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PubMed1991

Dorsal selective rhizotomy through a limited exposure of the cauda equina at L-1. Technical note.

The technique of the dorsal selective rhizotomy as originally developed by Professor Fasano and by the author is described. The rhizotomy is performed through a one-level laminectomy at L-1. Exposure of the conus medullaris and the cauda equina at this level is adequate to thoroughly assess the reflex electrical response to stimulation of the lumbosacral roots and to section the selected roots/rootlets. This approach, based on over 100 surgical procedures, obviates the need for an extensive laminectomy in a growing child without compromising the clinical results.

Cauda Equina↗
PubMed1999

Chemokine mRNA expression in the cauda equina of Lewis rats with experimental allergic neuritis.

Chemokines play an important role in the migration of leukocytes to inflammatory sites. In this study, using the quantitative competitive reverse transcriptase PCR method, we analyzed sequential expression of certain chemokine mRNAs in the cauda equina (CE) of rats with experimental allergic neuritis (EAN). Interferon-gamma-inducible protein (IP)-10, monocyte chemotactic protein (MCP)-1, macrophage inflammatory protein (MIP)-1alpha, the regulated upon activation normal T cell expressed and secreted chemokine (RANTES), and lymphotactin were analyzed on days 0 (pre-immunization), 7 (preclinical stage), 10 (disease onset), 13 (clinical progression), 17 (disease peak), as well as on days 20, 24, and 34 post-immunization (p.i.) (recovery). MCP-1 message increased at the preclinical stage and peaked at day 17 p.i. The increase in the early stage was not detected in other tissues, indicating peripheral nerve-specific upregulation. MIP-1alpha and IP-10 messages surged at day 13, then returned to low in the recovery stage. RANTES message increased at day 13 and peaked at day 17 p.i.; however, unlike other chemokines, it showed a second peak of expression on day 24. Lymphotactin message was undetectable at any time point. MCP-1 protein was detected immunohistologically in endothelial cells at day 7 p.i. The sequential expression of these chemokines in relation to the inflammatory process in the nerve leading to demyelination is discussed.

Animals↗
PubMed1976

Displaced fracture of the lumbosacral spine with delayed cauda equina deficit: report of a case and review of literature.

A 41-year-old man with a fracture of the upper sacrum and forward and downward displacement of the superior sacral fragment and upper spine on the lower sacrum, developed partial deficit of cauda equina function. Similar fractures rarely have been reported. Signs of lumbar pain, contusion, and fractured transverse processes should lead the surgeon to carefully examine the radiologic fractures of the area of injury; otherwise, this lesion may heal unrecognized. With the spine in flexion, the fracture may create mechanical instability. Early closed or open reduction is theoretically ideal. Surgical treatment must be weighed in terms of the risks and needs of the individual.

Adult↗
PubMed1989

[Cauda equina syndrome in ankylosing spondylitis].

A 55-year-old man who has had ankylosing spondylitis for over 20 years developed gradually increasing pain and sensory disorders in the legs, as well as mild foot and toe elevator weakness. There was no evidence of inflammatory activity. Clinical, neurophysiological and neuroradiological examination revealed a cauda equina syndrome as a late complication of ankylosing spondylitis. There is no known causal treatment.

Cauda Equina↗
PubMed2005

Outcomes in patients admitted for rehabilitation with spinal cord or cauda equina lesions following degenerative spinal stenosis.

PURPOSE: To evaluate outcome measures and the factors affecting them in patients treated between 1962 and 2000 at Loewenstein Rehabilitation Hospital, Israel. METHOD: This retrospective cohort study included 262 patients with spinal neurological lesions (spinal cord or cauda equina lesions) following degenerative spinal stenosis. Data were collected retrospectively. Survival was assessed using the Kaplan-Meier method and the relative mortality risk by the Cox model. Neurological recovery was evaluated by the change in Frankel grades, and factors that affect it were assessed by logistic regression. Associations of length of stay in rehabilitation were analyzed with ANOVA. RESULTS: Median age at lesion onset was 61 years and median survival 17.6 years. Age at spinal neurological lesion onset was found to be the only factor with a significant effect on survival. Of the 148 patients who had Frankel grades A, B, or C on admission, 58% achieved recovery to grades D and E. Frankel grade at admission, age, and spinal neurological level had a significant effect on recovery. The mean length of stay was 99.7 days, and only Frankel grade had a significant effect on length of stay. CONCLUSIONS: Patients with spinal stenosis and disabling spinal neurological lesions can achieve significant neurological recovery and survive for many years. They require adequate care in a specialist rehabilitation system.

Cauda Equina↗
PubMedDate not supplied

Magnetic resonance imaging of articular process joint geometry and intervertebral disk degeneration in the caudal lumbar spine (L5-S1) of dogs with clinical signs of cauda equina compression.

