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PubMed2006

Functional reinnervation of the rat lower urinary tract after cauda equina injury and repair.

Conus medullaris and/or cauda equina forms of spinal cord injury commonly result in a permanent loss of bladder function. Here, we developed a cauda equina injury and repair rodent model to investigate whether surgical implantation of avulsed lumbosacral ventral roots into the spinal cord can promote functional recovery of the lower urinary tract. Adult female rats underwent sham surgery (n = 6), bilateral L5-S2 ventral root avulsion (VRA) injury (n = 5), or bilateral L5-S2 VRA followed by an acute implantation of the avulsed L6 and S1 ventral roots into the conus medullaris (n = 6). At 12 weeks after operation, the avulsed group demonstrated urinary retention, absence of bladder contractions and external urethral sphincter (EUS) electromyographic (EMG) activation during urodynamic recordings, increased bladder size, and retrograde death of autonomic and motoneurons in the spinal cord. In contrast, the implanted group showed reduced urinary retention, return of reflexive bladder voiding contractions coincident with EUS EMG activation, anatomical reinnervation of the EUS demonstrated by retrograde neuronal labeling, normalization of bladder size, and a significant neuroprotection of both autonomic and motoneurons. In addition, a positive correlation between motoneuronal survival and voiding efficiency was observed in the implanted group. Our results show that implantation of avulsed lumbosacral ventral roots into the spinal cord promotes reinnervation of the urinary tract and return of functional micturition reflexes, suggesting that this surgical repair strategy may also be of clinical interest after conus medullaris and cauda equina injuries.

Amidines↗
PubMed1997

[Paraganglioma of the cauda equina].

We report on a case of paraganglioma of the cauda equina in a 48-year-old man. These slow-growing, mostly benign and encapsulated intradural-extramedullar tumours are clinically characterized by lumbago, paraesthesia and motor deficits as well as occasionally by incontinence. Paragangliomas of the cauda equina show monomorphous (main) cells arranged in a typical cell cluster pattern, demonstrating a lobular architecture and a fine net of connective tissue formed by so-called sustentacular cells; some tumours show focal ganglionic differentiation. Because of their morphological similarity to the more common ependymomas, paragangliomas of the cauda equina are sometimes misdiagnosed so that their incidence is likely to be higher than previously estimated. Immunohistochemistry findings are positive for neuron-specific enolase, chromogranin and other neuronal markers as well as neuropeptides (main cells) and S-100 protein (sustentacular cells) while widely lacking reactivity for GFAP. Paragangliomas of the cauda equina represent a rare entity, of which only 80 cases have been described in the literature. Because they only occur sporadically, they are often not included in the differential diagnosis of mass lesions of the region of the cauda equina.

Biomarkers↗
PubMed2003

Cauda equina paraganglioma: a review.

Although rare, cauda equina paraganglioma (CEP) is definitely established in the table of cauda equina tumours. There are no particular investigations to document its preoperative diagnosis, unless a vasomotor amine syndrome is present to guide the differential diagnostic spectrum. Magnetic resonance imaging is the examination of choice for the presurgical assessment, but there are still overlapping findings, mainly among CEP, ependymoma, schwannoma, and hemangioblastoma. It is also the only means for postoperative follow-up. Computed tomography may fail to reveal all intrathecal lesions. Total excision is the gold standard for lesions with such a benign or at least protracted clinical course, as observed with the CEP. In contrast to well-known oncologic principles in micro, ultrastructural, and immunohistochemical prediction analysis, these tumours behave in an independent fashion. Promising efforts are being conducted in immunohistochemistry and DNA search, but the mainstay of our knowledge regarding its natural history still stems from our sporadic observation of its clinical behaviour.

Cauda Equina↗
PubMed2005

Giant nondural-based cauda equina meningioma with multiple cysts.

