SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The authors describe a simple clinical adjunct to the routine neurological examination of patients with intermittent cauda equina compression syndrome. The "bicycle test" helps exclude intermittent claudication due to vascular insufficiency and frequently confirms the relationship of posture to radicular pain.
Paragangliomas are tumors arising in the paraganglia and rarely occurring in the cauda equina. We report two cases of paraganglioma arising in this region. The tumors exhibited a typical "Zellballen" pattern, and immunohistochemical studies were positive for neuron-specific enolase, but negative for S-100 protein and glial fibrillary acidic protein. Electron microscopic studies confirmed electron-dense neurosecretory types of granules in the tumor cells. Only 23 cases of paragangliomas in this region have been previously reported. A brief review of the literature is included.
We have had the opportunity to treat and follow up two young males with cauda equina syndromes after recurrent resection of intraspinal lipomas. This condition is relatively rare. The patients underwent myelographies, operations, long periods of hospitalisation, and rehabilitation. The syndromes included low back pain, arachnoiditis, and recurrence of the lipoma after several years and multiple operations. These are the problems that we were faced with: (1) Although the tumor is benign it is impossible to resect it completely. (2) There are complications which interfere with rehabilitation, including pain, arachnoiditis, and neurological deterioration. (3) Long term prognosis might be grave and the patient and family should know this. (4) Physiotherapy and sports: should these patients perform strenuous exercise or not?
An unusual case of intradural paragangliomas in the cauda equina region in a 29-year-old male is presented. The patient presented with signs and symptoms of raised intracranial pressure. The symptoms resolved after tumor resection.
A 50-year-old man, who had previously been well, presented with symptoms and signs of progressive cauda equina compression. This was shown to be due to an extradural lesion which on biopsy was found to be a non-Hodgkin's lymphoma of the small cell lymphocyte type. There was no evidence of lymphoma deposits elsewhere. Non-Hodgkin's lymphoma rarely affects the central nervous system except as a late feature of widely disseminated disease. This case demonstrates that isolated spinal infiltration in the absence of widespread disease can be a mode of presentation of a non-Hodgkin's lymphoma. Accordingly primary extradural non-Hodgkin's lymphoma should be considered in the differential diagnosis of spinal cord and root compression.
In this experimental study the efficacy of methylprednisolone was investigated by neurophysiological and histopathological evaluation in a rabbit cauda equina model where injury was produced with an aneurysm clip (closed pressure 192 gr). High dose methylprednisolone (kg/30 mg) was administered by intravenous infusion in the 8th, 16th and 24th hours after injury followed by infusion of the same dosage every 6 hours for 24 hours. Nerve conduction velocity was measured before and early after trauma and 3 weeks after injury. Both neurophysiological and histopathological investigations demonstrated the neuroprotective effectiveness of methylprednisolone if it was given in the 8th hour after trauma. Although recovery was observed its efficacy was less pronounced when it was given in the 16th and 24th hours.
Somatosensory evoked potentials were recorded from the scalp in response to cauda equina stimulation in a total of 30 patients who were treated neurosurgically for spinal space-occupying lesions. Reproducible potentials could be obtained intraoperatively in 26 patients (86.7%). Preoperatively all of the four remaining patients had severe neurological deficits and an incomplete para- or tetraparesis. On the basis of an acceptable amplitude reduction of up to 50% at the end of the operation, it was possible to make an accurate statement as to the expected postoperative neurological state in all of the 26 patients in whom potentials could be obtained intraoperatively. There were no false positive or false negative findings. Our results confirm the reliability and usefulness of this invasive stimulation and non-invasive recording technique when applied intraoperatively.
Forty-nine patients with complete and incomplete injuries of the spinal cord or cauda equina who had undergone anterior decompression at a minimum of 3 months after injury were examined. Follow-up was from 12 months to 19 years. Postoperative neurologic improvement occurred in 46.5% of patients with incomplete injuries. If the surgery was performed less than 2 years after injury, neurologic improvement occurred in 68% with an improvement in Frankel grade of 32%. Bladder function improved in 27% of patients and if operated on less than 2 years after injury improvement occurred in 43%. Conus medullaris decompression resulted in a 50% improvement. There was an 83% improvement in the pattern of pain after decompression. Of 23 patients with preoperative spasticity, 10 improved but 6 were worse after surgery.
A series of 42 patients with lumbar disc disease and herniation, presenting with the cauda equina syndrome, has been studied. It was observed that pure disc herniation accounted for the syndrome in five cases only. Associated structural lesions were contributory factors in the remaining 37 cases, and operative manipulation and trauma during disc removal through an interlaminar approach was the added factor in two of them. Wide laminectomy with excision of the overhanging facet joints and adequate visualization of the lumbar nerve roots has been found to be the ideal procedure for disc removal and for relief of the symptoms, including backache. No postoperative spinal instability has been observed. There was no morbidity was insignificant. All cases have been followed up, and "good to excellent" results were obtained in 95 per cent of patients, and "fair" results in the other 5 per cent.
