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PubMed2004

[Blood flow changes of cauda equina in experimental lumbar spinal canal stenosis under dynamic burden].

OBJECTIVE: To study the changes of blood flow of the already-compressed cauda equina under dynamic burden, high frequency stimulation (HFS) and increased additional compression, and to clarify the mechanism of neurogenic intermittent claudication. METHODS: Thirty SD rats were divided into 5 groups, 6 in each. All groups were operated with laminectomy of the fifth lumbar verfebra. One hour after the measurement of blood flow, in 4 experimental groups, the silicon sheets were inserted into the spinal canal of L4 and L6 to cause double level compression of cauda equina by 30%. Two hours after onset of compression, no dynamic burden was introduced to the subjects of the experimental group 1. Only HFS was introduced to the subjects of the experimental group 2 for 6 minutes. Both HFS and increased additional compression were introduced to the subjects of the experimental group 3 for 6 minutes. While only increased additional compression was introduced to the subjects of the experimental group 4 for 6 minutes. The subjects of control group only underwent laminectomy of the fifth lumbar vertebra and HFS 6 minutes. The blood flow of cauda equina was measured with laser Doppler flowmeter. RESULTS: In the first 2 hours, there was no significant change of cauda equina blood flow in the control group. During the time of HFS, the blood flow increased significantly to 186.4% +/- 31.5% of initial value (P < 0.05). In the experimental group 1, there was no blood flow change during the period of dynamic burden(110.4% +/- 7.5%, P > 0.05). After introduction of dynamic burden, there was no blood flow changes in the experimental group 2 (111.6% +/- 17.6%, P > 0.05). The blood flow in the experimental group 3 decreased to 65.3% +/- 10.7% of initial value (P < 0.05); and the blood flow in the experimental group 4 decreased to 60.1% +/- 9.2% of initial value (P < 0.01). There was no significant difference between the experimental groups 3 and 4 (P > 0.05). CONCLUSION: The results above show that during the period of increased impulse transmission, double level compression of cauda equina may limit the increase of blood flow, which may cause relative ischemia. If there is increased additional compression along with increased impulse transmission, the blood flow will decrease significantly, which will cause absolute ischemia.

Animals↗
PubMed1986

Cauda equina syndrome: a complication of lumbar discectomy.

Six cases of acute postdiscectomy cauda equina syndrome (C.E.S.) following lumbar discectomy were reviewed retrospectively in a series of 2842 lumbar discectomies over a ten-year period. Five cases had coexisting bony spinal stenosis at the level of the disc protrusion. The bony spinal stenosis was not decompressed at the time of discectomy. Inadequate decompression played a role in the neurologic deterioration postoperation. The cause of the sixth case is unknown. Bowel and bladder recovery was good when the cauda equina decompressed early; sensory recovery was universally good, and motor recovery was poor if a severe deficit had developed before decompression. Careful review of the preoperative myelogram to rule out spinal stenosis and decompression of bony stenosis at discectomy are recommended for prevention of postoperative C.E.S. Urgent decompression of postoperative C.E.S. is advisable if compression of the cauda equina is confirmed radiographically.

Adult↗
PubMed2005

Lumbar vertebral hemangioma causing cauda equina syndrome: a case report.

STUDY DESIGN: Case report. OBJECTIVES: To report a case of lumbar hemangioma causing neurogenic claudication and early cauda equina, managed with hemostatic vertebroplasty and posterior decompression. SUMMARY OF BACKGROUND DATA: This is the first report to our knowledge of a lumbar hemangioma causing neurogenic claudication and early cauda equina syndrome. Most hemangiomas causing neurologic symptoms occur in thoracic spine and cause spinal cord compression. Vertebroplasty as a method of hemostasis and for providing mechanical stability in this situation has not been discussed previously in the literature. METHODS: L4 hemangioma was diagnosed in a 64-year-old woman with severe neurogenic claudication and early cauda equina syndrome. Preoperative angiograms showed no embolizable vessels. Posterior decompression was performed followed by bilateral transpedicular vertebroplasty. The patient received postoperative radiation to prevent recurrence. RESULTS: Complete relief of neurogenic claudication and cauda equina with less than 100 mL of blood loss. CONCLUSION: A lumbar hemangioma of the vertebral body, although rare, can cause neurogenic claudication and cauda equina syndrome. Intraoperative vertebroplasty can be an effective method of hemostasis and provide stability of the vertebra following posterior decompression.

Decompression, Surgical↗
PubMed2003

Clinical features associated with recurrence of tumours of the spinal cord and cauda equina.