A very rare case of a giant nondural-based cauda equina meningioma with multiple cysts was presented. Spinal meningioma most commonly occurs in the thoracic or cervical region and typically adheres to the dura. Only six cases of nondural-based meningioma have been reported in English literature. All occurred in the cauda equina region. These patients were predominantly female and younger than those with typical intraspinal meningioma.A 46-year-old woman had a 4-year history of lower back pain and right leg pain. Progressive weakness of both lower extremities occurred. Magnetic resonance imaging revealed a giant cauda equina tumor with multiple cysts from T(12) to L(4). Following laminectomies from T(11) to L(5) and intradural exposure, the tumor was found to be draped loosely by the roots of the cauda equina and attached to a root without any firm connection with dura mater. Complete removal of the tumor was achieved after microdissection of arachnoid and sacrifice of an involved rootlet of the cauda equina. The appearance of tumor was that of a typical neurilemmoma. However, histological and immunohistochemical analyses were consistent with meningioma. Nondural-based intraspinal meningiomas are very rare, particularly a giant tumor with multiple cysts as our presenting case. All of the cases previously reported, including our case, have been located in the cauda equina region. Most of the patients were female and were young, suggesting that the nondural-based cauda equina meningiomas are age- and sex-related. An accurate preoperative and operative diagnosis are difficult. Care must be taken in the management of cauda equina tumors resembling neurilemmoma which may in fact represent meningioma, particularly in the younger female.

Cauda Equina↗
PubMed2003

A histologic and functional study on cauda equina adhesion induced by multiple level laminectomy.

STUDY DESIGN: A histologic and functional study on cauda equina adhesion induced by multiple-level laminectomy was performed using rats. OBJECTIVE: To assess the relation between the extent of laminectomy and histologic and functional changes of the cauda equina induced by laminectomy. SUMMARY OF BACKGROUND DATA: It has been demonstrated that laminectomies may induce cauda equina adhesion, transiently or permanently. However, the relation between the extent of laminectomy and histologic and functional changes of the cauda equina induced by laminectomy is still unclear. METHODS: Sprague-Dawley rats (250-300 g) were used. They were divided into four groups: no-laminectomy group (n = 5) and single, double, and triple level laminectomy groups (n = 20, respectively). At 24 hours and 1, 3, and 6 weeks after laminectomy, rats in each group were killed, and specimens were obtained from L4 to L6. The histologic changes were assessed using the classification of Yamagami. Walking durations on treadmill test and ascending spinal nerve-evoked potential were assessed in laminectomy groups before laminectomy, then weekly for 1 to 6 weeks after laminectomy. RESULTS: With the greater extent of laminectomy, the decrease in cauda equina adhesions was more delayed. There was no difference in walking durations and ascending spinal nerve-evoked potential between pre- and postlaminectomy. CONCLUSIONS: The extent of laminectomy was related to recovery time of induced cauda equina adhesion. However, a delay in recovery from cauda equina adhesion may not produce a recognizable delay in recovery from clinical symptoms.

Animals↗
PubMed1991

[Cauda equina neurinoma associated with intracranial hypertension--case report].

A case of cauda equina neurinoma associated with intracranial hypertension is reported. A 59-year-old female with a history of disturbed orientation was admitted. A neurological examination upon admission revealed the disorientation and gait disturbance. Superficial sensation under L3 was impaired. A computed tomographic(CT) scan presented the enlargement of ventricles and the slightly poor description of cerebral sulci. Since the patient had a high fever up to 40.1 C, meningitis was suspected. Cerebrospinal fluid revealed that cell count was only 2/3, while the protein concentration was markedly elevated (389mg/dl). Froin reaction was extremely positive and fibrin was observed. Based upon these findings, the spinal tumor was considered. Plain lumber film showed the posterior scalloping of the L5 and S1 vertebral bodies. Gd-DTPA enhanced MRI showed a high signal intensity area at the cauda equina. Diagnosed as a cauda equina tumor, the total resection of the tumor was performed via laminectomy of L3-S1. The tumor was involved with nerve filaments at the cauda equina. The pathological diagnosis was neurinoma. After the operation, her symptoms improved and a CT scan revealed the reduction of the ventricular size. However, the protein concentration of cerebrospinal fluid did not normalized.

Cauda Equina↗
PubMed1992

Cauda equina syndrome in patients undergoing manipulation of the lumbar spine.

Cauda equina syndrome has been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1989 revealed ten reported cases of cauda equina syndrome in patients undergoing manipulation without anesthesia. This article presents three new cases where a temporal association was found between the onset of cauda equina symptoms and lumbar manipulation. The type of manipulation administered and the relationship between the treatment and symptoms is reviewed. In each of these cases both the chiropractic practitioner and the emergency room physician failed to comprehend the nature of the problem and take appropriate action. As a consequence, the patients went untreated for several days. This may have led to residual symptomatology. It is concluded that patients who present with bowel or bladder disturbances, leg weakness, or rectal and genital sensory changes after manipulation, be recognized as experiencing a cauda equina syndrome.

