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PubMed2001

Radiculomeningomyelitis due to Halicephalobus gingivalis in a horse.

An adult horse was euthanatized following a clinical diagnosis of cauda equina neuritis. Significant gross postmortem and histopathologic findings were limited to the sacral spinal cord and cauda equina. The sacral spinal cord, meninges, and spinal nerve roots were expanded and partially effaced by sclerosing granulomatous inflammation with necrosis. The lesion contained numerous nematode larvae and fewer adults with a rhabditiform esophagus having a corpus, isthmus, and valved bulb. Female nematodes were amphidelphic and didelphic with reflexed ovaries. These morphologic features confirm Halicephalobus gingivalis as a novel cause of clinical signs in this case of cauda equina neuritis.

Animals↗

PubMed2001

Surgery for lumbar disc herniation during pregnancy.

STUDY DESIGN: The case reports of three pregnant patients with lumbar disc herniation causing cauda equina syndrome or severe neurologic deficits are presented to illustrate that disc surgery during gestation is a safe method of management. OBJECTIVE: To emphasize the importance of recognizing and definitively treating lumbar disc displacement causing neurologic deficits during pregnancy. SUMMARY OF BACKGROUND DATA: The advent of magnetic resonance imaging and modern surgical techniques for treatment of lumbar disc displacement allows safe management of this condition at any stage of gestation. A review of the literature on the risks of nonobstetric surgery and the risks of delaying disc surgery until delivery shows that operating at any stage during gestation for severe neurologic deficit secondary to lumbar disc displacement is justified. METHODS: A review of the literature on the use of magnetic resonance imaging scan and nonobstetric surgery during pregnancy was performed. Three case reports of the authors' patients who had lumbar disc displacement with cauda equina syndrome or severe neurologic deficit are presented. Patients were placed prone on a four-poster frame, and an epidural anesthetic agent was administered. A one-level hemilaminectomy, partial facetectomy, and disc excision were performed in all three cases. RESULTS: The methods used for diagnosis and surgical treatment of three patients with disc herniation during pregnancy resulted in a satisfactory outcome for both mother and child. The medical literature supports surgical intervention in pregnant patients with cauda equina syndrome and severe and/or progressive neurologic deficit(s) from lumbar disc displacement at any state of gestation. CONCLUSION: Although extremely rare, cauda equina syndrome and severe and/or progressive neurologic deficit caused by lumbar disc displacement can occur during pregnancy. The prevalence of symptomatic lumbar disc herniation during pregnancy may be on the increase because of the increasing age of patients who are becoming pregnant. These cases showed, and the literature confirms, that pregnancy at any stage is no contraindication to magnetic resonance imaging scan, epidural and/or general anesthesia, and surgical disc excision.

Adult↗

PubMed2001

Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love's method.

STUDY DESIGN: We performed a study to compare the magnetic resonance imaging findings up to 24 weeks after microendoscopic discectomy or surgery using Love's method in patients with lumbar disc herniation. OBJECTIVES: The objective was to determine whether or not microendoscopic discectomy was minimally invasive with respect to the nerve roots, cauda equina, and paravertebral muscles by comparing the postoperative magnetic resonance imaging findings in patients treated by microendoscopic discectomy and the conventional Love's method. SUMMARY OF BACKGROUND DATA: We introduced microendoscopic discectomy as a minimally invasive surgical procedure for lumbar disc herniation in September 1998 and have obtained good results. Microendoscopic discectomy is superior to the conventional Love's method in that it reduces postoperative pain, shortens the duration of hospitalization, and allows earlier resumption of normal activities. However, the effect of microendoscopic discectomy on the nerves and paravertebral muscles has not been evaluated objectively. METHODS: Enhancement of the nerve roots and paravertebral muscles, as well as the configuration of the cauda equina at the level of herniation, was assessed on axial magnetic resonance images obtained with contrast enhancement using gadolinium-diethylenetriamine penta-acetic acid before surgery and 1, 4, 8, 12, and 24 weeks after surgery in 25 patients who underwent microendoscopic discectomy and 15 patients who were treated using Love's method. RESULTS: Increased enhancement of the nerve roots was seen in 50.0% of the microendoscopic discectomy group and 46.2% of the Love group at 1 week after surgery. Enhancement of the paravertebral muscles at the surgical site tended to persist for longer in the microendoscopic discectomy group than in the Love group. However, muscle enhancement was widespread in some patients from the Love group. Abnormalities of the cauda equina attributed to surgical invasion were seen in 12.5% of the microscopic discectomy group and 15.4% of the Love group at 1 week after surgery. CONCLUSIONS: Microendoscopic discectomy had an effect on the nerve roots and cauda equina that was comparable with that of Love's method. The magnetic resonance images of the route of entry failed to show that microendoscopic discectomy is appreciably less invasive with respect to the paravertebral muscles.