STUDY DESIGN: Retrospective review of consecutive cases of recurrent spinal cord and cauda equina tumours. OBJECTIVES: We sought to identify factors and conditions resulting in re-operation to treat recurrences of spinal cord and cauda equina tumours. SETTING: Keio University Hospital, Tokyo, Japan. METHODS: Re-operation was performed in 39 patients with spinal cord and cauda equina tumours. Times of operation, interval between operations, affected spinal level, tumour site on cross section, configurations among dumb-bell tumours, and pathologic diagnoses were analysed. Recurrence rates were defined in terms of the number of cases with re-operation due to tumour recurrence relative to the total number of surgical cases for the same period at our institution. RESULTS: Recurrence rates were relatively high for intradural, extramedullary tumours and for tumours located anteriorly rather than laterally. Of patients with intradural, extramedullary plus extradural tumours who underwent initial surgery at our hospital, 75% (9/12) recurred; all tumours had dumb-bell-type configurations. The overall rate of re-operation due to tumour recurrence in 249 cases was 7.2% at our institution. By tumour types, 40% of malignant schwannomas recurred (2/5), as did 35.7% of neurofibromas (5/14), and 33.3% of ependymomas (6/18). CONCLUSION: Risk factors for tumour recurrence were anterior location, an intradural, extramedullary plus extradural site, extensive dumb-bell tumours, and pathologic diagnoses of neurofibroma, ependymoma, or malignant schwannoma.

Adolescent↗
PubMed2006

Clinical features of cauda equina tumors requiring surgical treatment.

In this study, we evaluated the clinical features of cauda equina tumors requiring surgical treatment. Medical records of 28 patients with cauda equina tumors (13 men and 15 women) undergoing surgical treatment were retrospectively reviewed. The majority of histological diagnoses indicated schwannoma (23 cases, 82%), and the remaining 5 indicated ependymoma, neurofibroma, meningioma, and ganglioneuroblastoma. In 86% of the cases, the initial symptom was pain in the lower back and/or lower extremities. Preoperatively, half of the patients had symmetrical pain in the lower back or lower extremities, severe pain in the supine position, or pain that was increased by coughing. One third of the patients needed morphine to control nocturnal pain. Tumor size, as determined by magnetic resonance imaging (MRI), correlated with preoperative symptom duration (r = 0.66, p < 0.001). These findings indicate that symmetrical lower back pain and/or pain that radiates to both lower extremities and increases in the supine position are characteristic of cauda equina tumors. The correlation between symptom duration and tumor size indicates that earlier diagnosis of this tumor is necessary. Earlier diagnosis based on these characteristic symptoms should make use of further examinations such as MRI.

Adolescent↗
PubMed2000

Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes.

STUDY DESIGN: A meta-analysis of surgical outcomes of cauda equina syndrome secondary to lumbar disc herniation. OBJECTIVES: To determine the relationship between time to decompression after onset of cauda equina syndrome and clinical outcome, and to identify preoperative variables that were associated with outcomes. SUMMARY OF BACKGROUND DATA: The timing of surgical decompression for cauda equina syndrome is controversial. Although most surgeons recommend emergent decompression, results in certain studies show that delayed surgery may provide a satisfactory outcome. METHODS: A meta-analysis was performed to determine the correlation between timing of decompression and clinical outcome. One hundred four citations were reviewed, and 42 met the inclusion criteria. Preoperative and postoperative data were recorded. Length of time to surgery was broken down into five groups: less than 24 hours, 24-48 hours, 2-10 days, 11 days to 1 month, and more than 1 month. Logistic regression was used to determine the association between preoperative variables and postoperative outcomes. RESULTS: Outcomes were analyzed in 322 patients. Preoperative chronic back pain was associated with poorer outcomes in urinary and rectal function, and preoperative rectal dysfunction was associated with worsened outcome in urinary continence. In addition, increasing age was associated with poorer postoperative sexual function. No significant improvement in surgical outcome was identified with intervention less than 24 hours from the onset of cauda equina syndrome compared with patients treated within 24-48 hours. Similarly, no difference in outcome occurred in patients treated more than 48 hours after the onset of symptoms. Significant differences, however, were found in resolution of sensory and motor deficits as well as urinary and rectal function in patients treated within 48 hours compared with those treated more than 48 hours after onset of symptoms. CONCLUSIONS: There was a significant advantage to treating patients within 48 hours versus more than 48 hours after the onset of cauda equina syndrome. A significant improvement in sensory and motor deficits as well as urinary and rectal function occurred in patients who underwent decompression within 48 hours versus after 48 hours.

Adult↗
PubMed2003

Acute cauda equina compression revealing Hodgkin's disease: a case report.

