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PubMed1989

Edema formation in spinal nerve roots induced by experimental, graded compression. An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression.

Edema formation in spinal nerve roots of the pig cauda equina was studied following experimental compression at various pressure levels, durations, and rates of onset, using a fluorescence microscopic technique. The time-pressure thresholds for the occurrence of edema in the nerve roots were: following rapid onset of compression (0.05-0.1 seconds), 2 minutes at both 50 mm Hg and 200 mm Hg, and following slow onset of compression (the pressure was slowly increased during 15-20 seconds), 2 hours at 50 mm Hg and 2 minutes at 200 mm Hg. Generally, the edema formation was more pronounced after rapid than after slow onset of compression. The data in this study also indicate that intraneural edema might be more easily formed in nerve roots than in peripheral nerves after compression injury.

Animals↗
PubMed1991

[Cauda equina syndrome complicating cutaneous T-cell lymphoma (mycosis fungoides)].

Authors present a case of a cutaneous T. cell lymphoma (mycosis fungoides) complicated by a cauda equina syndrome. Crural and sciatic radicular pain were due to epidural lumbar involvement by tumoral process. After surgical decompression completed by chemotherapy the evolution was uneventful. This case is the second one reported in the literature.

Cauda Equina↗
PubMed1997

Lesions of the cauda equina: a clinical and pathology review from the Armed Forces Institute of Pathology.

We reviewed the clinical records of 149 patients with pathologically proved cauda equina lesions in order to define the relative frequency and clinical presentations of the various diagnoses. The most common pathology was ependymomas (47 patients) followed in frequency by nerve sheath tumors (35 patients), metastases (27 patients), nonependymal glial neoplasms (six patients), meningiomas (six patients), lipomas (five patients), paragangliomas (five patients) and various other diagnoses (19 patients). Mean patient age at presentation for the various lesions included: metastases (51.5 years), nerve sheath tumors (49.7 years), nonependymal glial tumors (46.5 years), paragangliomas (41.2 years), ependymomas (38.3 years), meningiomas (34.7 years), and lipomas (18.4 years). ANOVA showed that the relationship between age and diagnosis for these groups to be statistically significant at a high level (P = 0.002). Low back pain was the most common symptom and occurred in 44 patients. Other symptoms included unilateral lower extremity pain or tenderness (24 patients), bilateral lower extremity pain or tenderness (16 patients), and bilateral lower extremity weakness (16 patients). No relationship between pathologic diagnosis and specific symptoms was found.

Academies and Institutes↗
PubMed1987

Neuritis of the cauda equina in the horse.

Ultrastructural lesions of the cranial nerves and their ganglia and the autonomic nervous system from 5 cases of neuritis of the cauda equina in the horse are described. They include lysosomal inclusions within the semilunar, geniculate and sympathetic chain ganglia, granulomatous involvement of the coeliaco-mesenteric ganglion and accumulation of axonal organelles in unmyelinated fibres of the great splanchnic nerve, sympathetic chain and oesophageal vagus.

Animals↗
PubMed1999

Predictors of outcome in cauda equina syndrome.

This retrospective review examined the cause, level of pathology, onset of symptoms, time taken to treatment, and outcome of 19 patients with cauda equina syndrome (CES). The minimum time to follow up was 22 months. Logistical regression analysis was used to determine how these factors influenced the eventual outcome. Out of 19 patients, 14 had satisfactory recovery at 2 years post-decompression; 5 patients were left with some residual dysfunction. The mean time to decompression in the group with a satisfactory outcome was 14 h (range 6-24 h) whilst that of the group with the poor outcome was 30 h (range 20-72 h). There was a clear correlation between delayed decompression and a poor outcome (P = 0.023). Saddle hypoaesthesia was evident in all patients. In addition complete perineal anaesthesia was evident in 7/19 patients, 5 of whom developed a poor outcome. Bladder dysfunction was observed in 19/19 patients, with 12/19 regarded as having significant impairment. Of the five patients identified as having a poor overall outcome, all five presented with a significant sphincter disturbance and 4/5 were left with residual sphincter dysfunction. There was a clear correlation between the presence of complete perineal anaesthesia and significant sphincter dysfunction as both univariate and multivariate predictors of a poor overall outcome. The association between a slower onset of CES and a more favourable outcome did not reach statistical significance (P = 0.052). No correlation could be found between initial motor function loss, bilateral sciatica, level or cause of injury as predictors of a poor outcome (P>0.05). CES can be diagnosed early by judicious physical examination, with particular attention to perineal sensation and a history of urinary dysfunction. The most important factors identified in this series as predictors of a favourable outcome in CES were early diagnosis and early decompression.