Four new cases of ankylosing spondylitis complicated by a cauda equina syndrome are reported. Similarly to the previous descriptions, the patients present with long-standing and severe spondylitis at the time when neurological symptoms, mainly radicular pain, develop. Computed tomography of the lumbar spine demonstrates in all cases typical laminar erosions and posterior arachnoid diverticula. Up to now, magnetic resonance imaging has rarely been performed in this particular pathology, though it is helpful in determining the anatomical relations and the nature of the lesions. Based on the previous publications, our study aims at describing the clinical and pathogenic aspects of the disease and defining the most useful diagnostic investigations and treatment choices. Therapeutic possibilities are often limited because of a late diagnosis. Better knowledge of this rare complication could lead to earlier recognition and more efficient therapy.
Ependymomas are the most common glial tumors of the spinal cord, including the conus medullaris, filum terminale, and cauda equina. This study involved eight ependymomas of the spinal cord encountered during a 29-year period (1968-1996). The male:female ratio was 1:1.7, and the mean age at diagnosis was 33.7 years (range, 13-55 years). The outcome was studied in relation to initial presentation, initial therapy, location of tumor, histology of tumor, and gender after a follow-up period ranging from 2-16 years (mean, 113 months). Complete removal was achieved in six patients. Two patients received postoperative irradiation after partial removal. Histological examination revealed a benign ependymoma in all patients. Patients undergoing gross total excision at initial operation had excellent or good outcomes. We conclude that ependymomas of the spinal cord should be removed completely, if possible. Spine surgeons should be aware of the disease, and magnetic resonance imaging should be used in its detection.
In order to investigate the clinical significance of redundant nerve roots of the cauda equina (RNR) and their pathogenesis, the following studies were performed: 1) examination of 1,256 myelograms of patients with lumbar disease; 2) clinical analysis of 55 patients with RNR and 75 without RNR; 3) electrophysiological examination of 9 patients with RNR; and 4) anatomical and histopathological examination of 6 autopsy cases. RNR were found in 42% of patients with severely constricted spinal canals. In comparing patients with RNR and those without RNR, RNR were found in older patients, these patients exhibited a longer period from the onset of the symptoms to the time of myelographic manifestation, and they caused more severe signs and symptoms. The spatial distribution of redundant nerve roots and the extent of degeneration of nerve fibers in redundant nerve roots indicated the close causal relationship between RNR and constriction of the spinal canal. As the pathogenesis of RNR, the authors suggest a squeezing force from the constricted spinal canal acting on the nerve roots.
Thirty-one paragangliomas of the cauda equina region were studied (18 men and 13 women, ages 30-71 years [mean, 51 years]). Symptoms (1 day to 15 years in duration; mean, 48 months) included low back pain (87%), sensory/motor deficits (35%), urinary/fecal incontinence (13%), and paraplegia (6%). All patients studied had some myelographic block. Cerebrospinal fluid protein level ranged from 56 to 7000 mg/dl (mean, 1109 mg/dl). Most tumors were limited to the filum terminale, although one also involved the conus medullaris and two clearly arose from a caudal nerve root. All but one were entirely intradural. The tumor was totally excised in 26 cases; these patients remain disease-free. Of three patients whose tumors were excised subtotally, two received radiotherapy; the one non-radiated patient died of tumor-related complications. No autopsy was performed. One partially encapsulated tumor that had been subjected to biopsy and irradiation presented 1 year later with osseous invasion and retroperitoneal extension; 20 years after subtotal excision, this patient is alive but paraplegic. Morphologically, all tumors resembled paraganglioma at other sites. Cytologic atypia and mitotic activity generally were absent to mild. Fourteen (45%) cases showed ganglionic differentiation. All tumors tested were immunoreactive for neuron-specific enolase and neurofilament protein, and most showed somatostatin or serotonin reactivity. S-100 protein immunoreactivity was noted in sustentacular cells and, to a lesser extent, within chief cells and neurons. The authors conclude that paragangliomas are largely benign and encapsulated and respond to simple resection. When surgically feasible, gross total removal should be the goal of surgery. When subtotal resection is necessary or when local invasion leaves a question as to completeness of tumor removal, irradiation seems mandatory although far from guaranteeing prevention of recurrence. Biopsy alone is undesirable.
In a case of partial laminoarthrectomy for lateral recess stenosis cauda equina compression occurred post-operatively, and was caused by migration of a free graft. Recovery was complete within six months. The technical details of insertion of the free fat grafts are described.
After a brief introduction to the problem of the nature and localisation of sympathetic and parasympathetic paragangliomas a new case of paraganglioma of cauda equina is reported.
The authors reported an early case of cauda equina syndrome after hemilaminectomy and discectomy for lumbar disc herniation. CT-scan revealed the migration of the free fat graft used for preventing peridural scar formation. Removal of the graft resulted in total patient's recovery.
A case of metastasizing ependymoma is described, only the second in the British literature. The tumour, which arose in the cauda equina, spread to humerus and pleura over a period of 32 years. It is postulated that, in common with most of the previously reported cases, dissemination was a direct consequence of either surgical intervention or radiotherapy since neither the primary tumour nor its metastases shows any of the conventional morphological criteria of malignancy. The literature of similar cases is briefly reviewed.
The authors report four cases of cauda equina lesions following posterior surgery for severe dysplastic spondylolisthesis: three following fusion in situ, and one following decompressive laminectomy. The patients developed urinary retention, saddle anesthesia, and lax anal tone immediately after surgery. The mechanism of the nerve root damage is thought to be mechanical, occurring during decortication before bone grafting. It is recommended that patients should be counseled about the risk of neurologic impairment following decompressive laminectomy or fusion in situ for severe spondylolisthesis.