Cauda Equina and Conus Medullaris Syndromes

Excerpt

Cauda equina and conus medullaris syndromes have overlap in anatomy and clinical presentation. Therefore, for the purpose of this discussion, they will be grouped, and notable differences highlighted. The conus medullaris is the terminal end of the spinal cord, which typically occurs at the L1 vertebral level in the average adult. Conus medullaris syndrome (CMS) results when there is compressive damage to the spinal cord from T12-L2. The cauda equina is a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels L1-L5 and contains axons of nerves that give both motor and sensory innervation to the legs, bladder, anus, and perineum. Cauda equina syndrome (CES) results from compression and disruption of the function of these nerves and can be inclusive of the conus medullaris or distal to it, and most often occurs when damage occurs to the L3-L5 nerve roots. Both syndromes are neurosurgical emergencies as they can present with back pain radiating to the legs, motor and sensory dysfunction of the lower extremities, bladder and/or bowel dysfunction, sexual dysfunction and saddle anesthesia. CMS and CES also carry a high risk of litigation as delays in diagnosis and management can lead to devastating life-long impairment.