STUDY DESIGN: This is a case report of a young patient who experienced an acute epidural compression of cauda equina revealing Stage IV Hodgkin's disease. OBJECTIVES: To draw attention to this rare presentation of Hodgkin's disease, and to assess the role of surgery in acute cauda equina compression in a context of a chemosensitive disease. SUMMARY OF BACKGROUND DATA: Lymphomatous tissue in Hodgkin's disease may involve the spine usually in the setting of advanced disease. Initial manifestation of Hodgkin's disease in the spine is rare. The management of this rare presentation may be conservative, but surgery provides the most rapid way of neurologic tissue decompression. METHODS: The case of a 14-year-old patient who experienced an acute epidural compression of cauda equina revealing Stage IV Hodgkin's disease is presented. RESULTS: The patient complained of an increased lower back pain of 1-month duration before he developed lower limbs numbness, loss of perineal sensation, and urinary retention. Sagittal and axial T2-weighted magnetic resonance images of the lumbar spine revealed tumoral invasion of the epidural space compressing the cauda equina. Emergency surgical decompression was performed. In fine, Stage IV Hodgkin's disease revealed by acute epidural cauda equina compression was diagnosed. The patient recovered normal neurologic functions in a few days and then underwent chemotherapy and radiotherapy. CONCLUSION: Although a rare situation, Hodgkin's disease may involve the spinal epidural space at presentation. The management is complex, but surgery provides the most rapid means of diagnosis and neurologic tissue decompression in severely affected patients.

Acute Disease↗
PubMed1995

[Cauda equina cavernous hemangioma associated with hydrocephalus--case report].

Spinal cavernous hemangioma is rare, and it is extremely rare for cavernous hemangioma to develop in the cauda equina. There has been only one report of hydrocephalus associated with cavernous hemangioma in the cauda equina. We report a case of cavernous hemangioma in the cauda equina diagnosed on the basis of the headaches due to hydrocephalus. A 67-year-old man was being treated for Parkinson's disease because of tremor of both upper extremities for several years. In December 1991 he complained of occasional headaches. On February 15, 1992 the headaches became severe and frequent, with nausea and vomiting, and his gait became unsteady. Four days later he came to our hospital. Neurological examination revealed fine finger tremor and truncal ataxia. Computerized tomography scanning and magnetic resonance imaging of the head revealed ventricular enlargement, but there were no mass lesions obstructing the cerebrospinal fluid pathway. Lumbar puncture at the L3-L4 level yielded bloody cerebrospinal fluid, and the pressure had increased to 410 mmH2O. Cerebral angiography showed no abnormal findings. Magnetic resonance imaging of the lumbar spine demonstrated an intradural tumor at the level of vertebral body L2. Spinal angiography showed no evidence of abnormal vascularity in the mass at the L2 level. On March 10, 1992, laminectomy at three levels, L1 to L3 was performed, and a well-defined blueberry-like intra-cauda equina tumor 1 cm. in diameter, was removed. One spinal nerve root passed through the tumor. The pathological diagnosis was cavernous hemangioma. After removal of the tumor, the patient's headaches improved, and a follow-up computerized tomography scan six months later showed normal ventricle size.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Increases in COX II mRNA in the rat spinal cord induced by cauda equina traction.

This article investigated the time response of COX II induction by traction of the cauda equina assessed by a quantified RT-PCR method. Under deep GOI anesthesia, male Wistar rats were fixed in the prone position and a laminectomy of the dorsal part of the first and second sacral vertebrae was performed. Following, COX II-mRNA levels in the cervical, thoracic, lumbar, sacral, and caudal segments were measured at 2, 4, 6, and 24 h after traction by a quantified RT-PCR method. After cauda equina traction, significant levels of COX II mRNA were detected in all segments of the spinal cord examined. Maximum levels in each segment were determined 4 h after traction of the cauda equina. Particularly in the sacrocaudal segments significantly higher levels of COX II mRNA were measured 24 h after traction. These results indicate that significant induction of spinal COX II mRNA was caused by cauda equina traction and that such induction plays a regulatory role in the nociceptive pain pathway.

Animals↗
PubMed2005

Cauda equina and conus medullaris syndrome in sarcoidosis.

