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Thirteen cases of cauda equina syndrome of discal ethiology are analyzed. The clinical characteristics and course are studied. The factors which influence the prognosis and the possibilities of treatment are analyzed.
A patient with observed acute collapse of a lumbar vertebral body developed cauda equina compression. He was known to have contracted syphilis some 20 years before and, while he may well have suffered from tabetic spinal neuroarthropathy, histology of the collapsed vertebra showed features which indicate that an intra-osseous gumma could also have been responsible for his vertebral collapse and subsequent neurological deficit.
Cutaneous involvement by myxopapillary ependymoma of the cauda equina is described clinically and morphologically. The patient, a young woman, was 12 years old at the time that the neoplasm was diagnosed. Skin involvement developed 12 1/2 years following the initial diagnosis of the primary neoplasm and after the third attempt at surgical extirpation. Involvement of the skin preceded the death of the patient by 11 months.
Bladder and urethral function was studied in 21 patients with lesions of the cauda equina or conus medullaris using gas cystometry, integrated sphincter electromyography, uroflowmetry and computer assisted measurement of detrusor and urethral innervation. An areflexic cystometrogram, impaired electromyographic sphincter activity and delayed reflex-evoked potentials from stimulation of the detrusor muscle and urethra were the most consistent indicators of lesions of the conus medullaris and/oather than the ice water test is suggested.
A case of injury to the cauda equina or conus medullaris after lumbar vertebral manipulation is reported. In contrast to all other previously reported cases, no migrated disk fragment was demonstrated. Similar to experience at the cervical spine, lumbar vertebral manipulation may carry a risk of vascular injury. The neurological manifestations in our patient were consistent with compression of the Desproges-Gotteron artery by a small L4-L5 disk herniation.
Cauda equina syndrome is a rare neurological complication of ankylosing spondylitis. The specific myelographic and tomodensitometric anomalies are exemplified by the reported observation. This case is unusual by the moderation of the neurological manifestations, and especially by the absence of sphincteral disorders. The characteristic roentgenologic signs of ankylosing spondylitis are associated with a scalloped appearance of the lumbar spinal column and antecedent quiescent acromegaly.
A retrospective study of 32 patients with primary tumours of the cauda equina is presented. Most of the patients were initially diagnosed as having prolapsed intervertebral discs and treated accordingly. The correct diagnosis was eventually made, usually after a long delay, and confirmed by myelography. Treatment consisted of laminectomy and excision of the tumour. Only one tumour was frankly malignant; all the remaining patients were relieved of their pain and the majority recovered completely. The exceptions were those patients with long-standing neurological deficits; this highlights the importance of early diagnosis and correct treatment before irreparable damage occurs.
A case of the cauda equina syndrome complicating ankylosing spondylitis (AS) is described. An unusual feature of this case was the relapsing and remitting nature of the condition, but there is sufficient evidence to explain the clinical picture on the basis of a recurrent intraspinal inflammatory process. The clinical and radiological features are similar to those of a further 28 reported in the literature. An electromyogram (EMG) proved important in defining the extent of neurological involvement. Computerised tomography (CT) showed marked laminar erosion and no bony exit foramen encroachment. We believe that the clinical diagnosis of this condition can be adequately confirmed with plain radiology, EMG, and CT scan.
A case report of paraplegia secondary to a malignant B-cell lymphoma primary in the cauda equina is presented. Initial diagnosis was suggested on cytocentrifuge preparations of cerebrospinal fluid with subsequent tissue confirmation following bilateral laminectomy (T12-L3). Histologically, the tumor was a diffuse "histiocytic" lymphoma by Rappaport's or large noncleaved FCC lymphoma by Lukes and Collins classification. Immunologic studies typed the tumor as a B-cell neoplasm with lambda light chains. Following an extensive evaluation of the patient, the lymphoma was found to be limited to the lower spinal cord. Although radiotherapy was initiated there was no improvement of her neurological symptoms, and CSF cytology remains positive for rare malignant cells 2 months after diagnosis. A complete reevaluation at 3 months after laminectomy was negative for lymphoma involvement of other sites.
Speed and completeness are vital in the radiographic evaluation of an acute cauda equina syndrome presentation to maximize its resolution with rapid appropriate surgical intervention. Magnetic resonance imaging provides the optimal method for non-invasive evaluation.
A 48 year-old patient with a myelosclerosis was operated from a cauda equina compression which had been revealed by bilateral sciatica. The epidural space was filled with extra-medullary hematopoietic tissue. The mechanism of epidural hematopoiesis is discussed.
A well-controlled experimental model for analysis of compression-induced functional changes of the porcine cauda equina is presented. The model allows for electrophysiologic investigation of a variety of neurophysiologic changes induced by nerve root deformation. At an acute pressure threshold of 50-75 mm Hg, changes in both afferent and efferent conduction are induced. With higher compression pressure, a differential recovery in afferent and efferent conduction is seen.
The twenty-five patients with the intermittent claudication syndrome of th cauda equina included 19 men and 6 women aged from 23 to 70 years. The results of operation were very good in 16 cases, with improvement in 6 others and failure in 3 cases. There are various mechanisms which can cause the stenosis. The authors stress the importance of congenital vertebral abnormalities and the presence of apophyseal appendices which, at the present time, have not been considered responsible.
An unusual case is reported of an intradural lumbar arachnoid diverticulum causing mild compression of the cauda equina and producing debilitating symptoms which were relieved by inadvertent drainage. A survey of the literature indicates that lumbar arachnoid diverticula are very rare. Only one other report of an intradural lesion of this type has been found. These lesions cause back pain or radicular pain and sensory disturbances when the patient is upright of bending forward. These symptoms are relieved by lying down. Percussion tenderness over the level of the diverticulum is a consistent finding. The key to the diagnosis is supine myelography.
The results with the cauda-equina-neurography in more than 150 patients demonstrate a value for differentiation of lumbosacral disorders. The action potentials of normal adults are mostly biphasic, have the same configuration for both sides and their amplitude is between 0,3 and 20 uV. The conduction velocity decreases with age for both nerves. In cases of lumbosacral disorders with isolated nerve root affection by discogenic compressions the potentials are delayed, reduced, polyphasic or absent. Mostly the clinical, electromyographic, myelographic and surgical results correspond with neurographic examination. The examination is possible since technical problems permit a good differentiation and localisation of root lesions.
Three patients with the combination of long-standing ankylosing spondylitis (AS) and cauda equina syndrome are described and compared with 17 from the literature. The nerve root lesion has been of gradual onset and has since the time of diagnosis either been stationary or progressed slowly. Radicular pain in the feet and legs, and genito-urinary complaints have been the dominant and most disabling symptoms. Typical myelographic findings were expansion of the dural sac and arachnoidal diverticula. There is a highly probable relationship between AS and the neurological syndrome. The pathogenesis is probably related to early arachnoiditis with subsequent loss of meningeal elasticity. Earlier recognition of the root lesion may result in a more effective treatment.
A case of an intrathecal cryptococcal granuloma in the cauda equina is reported. Successful and minimally toxic therapy with intrathecal amphotericin B and oral 5-fluorocytosine, preceded by surgery, is described.
A case of tabetic neuroarthropathy of the lumbar spine causing cauda equina compression with paraplegia and retention of urine is described. The literature is reviewed and the role of surgery in such cases is discussed.