Adult↗
PubMed1986

Enterogenous cyst of the cauda equina. A case report and a review of the literature.

The clinico-pathological findings in a 38-year-old man with a progressive cauda equina syndrome and with a dorsal dermal fistula in the lower back are presented. The X-rays of the spine revealed fusion of the vertebrae L4-L5 and L5-S1, and the myelogram showed an intradural tumour, extending upto the level of L2. An enterogenous cyst, adherent to the right third lumbar radix was completely removed. The clinical and pathological data are compared to previous published cases and discussed in relation to the origin of the tumour.

Adult↗
PubMed1980

A urodynamic study of cauda equina syndrome due to lumbar disc herniation.

Among 1,972 patients operated upon because of lumbar disc herniation in a 7-year period (1971-1978), cauda equina syndrome was diagnosed in 26 patients. 22 patients had follow-ups 4-72 months postoperatively (average 37 months). At follow-up half of the patients had histories of normal micturition and only 6 patients made serious micturition complaints. One third were free from lumbar or sciatic pain, two thirds complained of distressing pain and neurological symptoms. The urodynamic investigation revealed complete bladder emptying in all but 1 patient. In half of the patients normal detrusor contraction was demonstrated, while one third of the patients voided by straining only. Preoperative micturition symptoms exceeded 2 days in almost all patients voiding by straining. This finding indicates a connection between early diagnosis and treatment, and the degree of detrusor damage.

Acute Disease↗
PubMed1992

Case report: CT and MRI of the cauda equina syndrome in ankylosing spondylitis.

The clinical and radiological findings in a patient with long-standing ankylosing spondylitis who developed the clinical features of a cauda equina syndrome are presented. CT and MRI revealed characteristic expansion of the lumbar spinal canal with scalloping of the laminae and spinous processes related to the presence of dorsal dural diverticulae. MRI permitted confident exclusion of other intradural pathology without recourse to invasive investigations.

Cauda Equina↗
PubMed2000

Epidural compression of the cauda equina caused by vertebral osteoblastic metastasis of prostatic carcinoma: resolution by hormonal therapy.

A 59 year old man with prostatic carcinoma developed epidural compression of the cauda equina caused by bony expansion from a vertebral osteoblastic metastasis. For medical reasons he could not undergo radiation or surgery. Hormonal therapy alone relieved his low back pain and restored ambulation and urinary function. Postmyelography CT showed that the bony expansion from the vertebra had completely disappeared after treatment. This is the first report of remarkable improvement due to hormonal therapy alone.

Bone Neoplasms↗
PubMed1993

Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots.

Epidural application of autologous nucleus pulposus in pigs, without mechanical nerve root compression, induced a pronounced reduction in nerve conduction velocity in the cauda equina nerve roots after 1-7 days, compared to epidural application of retroperitoneal fat in control experiments. Histologically, the nerve fiber injury was more pronounced after application of nucleus pulposus than after control tissue application. The results demonstrate that nucleus pulposus may induce nerve tissue injury by mechanisms other than mechanical compression. Such mechanisms may be based on direct biochemical effects of nucleus pulposus components on nerve fiber structure and function and microvascular changes including inflammatory reactions in the nerve roots.

Animals↗
PubMedDate not supplied

[Cauda equina syndrome with plantar perforating ulcer and neurogenic osteoarthropathies in a case of rheumatismal pelvospondylitis].