Adult↗
PubMed1996

Alternating sciatica while jogging: an early symptom of cauda equina tumor.

Three athletic patients with cauda equina or lumbosacral cord tumor noticed, as an early symptom of the disease, alternating bilateral sciatica synchronized with each stride while jogging. Comparison with athletic patients who developed lumbar disc hernia suggested that this symptom was significant. The authors speculated that the mechanism producing this symptom is the inertial force induced while jogging, which acts on the tumor in its early stage, when it is still quite mobile in the intradural space. The diagnostic role of this symptom in cauda equina and lumbosacral cord tumor should be recognized.

Adolescent↗
PubMedDate not supplied

Cytokeratins expression in paragangliomas of the cauda equina.

BACKGROUND: Paragangliomas rarely involve the cauda equina region. In this location, these tumors can show misleading morphological features such as trabecular or papillary growth patterns and variable expression of cytokeratins. METHODS: We comparatively studied the immunohistochemical and ultrastructural patterns of 3 paragangliomas of the cauda equina (PCE) and of 8 paragangliomas from other sites. RESULTS: All the paragangliomas expressed neuroendocrine markers (neuron-specific enolase, chromogranin A, synaptophysin and neurofilament protein). In PCE, chief cells exhibited a strong positivity with a broad spectrum anti-cytokeratin antibody. The staining was diffuse in the cytoplasm or had a paranuclear dot-like disposition. In other sites, only one paraganglioma showed a focal expression of cytokeratins. At ultrastructural level, chief cells of PCE contained characteristic dense core granules and intermediate-sized filaments sometimes grouped in paranuclear whorls. CONCLUSION: The dual immunophenotype of PCE, paraganglionic and epithelial, must be recognized in order to distinguish these tumors from, for example, a metastasis of a neuroendocrine carcinoma. PCE are slow-growing tumors and have mostly a favorable prognosis after complete surgical excision.

Adolescent↗
PubMedDate not supplied

[Cauda equina syndrome after intradural anesthesia with bupivacaine].

A 70-year-old man developed pain and functional weakness in the lower limbs with dysesthesia and urinary retention after subarachnoid anesthesia with 0.5% hyperbaric bupivacaine. Neurological and electrophysiological tests and follow-up, as well as diagnostic images (CAT and MR), ruled out spinal cord lesions. The diagnosis was cauda equina syndrome. Cauda equina syndrome is a neurological complication of subarachnoid anesthesia. Associated with use of microcatheters for continuous subarachnoid anesthesia and 5% hyperbaric lidocaine, cauda equina syndrome is rare after a single injection of bupivacaine. Although the pathogenesis of cauda equina syndrome is poorly understood, there is agreement on the neurotoxicity of local anesthetics, particularly of 5% hyperbaric lidocaine.

Aged↗
PubMed1991

Experimental nerve root compression. A model of acute, graded compression of the porcine cauda equina and an analysis of neural and vascular anatomy.

Nerve root compression has been suggested as one important pathogenetic factor in low-back pain syndromes and sciatica. The underlying pathophysiologic mechanisms are, however, incompletely known, partly because of the lack of experimental data on this topic. In the present study, a model for experimental compression of the porcine sacrococcygeal cauda equina is presented. The model consists of surgical exposure of the cauda equina and compression of the cauda equina toward the ventral aspect of the spinal canal by an inflatable balloon fixed to the spine. This compression system was shown to have a high accuracy in pressure transmission from the balloon to the cauda equina. The gross and microscopic neural anatomy and the vascular anatomy of the porcine cauda equina were analyzed with light microscopic and ink-perfusion techniques. The porcine cauda equina showed a close anatomic resemblance to the human lumbosacral cauda equina. The presented model offers unique possibilities for experimental studies on nerve root compression injury because of the easy surgical exposure and the sufficient length of the nerve roots. In separate studies, this model, along with investigations of solute transport to the nerve tissue and of impulse propagation, has been used to analyze the effects of acute, graded compression on blood flow and edema formation in the cauda equina. The porcine cauda equina would also be particularly suitable for chronic compression studies because any neurologic deficit acquired would be restricted to the tail.

Animals↗
PubMed1990

Cauda equina syndrome complicating ankylosing spondylitis.

