Definitions of traumatic conus medullaris and cauda equina
Radboud University Medical Center, Nijmegen, Gelderland, The netherlands
Objective: Fifteen percent of spinal cord injuries (SCI) occur in the thoracolumbar spine. Traumatic injuries of the thoracolumbar spine may result in a Conus Medullaris Syndrome (CMS) or Cauda Equina Syndrome (CES). The Conus Medullaris Syndrome (CMS) and Cauda Equina Syndrome (CES) are well-known neurological entities. It is assumed that these syndromes are different regarding neurological- and functional prognosis. However, literature concerning spinal trauma is not unambiguous about the exact definition of the syndromes. A clear definition of both syndromes is required to determine functional outcomes, guide treatment decision-making and predict complications. Therefore a search for the exact definitions of CMS and CES in trauma literature was performed.
Design/Methods: Systematic review. A comprehensive electronic database search was performed in
Medline (PubMed), Cochrane and Embase. Papers were identified by the following key words: CM, CE, spinal cord syndromes, thoracolumbar junction, thoracolumbar fracture, SCI and trauma.
Results: Out of the 1.046 articles, we identified 14 original articles concerning patients with a traumatic CMS and/or CES. Most articles were retrospective evaluations of single center studies. The period of published articles spanned from 1982 to 2010. A compilation of neurological symptoms or vertebral level of the CM was defined in 14 articles. A fracture at level Th12 and L1 was repeatedly associated with CMS. Seven articles were identified that described traumatic CES. Most studies identify vertebral level (L2) as the cranial border of the CE. A differentiation in neurological symptoms between the CMS and CES was not found.
Conclusion: based on this review and anatomical/radiology studies, CMS may result from injury of vertebrae Th12–L2, and it involves damage to neural structures from spinal cord segment Th12 to nerve root S5. CES may result from an injury of vertebrae L3–L5, and it involves damage to nerve roots L3–S5. This differentiation between CMS and CES is necessary to examine the hypothesis that CES patients tend to have a better functional outcome.
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