The authors report a case of ankylosing spondylitis complicated by a cauda equina syndrome presenting with a plantar perforating ulcer and lesions of neuropathic arthropathy of the foot. On the basis of an analysis of 54 cases published in the literature they review the principal aspects of this complication of ankylosing spondylitis. Neurological manifestations occur late after several decades of progression of the disease. Urinary sphincter problems are common whilst trophic disturbances remain rare. Myelography and, above all, lumbar CAT scan reveal characteristic and stereotyped anatomical lesions: widening of the dural sac in its posterior part with meningoceles eroding the posterior vertebral arch. The pathogenic mechanisms are unknown. The authors suggest that lesions may start with posterior epidural inflammation rather than a primary process of arachnoiditis as has been mentioned in earlier publications.

Aged↗
PubMed2005

[Possibility of cauda equina nerve root damage from lumbar punctures performed with 25-gauge Quincke and Whitacre needles].

OBJECTIVE: To assess the possibility of puncturing nerve roots in the cauda equina with spinal needles with different point designs and to quantify the number of axons affected. MATERIAL AND METHODS: We performed in vitro punctures of human nerve roots taken from 3 fresh cadavers. Twenty punctures were performed with 25-gauge Whitacre needles and 40 with 25-gauge Quincke needles; half the Quincke needle punctures were carried out with the point perpendicular to the root and the other half with the point parallel to it. The samples were studied by optical and scanning electron microscopy. The possibility of finding the needle orifece inserted inside the nerve was assessed. On a photographic montage, we counted the number of axons during a hypothetical nerve puncture. RESULTS: Nerve roots used in this study were between 1 and 2.3 mm thick, allowing the needle to penetrate the root in the 52 samples studied. The needle orifice was never fully located inside the nerve in any of the samples. The numbers of myelinized axons affected during nerve punctures 0.2 mm deep were 95, 154, and 81 for Whitacre needles, Quincke needles with the point held perpendicular, or the same needle type held parallel, respectively. During punctures 0.5 mm deep, 472, 602, and 279 were affected for each puncture group, respectively. The differences in all cases were statistically significant. CONCLUSIONS: It is possible to achieve intraneural puncture with 25-gauge needles. However, full intraneural placement of the orifice of the needle is unlikely. In case of nerve trauma, the damage could be greater if puncture is carried out with a Quincke needle with the point inserted perpendicular to the nerve root.

Cauda Equina↗
PubMed1990

Compression-induced changes of the nutritional supply to the porcine cauda equina.

The effects of compression on the transport of 3H-labeled methyl glucose to spinal nerve roots were analyzed in an experimental model of the pig cauda equina. A rapid onset of compression (0.05-0.1 s) induced more pronounced effects than a slow onset (20 s) at corresponding pressure levels. There was evidence that this observed difference may be related to the magnitude of intraneural edema formed outside the compression zone. The results also indicate that the nutritional transport might be impaired at very low pressure levels and that diffusion from adjacent tissues with a better nutritional supply, including the cerebrospinal fluid, may not fully compensate for any compression-induced impairment of the intraneural blood flow.

3-O-Methylglucose↗
PubMed2004

Cauda equina syndrome as a postoperative complication of lumbar spine surgery.

OBJECT: The term "cauda equina syndrome" (CES) has been used to describe the signs and symptoms in patients with compressive neuropathy of multiple lumbar and sacral roots. This syndrome is well known as an indication for surgical intervention in treating lumbar spine disease, but relatively unknown as a postoperative complication following surgery for disease. In this study the author describes two cases of CES that occurred following uneventful lumbar spine procedures--one microdiscectomy and one decompressive laminectomy. METHODS: Preoperative, operative, and postoperative management is discussed and the relevant literature reviewed. One patient suffered perineal numbness and bowel and bladder difficulty following a decompressive laminectomy. Postoperative imaging studies were negative for residual lesion and the treatment goal pursued was partial long-term resolution of symptoms. The second patient had progressive numbness and weakness in the lower extremities. Results of urgent postoperative magnetic resonance imaging studies were inconclusive and repeated exploration was performed within hours of the initial procedure. The patient made a full recovery, although the intraoperative findings did not reveal a clear cause of the patient's symptoms. CONCLUSIONS: Postoperative symptoms of partial or complete CES represent a medical emergency, especially if they are progressive. It is necessary to perform urgent postoperative imaging in patients, but the results are not always helpful. Surgical exploration is warranted if a mass lesion is demonstrated on imaging studies or if symptoms progress and the disease origin is not clear based on available information.

Adult↗