel reflex: incontinence </li>-<li>lower limb motor weakness, paraesthesia and numbness (mixed upper and lower motor neurone pattern)</li>-</ul><p>Unlike <a href="/articles/cauda-equina-syndrome">cauda equina syndrome</a> which will only have lower motor neurone deficits, conus medullaris will have a combination of upper and lower motor neurone involvement <sup>3</sup>. </p><h4>Pathology</h4><p>The conus medullaris lies in close proximity to nerve roots and injury to this region results in combined upper motor neurone and lower motor neurone features</p><p>Conus medullaris injury can result most commonly from:</p><ul>-<li>lumbar canal stenosis due to herniation of intervertebral disc(s)</li>-<li>trauma <ul>-<li>vertebral body fractures (e.g. <a title="Burst fractures" href="/articles/burst-fracture">burst fractures</a>)</li>-<li>traumatic <a href="/articles/spondylolysis">spondylolysis</a> and <a href="/articles/spondylolisthesis-1">spondylolisthesis</a>-</li>- +<p><strong>Conus medullaris syndrome </strong>is caused by an injury or insult to the <a href="/articles/conus-medullaris">conus medullaris</a> and lumbar nerve roots. It is a clinical subset of <a href="/articles/spinal-cord-injury">spinal cord injury</a> syndromes. Injuries at the level of T12 to L2 vertebrae are most likely to result in conus medullaris syndrome.</p><h4>Clinical presentation</h4><p>Patients present with a combination of severe back pain and upper and lower motor neurone deficits, similar to <a href="/articles/cauda-equina-syndrome">cauda equina syndrome</a>, which include <sup>1-3</sup>:</p><ul>
- +<li><p>saddle anaesthesia</p></li>
- +<li><p>loss of bladder reflex: urinary retention</p></li>
- +<li><p>loss of bowel reflex: incontinence </p></li>
- +<li><p>lower limb motor weakness (mixed upper and lower motor neurone pattern)</p></li>
- +</ul><p>Unlike <a href="/articles/cauda-equina-syndrome">cauda equina syndrome</a> which will only have lower motor neurone deficits, conus medullaris will have a combination of upper and lower motor neurone involvement <sup>3</sup>. </p><h4>Pathology</h4><p>The conus medullaris lies in close proximity to nerve roots and injury to this region results in combined upper motor neurone and lower motor neurone features.</p><h5>Aetiology</h5><p>Conus medullaris injury can result most commonly from:</p><ul>
- +<li><p>lumbar canal stenosis due to herniation of intervertebral disc(s)</p></li>
- +<li>
- +<p>trauma </p>
- +<ul>
- +<li><p>vertebral body fractures (e.g. <a href="/articles/burst-fracture" title="Burst fractures">burst fractures</a>)</p></li>
- +<li><p>traumatic <a href="/articles/spondylolysis">spondylolysis</a> and <a href="/articles/spondylolisthesis-1">spondylolisthesis</a></p></li>
-<li>tumours<ul>-<li>vertebral body tumours (e.g. <a title="Vertebral body metastases" href="/articles/vertebral-metastases">vertebral body metastases</a>)</li>-<li>intrathecal-extramedullary tumours (e.g. <a title="Spinal meningioma" href="/articles/spinal-meningioma">spinal meningioma</a>, <a title="Spinal myxopapillary ependymoma" href="/articles/spinal-myxopapillary-ependymoma">myxopapillary ependymoma</a> etc... )</li>-<li>intramedullary tumours (e.g. <a title="Intramedullary spinal cord metastases" href="/articles/intramedullary-spinal-metastasis-1">spinal cord metastases</a>)</li>- +<li>
- +<p>tumours</p>
- +<ul>
- +<li><p>vertebral body tumours (e.g. <a href="/articles/vertebral-metastases" title="Vertebral body metastases">vertebral body metastases</a>)</p></li>
- +<li><p>intrathecal-extramedullary tumours (e.g. <a href="/articles/spinal-meningioma" title="Spinal meningioma">spinal meningioma</a>, <a href="/articles/myxopapillary-ependymoma-1" title="Spinal myxopapillary ependymoma">myxopapillary ependymoma</a> etc.)</p></li>
- +<li><p>intramedullary tumours (e.g. <a href="/articles/intramedullary-spinal-metastasis-1" title="Intramedullary spinal cord metastases">spinal cord metastases</a>)</p></li>
-<li>vascular lesions<ul>-<a title="Spinal cord cavernous malformation" href="/articles/spinal-cord-cavernous-malformation">spinal cord cavernous malformation</a> (cavernoma)</li>-<li><a title="Spinal dural arteriovenous fistula" href="/articles/spinal-dural-arteriovenous-fistula">spinal dural arteriovenous fistula</a></li>- +<p>vascular lesions</p>
- +<ul>
- +<li><p><a href="/articles/spinal-cord-cavernous-malformation" title="Spinal cord cavernous malformation">spinal cord cavernous malformation</a> (cavernoma)</p></li>
- +<li><p><a href="/articles/spinal-dural-arteriovenous-fistula" title="Spinal dural arteriovenous fistula">spinal dural arteriovenous fistula</a></p></li>
-<li>infection<ul><li><a title="Spinal epidural abscess" href="/articles/spinal-epidural-abscess">epidural abscess</a></li></ul>- +<li>
- +<p>infection</p>
- +<ul><li><p><a href="/articles/spinal-epidural-abscess" title="Spinal epidural abscess">epidural abscess</a></p></li></ul>
-</ul><h4>Radiographic features</h4><p>Depending on the suspected aetiology in addition to MRI that is almost invariably indicated, CT and catheter angiography may also be required. The features will vary according to the causative pathology and are therefore discussed separately. </p><h4>Treatment and prognosis</h4><p>The prognosis depends on upon the timing of patient presentation, the severity of deficits and underlying pathology. Early diagnosis and treatment may facilitate improvement in symptoms. Approximately 10% of patients may regain functional recovery.</p>- +</ul><h4>Radiographic features</h4><p>Depending on the suspected aetiology in addition to MRI that is almost invariably indicated, CT and catheter angiography may also be required. The features will vary according to the causative pathology and are therefore discussed separately. </p><h4>Treatment and prognosis</h4><p>The prognosis depends on upon the timing of patient presentation, the severity of deficits and underlying pathology. Early diagnosis and treatment may facilitate improvement in symptoms. Approximately 10% of patients may regain functional recovery.</p>
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