The cauda equina syndrome is an uncommon and poorly understood complication of ankylosing spondylitis. The clinical and radiologic findings in five patients with this syndrome are described. Typical findings include cutaneous sensory impairment of the lower limbs and perineum with sphincter disturbances. Motor impairment occurs less frequently, and associated pain is an inconstant feature. Enlargement of the caudal sac and dorsal arachnoid diverticula that erode the lamina and spinous processes are characteristic myelographic and computed tomographic findings. The pathogenesis of the cauda equina syndrome in ankylosing spondylitis remains unknown but may be due to demyelination, post-irradiation ischemia, or compression from spinal arachnoiditis.

Adult↗
PubMedDate not supplied

Synovial cysts and the lithotomy position causing cauda equina syndrome.

We describe a case of cauda equina syndrome caused by synovial cysts and the lithotomy position. A transurethral resection of the prostate was performed under spinal anesthesia in the lithotomy position. We believe that this is the first case report of facet joint synovial cysts and the lithotomy position causing ischemic neurologic injury to the cauda equina. Other etiologies such as needle trauma, neurotoxicity, hematoma, and abscess were not evident. We believe that positioning the patient in the lithotomy position narrowed the cross-sectional area of the spinal canal in a patient with a coexisting critically stenosed lumbar spinal canal. The resultant mechanical pressure caused an ischemic compression injury to the cauda equina.

Aged↗
PubMedDate not supplied

[Metastases to the spinal cord and cauda equina].

The authors present 3 rare cases of metastases to the spinal cord and cauda equina. In 2 cases the tumours were of epithelial, and in the third neuroepithelial origin. In one case the tumour was localized in the thoracic segment of spinal cord, and in the second case in the conus and cauda equina, whereas in the third at the cauda equina. The diagnosis was established by CT and myelography. Total removal of the tumour in the cauda equina was carried out. The most significant neurologic symptoms in the two cases were pain and paresis in one case. In our series the rate of metastases to intramedullary and cauda equina constitute 11.1% of all metastases to vertebral column and vertebral canal, and 8% of all epithelial metastases to central nervous system. Death were reported in all the patients within the 1st-5th month of diagnosis of tumour in the spinal cord.

Adult↗
PubMedDate not supplied

[The role of surgical decompression of cauda equina in lumbar disc herniation and recovery of bladder function].

INTRODUCTION: Cauda equina syvndrome from lumbar disc herniation accounts for up to 2-3% of all disc herniations. The aim of this study was to investigate whether recovery of bladder function after surgery depends on preoperative duration of desease. PATIENTS AND METHODS: This retrospective study included 47 patients who underwent surgery for cauda equina syndrome due to a herniated disc in the period between 1997 and 2002. Eleven patients were female and 36 male, with a mean age of 43 years (range 23-67). All presented with sciatica and saddle hypoesthesia, whereas 13 presented with motor weakness of legs. All patients had been catheterized at the time of admission to the Neurosurgical unit. Levels of herniation were L4-L5 in 27 (57%), L5-S1 in 14 (30%), and L3-L4 in 6 (13%) patients. In 7 (15%) patients, surgery was performed within 48 hours of the cauda equina syndrome onset. None underwent surgery within 24 hours. 13 (28%) patients were operated between the 2nd and 7th day and 27 (57%) after 7th day of the cauda equina onset. The role of preoperative duration of symtoms in recovery of bladder function was examined (chi 2 analysis). RESULTS: The follow-up ranged from 15 to 74 months (mean 24.2 months). In 33 patients (70%) excellent result were achieved, in 9 (19%) patients good results and 5 (11%) patients presented with poor results. There was no statistically significant difference concerning the time between the onset of symptoms and surgical decompression and subsequent recovery of bladder function (p>0.05). CONCLUSION: After accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome due to lumbar disc herniation appear satisfactory regardless of the timing of surgery.

Adult↗
PubMed2004

Lumbar sympathectomy increases blood flow in a dog model of chronic cauda equina compression.