BACKGROUND: Neurosarcoidosis is a rare manifestation of sarcoidosis. Involvement of the nervous system in sarcoidosis can range from peripheral or cranial neuropathy to central nervous system disease. Cauda equina sarcoidosis is distinctly rare. REVIEW SUMMARY: The authors present a 58-year-old patient with systemic sarcoidosis who developed cauda equina and conus medullaris syndrome. Seventeen previous published cases of cauda equina sarcoidosis are reviewed. The history of systemic sarcoidosis, cerebrospinal fluid characteristics of lymphocytic pleocytosis with elevated protein, and evidence of acute denervation by needle electromyography are helpful in the diagnosis of this condition. Early diagnosis and treatment of cauda equina sarcoidosis usually provide a rapid recovery and yield a good prognosis. CONCLUSION: Although rare, sarcoidosis should be considered in the differential diagnosis of cauda equina syndrome, particularly in patients with unclear etiology.

Anti-Inflammatory Agents↗
PubMed1986

Nasopharyngeal carcinoma metastatic to the cauda equina.

A case of nasopharyngeal carcinoma metastatic to the cauda equina is reported. The patient, treated 3 years earlier for his primary disease, presented with bilateral weakness of his legs. Myelographic studies showed only patchy thickening of certain lumbosacral nerve roots. A biopsy from a root in the cauda equina was made through a T-12 to L-2 laminectomy revealing carcinomatous involvement. Careful examination of the specimen was necessary to distinguish the tumor from a lymphoma. Review of the literature has revealed no other cases of this type of neoplastic metastasis.

Adult↗
PubMed1986

Aggressive oncocytic neuroendocrine tumour ('oncocytic paraganglioma') of the cauda equina.

An oncocytic neuroendocrine tumour ('oncocytic paraganglioma') of the cauda equina is reported. The tumour was predominantly intradural, with extension into and destruction of surrounding vertebral bone. The tumour had an organoid pattern, and the tumour cells had abundant non-argyrophilic eosinophilic cytoplasm. Immunocytochemical stains for neurone-specific enolase, S-100 protein, keratin and carcinoembryonic antigen were positive, but stains for glial fibrillary acidic protein were negative. On ultrastructural examination, there were numerous mitochondria and scattered 200 nm dense-core membrane-bound granules, that rarely clustered in small aggregates. Intermediate filaments were focally arranged in long compact bundles. The histogenesis of tumours reported as cauda equina paragangliomas is discussed.

Actin Cytoskeleton↗
PubMed2004

The effect of cauda equina constriction on nitric oxide synthase activity.

Nitric oxide synthase (NOS) activity was studied in the gray and white matter regions of the spinal cord 2 and 5 days after multiple cauda equina constrictions of the central processes of L7-Co5 dorsal root ganglia neurons. The results show considerable differences in enzyme activity in the thoracic, upper lumbar, lower lumbar, and sacral segments. Increased NOS activity was observed at 2 days after multiple cauda equina constrictions in the dorsal, lateral, and ventral columns of the lower lumbar segments and in the ventral column of the upper lumbar segments. The values returned to control levels within 5 postconstriction days. In the lateral columns of thoracic segments taken 2 and 5 days after surgery, NOS activity was enhanced by 54% and 55% and in the upper lumbar segments by 130% and 163%, respectively. Multiple cauda equina constrictions performed surgically for 2 and 5 days caused a significant increase in NOS activity predominantly in the gray matter regions of thoracic segments. A quite different response was found 5 days postconstriction in the upper lumbar segments, where the enzyme activity was significantly decreased in the dorsal horn, intermediate zone, and ventral horn. No such extreme differences could be seen in the lower lumbar segments, where NOS activity was significantly enhanced only in the ventral horn. The data correspond with a higher number of NOS immunoreactive somata, quantitatively evaluated in the ventral horn of the lower lumbar segments at 5 days after multiple cauda equina constrictions. While the great region-dependent heterogeneity in NOS activity seen 2 and 5 days after multiple cauda equina constrictions is quite apparent and suggestive of an active role played by nitric oxide in neuroprotective or neurotoxic processes occurring in the gray and white matter of the spinal cord, the extent of damage or the degree of neuroprotection caused by nitric oxide in compartmentalized gray and white matter in this experimental paradigm would be possible only using longer postconstriction periods.

Animals↗
PubMed2006

Imaging of cauda equina edema in lumbar canal stenosis by using gadolinium-enhanced MR imaging: experimental constriction injury.