The geometry of the lumbosacral region has been suspected to play a role in the development of degenerative lumbosacral stenosis in the dog. In this study, 50 dogs (21 German Shepherd dogs and 29 dogs of other breeds) with clinical signs of cauda equina compression were studied by magnetic resonance (MR) imaging. The orientation of the articular process joints in the L5-S1 region and the angle difference between two adjacent motion segments were calculated. Intervertebral disc degeneration of the same region was identified and classified in four stages. A positive association between MR-imaging stage and articular process joint angle difference in the transverse plane was found in the two groups of animals. German Shepherd dogs and dogs of other breeds had different geometry of the lumbosacral region with different articular process joint angles in the transverse plane and statistically different stages of disc degeneration.

Animals↗
PubMed2004

Cauda equina syndrome after induction of spinal anesthesia.

In this report the authors present a case of cauda equina syndrome that developed following induction of spinal anesthesia in a patient who had no apparent preexisting bleeding abnormality. An acute subdural hematoma caused the syndrome and was believed to have resulted from direct vascular trauma during administration of spinal anesthesia or from vascular trauma combined with thrombocytopenia in the postoperative period.

Aged↗
PubMedDate not supplied

Lumbar disc herniation and cauda equina syndrome. Considerations on a pathology with different clinical manifestations.

The authors describe six cases of cauda equina syndrome (CES) with different clinical manifestations, etiopathogenetic causes, and degrees of disc prolapse. In three of the cases, the clinical onset was dramatic and acute, in the others it was a hemisyndrome (with acute onset in only 1 case). The site of the disc prolapse was L4-L5 in 3 patients, L3-L4 in 2 patients, and L5-S1 in 1 patient. The authors emphasize the need for the early recognition of the syndrome with a careful clinical examination and history of the patient, as well as timely treatment within 24 hours. For the sake of prevention, and particularly when the hernia is large, the authors suggest monitoring of the stability of the residual disc during surgery and postoperatively the use of a brace for at least one month.

Adult↗
PubMed2005

Outcomes in patients admitted for rehabilitation with spinal cord or cauda equina lesions following degenerative spinal stenosis.

PURPOSE: To evaluate outcome measures and the factors affecting them in patients treated between 1,962 and 2,000 at Loewenstein Rehabilitation Hospital, Israel. METHOD: This retrospective cohort study included 262 patients with spinal neurological lesions (spinal cord or cauda equina lesions) following degenerative spinal stenosis. Data were collected retrospectively. Survival was assessed using the Kaplan-Meier method and the relative mortality risk by the Cox model. Neurological recovery was evaluated by the change in Frankel grades, and factors that affect it were assessed by logistic regression. Associations of length of stay in rehabilitation were analyzed with ANOVA. RESULTS: Median age at lesion onset was 61 years and median survival 17.6 years. Age at spinal neurological lesion onset was found to be the only factor with a significant effect on survival. Of the 148 patients who had Frankel grades A, B, or C on admission, 58% achieved recovery to grades D and E. Frankel grade at admission, age, and spinal neurological level had a significant effect on recovery. The mean length of stay was 99.7 days, and only Frankel grade had a significant effect on length of stay. CONCLUSIONS: Patients with spinal stenosis and disabling spinal neurological lesions can achieve significant neurological recovery and survive for many years. They require adequate care in a specialist rehabilitation system.

Cauda Equina↗
PubMed1980

Experimental evaluation of the urethral response to section of the spinal cord or cauda equina and to the electrostimulation of the bladder in non-human primates.

Studies of urethral function in 32 female monkeys indicate a dual innervation of the mid-urethra from sympathetic and somatic supply. The resting urethral pressure profiles were preserved after low level section of the spinal cord or division of the cauda equina. They had lowered amplitude after overstretch or electrostimulation of the autonomous bladder.

Animals↗
PubMed1999

Intravascular papillary endothelial hyperplasia causing cauda equina compression: case report.

OBJECTIVE AND IMPORTANCE: Intravascular papillary endothelial hyperplasia (Masson's vegetant hemangioendothelioma) is a rare condition affecting the neuraxis. In the literature, only one case of this lesion involving the vertebral canal with spinal cord compression has been reported. We present a case of cauda equina compression due to this abnormality. CLINICAL PRESENTATION: A 17-year-old boy was admitted at our hospital with pain, numbness, paresis of the left lower extremity, and bladder dysfunction of approximately 1 month's duration. Computed tomography and magnetic resonance imaging of the spine revealed a tumor within the spinal canal at the T12-L1 level. INTERVENTION: The patient underwent a T12-L1 laminectomy. An epidural red nodular tumor was visualized and totally resected. The findings of the pathological examination were compatible with intravascular papillary endothelial hyperplasia. At follow-up examination 1 month after the operation, the patient had complete resolution of the pain, and the motor deficit and bladder dysfunction had improved significantly. CONCLUSION: This rare benign vascular lesion may be clinically and histopathologically mistaken for an angiosarcoma. Because the intravascular papillary endothelial hyperplasia can be cured by complete surgical resection, it is important to distinguish between these two lesions to avoid inappropriate aggressive treatment.

