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Cauda Equina & Conus Medullaris

An overview of Cauda Equina Syndrome, Conus Medullaris Syndrome, & an osteopathic approach to these.
by

Tyler O'Sullivan

on 18 April 2013

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Transcript of Cauda Equina & Conus Medullaris

Cauda Equina &
Conus Medullaris Syndromes and the Role of
Osteopathic Medicine 44 y/o female, Hx LBP, presents to ER with excruciating back pain radiating to buttocks
Loss of sensation in perianal area
~350 ml retained urine Clinical Case Lumbar Spinal Stenosis
PT, analgesics, steroids Prevention 82% chronic LBP for 3 yrs
62% cite recent trauma
Falls, MVA, chiropractic manipulation, & weight lifting
Previous spinal surgeries
Signs of infection: fever, chills Risk Factors Urgent MRI - herniated L5-S1
cauda equina compression Surgical decompression & sequestrectomy Anatomy Conus Medullaris - Distal end of the spinal cord
lives at L1-L2 level
Cauda Equina - bundle of intradural nerve roots at the end of the spinal cord in the subarachnoid space,
distal to the conus medullaris
resembles a horse's tail Cauda Equina Syndrome Conus Medullaris Syndrome Sudden, B/L
Less severe radicular pain
Greater degree LBP
Perianal numbness; symmetrical & B/L
Upper motor neuron signs
Frequent impotence
Early fecal incontinence & urinary retention Gradual, U/L
Severe radicular pain
Mild-moderate LBP
Saddle anesthesia; asymmetric & U/L
Lower motor neuron signs
Impotence & ED less frequent
Late-presenting incontinence & urinary retention by S. Tyler O'Sullivan, OMS-IV
University of New England - College of Osteopathic Medicine Disc Loading Diagnostics Physical Exam for Herniated Disc
Straight leg raise
91% sensitivity
26% specificity
Cross straight leg raise
29% sensitivity
88% specificity
Thorough Neuro exam
Altered sensation, saddle anesthesia, rectal tone
Hypoactive patellar (L2-L4) & ankle-jerk (S1-S2) reflexes with Cauda Equina Syndrome
Lower extremity muscle weakness
plantar flexion, dorsiflexion, great toe extension Etiologies Lumbar Spinal Stenosis
Vascular
IVC Thrombosis
Hematomas
Ankylosing Spondylitis
Space-occupying Lesions
Trauma
COMPRESSION Imaging
Stat MRI for concerns of cauda equina or conus medullaris compression Urinary retention, bladder &/or fecal incontinence Trauma Insidious Disc herniations
L1-L2 - 27%
L3-L4 - 26%
L5-S1 - 22%
L4-L5 - 16%
L2-L3 - 9% Mixed evidence Decompressive surgery
may reduce long-term disability Osteopathic manipulation
Patient education
Trauma prevention Treat before progressing Treatment Cauda Equina/Conus Medullaris Syndrome
Surgical decompression Overlap & mixed presentation Early symptoms - Conservative management Prompt! - within 48 hours peripheral nerves
vs.
central cord Thank you! Questions? Better outcomes: motor, sensory, & urinary function
Full transcript