BACKGROUND AND PURPOSE: It has been reported that disturbance of blood flow arising from circumferential compression of the cauda equina by surrounding tissue plays a major role in the appearance of neurogenic intermittent claudication (NIC) associated with lumbar spinal canal stenosis (LSCS). We created a model of LSCS to clarify the mechanism of enhancement within the cauda equina on gadolinium-enhanced MR images from patients with LSCS. METHODS: In 20 dogs, a lumbar laminectomy was performed by applying circumferential constriction to the cauda equina by using a silicon tube, to produce 30% stenosis of the circumferential diameter of the dural tube. After 1 and 3 weeks, gadolinium and Evans blue albumin were injected intravenously at the same time. The sections were used to investigate the status of the blood-nerve barrier function under a fluorescence microscope and we compared gadolinium-enhanced MR images with Evans blue albumin distribution in the nerve. The other sections were used for light and transmission electron microscopic study. RESULTS: In this model, histologic examination showed congestion and dilation in many of the intraradicular veins, as well as inflammatory cell infiltration. The intraradicular edema caused by venous congestion and Wallerian degeneration can also occur at sites that are not subject to mechanical compression. Enhanced MR imaging showed enhancement of the cauda equina at the stenosed region, demonstrating the presence of edema. CONCLUSION: Gadolinium-enhanced MR imaging may be a useful tool for the diagnosis of microcirculatory disorders of the cauda equina associated with LSCS.

Animals↗
PubMed1993

[Paraganglioma of the cauda equina].

The case of a 36 year old woman with a paraganglioma of the cauda equina was studied. This localization is rare and special emphasis is made concerning the peculiarities of presentation, aggravating factors of the clinical manifestations and neuroradiologic findings. A review of the 66 paragangliomas of the cauda equina published to date is carried out. This entity deals with a tumor in the adult, with slight male predominance and a clinical presentation not differing from that of other lesions occupying the space of the cauda equina. The most frequent initial symptom is low back pain with or without sciatic irradiation. Total resection of the tumor may cure the patient.

Adult↗
PubMed2005

Renal cell carcinoma and intradural spinal metastasis with cauda equina infiltration: case report.

STUDY DESIGN: A case report and clinical discussion. OBJECTIVE: To describe the diagnosis, pathophysiology, and treatment of a papillary renal cell carcinoma that developed an intradural spinal mass with cauda equina infiltration. SUMMARY OF BACKGROUND DATA: Cancers that metastasize intradurally to the spinal canal are uncommon, accounting for the 6% of all spinal metastases. Those from renal cell carcinoma are especially unusual. Only 3 reports that describe the spread of metastatic renal cell carcinoma to the cauda equina have been published to our knowledge. METHODS: A female patient had undergone nephrectomy for the treatment of the papillary renal cell carcinoma 2 years before, and only 1 localization (at the genital tract) was previously diagnosed. The patient presented with lower back pain irradiated to both legs, vesical incontinence, and severe paraparesis. RESULTS: Preoperative magnetic resonance images of the lumbar spine showed an intradural spinal mass from L3-L5 with infiltration of the cauda equina; the lesion measured 62 mm craniocaudally and 16 mm anteroposteriorly, and thus occupied the majority of the intrathecal space at that level. The magnetic resonance images, surgical treatment, and related pathophysiology are reviewed. CONCLUSIONS: The majority of cauda equina tumors are primary tumors, and metastases are very rare. To our knowledge, this is the fourth case described of metastasis of renal cell carcinoma at the cauda equina and the first of papillary type.

Aged↗
PubMed1995

Intradural metastasis to the cauda equina from carcinoma of the anus.

STUDY DESIGN: This is a report of a man with carcinoma of the anus and intradural metastasis to the cauda equina. OBJECTIVE: To perform a laminectomy with tumor removal for relief of pain. SUMMARY OF BACKGROUND DATA: Only 25 cases of intradural spinal metastasis have been reported in the English literature. This is the first report of a metastatic case, moving from the carcinoma of the anus to the cauda equina. METHODS: Magnetic resonance imaging showed an ill-defined mass, with central necrosis, to the cauda equina. The possibility of intradural metastasis to the cauda equina was indicated by unique pain symptoms. RESULTS: The patient's back pain subsided after total laminectomy of L3-L5 with subtotal removal of the tumor. The residual tumor became smaller with postoperative radiation. CONCLUSION: Magnetic resonance imaging is a good diagnostic choice in this situation. The cause of the metastasis was unclear, but it was presumed to have occurred through the perineural lymphatic ducts. Laminectomy with tumor removal is feasible for relieving pain and demonstrating pathology.

Anal Canal↗
PubMed1997

Functional outcome after experimental cauda equina compression.

Spinal nerve roots often sustain compression injuries. We used a Wistar rat model of the cauda equina syndrome to investigate such injuries. Rapid transient compression of the cauda equina was produced using a balloon catheter. The results were assessed by daily neurological examination and somatosensory evoked potential (SEP) recording before surgery and ten weeks after decompression. Compression of the spinal nerves induced changes in the SEP which persisted for up to ten weeks after decompression, but it had no effect on the final neurological outcome. Our study shows the importance of early surgical decompression for cauda equina syndrome.

Animals↗