Adolescent↗
PubMed1999

Ependymoma of the cauda equina.

Myxopapillary ependymomas are benign tumours which occasionally metastasize along cerebrospinal fluid pathways. Extraneural metastases of spinal ependymomas, however, are very rare, even more so when situated in the pleura. We report the case of a 67 year old woman presenting with shortness of breath after recurrent myxopapillary ependymomas of the cauda equina. Chest X-ray showed multiple pleural lesions diagnosed as metastases of a myxopapillary ependymoma. The MIB-1 proliferation index was 3.1% for the initial spinal tumour, 14.2% for the first and 11.2% for the second recurrence while 12.0% for the pleural metastasis.

Aged↗
PubMed1976

[Metastatic carcinoma involving the cauda equina].

The case of a 60 year-old man who had an indifferenciated carcinoma in the lung is reported. He had received cobaltotherapy and had improved. After 3 months a lumbar pain had began and the patient was hospitalized. A myelography with lipiodol demonstrated and intra-dural mass. At operation a big intra-dural tumor including the cauda equina was found. The microscopic examination revealed an undifferenciated carcinoma, that inflitrated the epi and peri-nerual space.

Cauda Equina↗
PubMed1994

Hemorrhage into a lumbar synovial cyst causing an acute cauda equina syndrome. Case report.

Juxtafacet cysts of the lumbar spine have been reported with increasing frequency but their pathogenesis remains obscure. These cysts most frequently present with back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms of spinal canal compromise. The authors report an unusual case of hemorrhage into a right L3-4 synovial cyst causing an acute cauda equina syndrome and describe its successful surgical treatment. The clinical, radiographic, and pathological features are discussed.

Acute Disease↗
PubMed1992

Ependymoma of the cauda equina region: diagnosis, treatment, and outcome in 15 patients.

New diagnostic imaging techniques make possible a reappraisal of current diagnostic, therapeutic, and management strategies for certain rare lesions of the central nervous system. With this in mind, we have reviewed our experience with ependymoma of the filum terminale and cauda equina region. Fifteen patients with this tumor have been treated since 1955. Typical presentations included pain, lower extremity weakness, and, occasionally, bladder dysfunction. Delays in arriving at the proper diagnosis have been the rule; however, we have noted a substantial increase in the number of these tumors referred to us since the advent of magnetic resonance imaging. Treatment includes surgical resection to the extent consistent with preservation of neurological function; postoperative irradiation appears to be of benefit in controlling recurrence except in those patients whose well-circumscribed tumors have been removed completely. Presence of urinary difficulties at the time of diagnosis is a relatively poor prognostic sign, and a more liberal use of magnetic resonance imaging in cases of persistent or recurrent low back and radicular pain unresponsive to conservative therapy may help to achieve earlier diagnosis. Because of the possibility of late recurrence, prolonged follow-up is mandatory for all patients, and magnetic resonance imaging is the diagnostic tool of choice.

Adolescent↗
PubMed1993

Lumbosacral transitional vertebrae as a predisposing cause of cauda equina syndrome in German shepherd dogs: 161 cases (1987-1990).

The records of 161 German Shepherd Dogs were divided into groups depending on whether there was a radiographic diagnosis of degenerative disk disease (DDD) involving the lumbosacral disk and lumbosacral transitional vertebral segments (TVS) and whether the dogs had cauda equina syndrome (CES). Statistical analysis of the data suggested an association between TVS and CES and an association between DDD and CES. Establishment of confidence intervals revealed the group without either DDD or TVS indicators differed markedly from the other 3 groups of CES relative to the presence of DDD and TVS. There was some overlap in the confidence intervals, but the proportions of CES were higher when DDD and TVS were both evident. This suggests that the important clinical syndrome of CES is at least partially dependent on TVS, which is probably an inherited condition. Because German Shepherd Dogs have a higher frequency of TVS than dogs of other breeds, this partially explains the higher frequency of CES in this breed. Because TVS are probably familial, we suggest the presence of this lesion should be considered in selection of breeding stock. Although it is believed that DDD is partially dependent on the existence of TVS, it is known that DDD can develop in the absence of TVS.

Animals↗
PubMed1997

Cauda equina syndrome resulting in late sequela of calcaneal gait and neuropathic heel ulcer.

The case of a 27-year-old female, 5 years after a motor vehicle accident that resulted in spinal cord damage, is reviewed. She progressed well after her accident for 4 years, at which time she developed a neuropathic heel ulceration, aggravated by her calcaneal gait and pregnancy weight gain. The rarity of such a case involving neuropathic ulceration and calcaneal gait after partial deficit of cauda equina function prompted this article.

Adult↗