OBJECTIVE: This study was designed to assess changes in blood flow of the dog cauda equina after lumbar sympathectomy using an experimental chronic cauda compression model. METHODS: The cauda equina was compressed at 10 mm Hg with a plastic balloon in all animals (n = 12). One week later, bilateral lumbar sympathectomy was carried out in the LSX group (n = 7), and vessels of the cauda equina were thereafter observed for 90 minutes using a specially designed microscope supplied with a video camera. Five animals did not undergo sympathectomy and were used as controls. The volume of blood flow was calculated from two parameters: velocity (mm/s) and diameter (microm) of a vessel observed in each animal. RESULTS: The increment in vessel diameter in the LSX group was pronounced at 30 and 45 minutes after sympathectomy compared with the control group (P < 0.05). Blood flow in the LSX group was increased at 30 minutes depending on dilation of the vessel diameter compared with the control group (P < 0.05). The velocity in the observed vessels remained unchanged throughout the measurements. CONCLUSIONS: These data suggest that lumbar sympathectomy could induce an increase in blood flow of the compressed cauda equina. As lumbar sympathetic block increases blood flow not only in the lower limbs but also in the cauda equina, it might be evaluated for a conservative treatment of intermittent claudication due to lumbar spinal canal stenosis.

Animals↗
PubMed1996

Hemi-cauda equina syndrome from herniated lumbar disc: a neurosurgical emergency?

BACKGROUND: We report experience with patients presenting with a specific combination of symptoms: unilateral sciatica, unilateral sensibility loss in the dermatomes S1 to S5 (hemi-saddle) and subjective micturation problems secondary to ruptured lumbar disc. Because of its similarities with a cauda equina syndrome, this combination of symptoms was thought to be a unilateral cauda equina syndrome and it was called hemi-cauda equina syndrome. Consequently, it was treated as an emergency. METHODS: Ten patients were evaluated. They compromised 2.3% of all patients undergoing lumbar discectomy. RESULTS: Outcome is good with only 10% persisting minor neurologic deficit (sensibility loss in dermatomes S3 to S5). With the exception of urinary retention or incontinence, duration of symptoms and signs does not seem to influence outcome. Comparing signs, symptoms and radiographic findings with those of a cauda equina syndrome which were recently and thoroughly studied, they were found to be more severe in cases of cauda equina syndrome. Especially, the good outcome, (apparently unrelated to the duration of symptoms in cases of hemi-cauda equina syndrome) contrasted with the treatment results of cauda equina syndrome. CONCLUSIONS: We defined the hemi-cauda equina syndrome from ruptured disc as a combination of unilateral leg pain, unilateral sensibility loss in dermatomes S1 to S5 and sphincter paralysis (proven urinary retention or incontinence). Motor deficit is not necessarily present. Emergency surgery is warranted. Patients presenting with micturation complaints other than urinary retention or incontinence do not suffer from a hemi-cauda equina syndrome.

Adult↗
PubMed1986

Slowed motor conduction in lumbosacral nerve roots in cauda equina lesions: a new diagnostic technique.

New techniques have been developed for the electrophysiological assessment of patients with suspected cauda equina lesions using transcutaneous spinal stimulation (500-1500 V: time constant 50 microseconds) to measure motor latencies to the external and sphincter and puborectalis muscles from L1 and L4 vertebral levels. These latencies represent motor conduction in the S3 and S4 motor roots of the cauda equina between these levels. Similarly motor latencies can be recorded from spinal stimulation to the anterior tibial muscles (L4 and L5 motor roots). Transrectal stimulation of the pudendal nerves is used to measure the pudendal nerve terminal motor latency. In 32 control subjects, matched for age and sex, mean motor latencies from L1 and L4 spinal stimulation were 5.5 +/- 0.4 ms and 4.4 +/- 0.4 ms (mean + SD). In the 10 patients with cauda equina disease including ependymoma, spinal stenosis, arachnoiditis and trauma, these latencies were 7.2 +/- 0.8 ms and 4.6 +/- 0.9 ms, a significant increase in the L1 latency. The L1/L4 latency ratios to the puborectalis muscle were 1.36 +/- 0.09 in control subjects and 1.72 +/- 0.13 in cauda equina patients. Pudendal nerve terminal motor latencies were normal in eight of the 10 patients with cauda equina disease. The single fibre EMG fibre density in the external and sphincter muscle (normal, 1.5 +/- 0.16) was increased in patients with cauda equina lesions (1.73 +/- 0.28), but was increased more than two standard deviations from the mean only in three patients. This increase in fibre density was not of diagnostic value since it was also found in two of the four patients with low back pain. Slowing of motor conduction in the cauda equina is thus a useful indication of damage to these intraspinal motor roots. These investigations can be used in the selection of patients for myelography, and to follow progress in patients managed conservatively.

Adult↗