Adult↗

PubMed2002

[Diagnosis and treatment of lumbar spinal canal stenosis].

Lumbar spinal canal stenosis (LSCS) was first described in 1954 by Verbiest, followed by the currently accepted international classification of LSCS in 1976 by Arnoldi. Briefly, LSCS is a nervous system syndrome that is characterized by neural symptoms in the lower extremities due to tightened cauda equina and spinal nerve root involvement. LSCS international classification consists of: (1) degenerative, (2) congenital developmental, (3) combined, (4) spondylolytic spondylolisthesis, (5) iatrogenic and (6) post traumatic stenosis. Degenerative stenosis-the most common type of LSCS-is caused by disc degeneration, osteoarthritis of the facet joint and hypertrophy of the ligamentum flavum. LSCS may also be the result of intervertebral disc degeneration, protruded intervertebral disc and/or bony spur compress cauda equina and spinal nerve root anteriorally, while degenerated facet joint and hypertrophied the ligamentum flavum compress cauda equina and spinal nerve root posteriorally? Most often, spondylolytic spondylolisthesis occurs at the fourth lumbar vertebrae in middle-aged women. As a result of a slipping forward of the vertebra, cauda equina and spinal nerve roots can be tightened between the edge behind the top of lower vertebra and frontal edge of the lower part of upper lamina. Typical clinical symptoms of LSCS are low back pain, leg pain and intermittent claudication. Low back pain is chronic with secondary radiating pain in the buttock. The leg pain is called "sciatica", which tends to appear on the back of thigh, in the lateral aspect of lower leg and calf muscles, and which intensifies when the patient is fatigued. Intermittent claudication is a symptom associated with this syndrome. Often, patients with LSCS find it impossible to walk because of increased numbness and pain in their leg. Many patients report that after squatting for a few minutes they are able to resume walking. LSCS patients may also report dysaesthesia in the perineum area, and may also report urinary dysfunction ranging from extreme urgency to urinary delay. Patients who present with symptoms of LSCS should be seen by an orthopedic surgeon. Correct diagnosis by imaging and clinical examination, with appropriate conservative or operative treatment in a timely fashion should be encouraged in order to prevent irreversible nerve damage.

Female↗

PubMed2004

Effects of 5-HT2A receptor antagonist on blood flow in chronically compressed nerve roots.

Neurogenic intermittent claudication (NIC) can be caused by compression of the cauda equina by spinal stenosis and is a major clinical problem. A reduction of blood flow is an important mechanism for inducing NIC and may be caused by a vasoconstrictive effect mediated by the serotonin 5-HT2A receptor in chronic cauda equina compression lesions. This study assessed the effects of the 5-HT2A receptor antagonist on nerve vasculature in chronically compressed nerve roots. A plastic balloon was placed under the lamina of L7 and inflated to 10 mmHg and left for 1 week in several cauda equina compression models. All experimental animals received an acute administration of serotonin. One group received sarpogrelate hydrochloride (5-HT2A receptor antagonist: 5-HTRA) before administration of serotonin, and another group was administered 5-HTRA after administration of serotonin. Diameters and blood flow in the vasculature of S2 or S3 nerve roots were measured after injection of serotonin. In animals without compression of the cauda equina (sham), blood vessels contracted and the blood flow was reduced after administration of serotonin. In sham and compression animals receiving both serotonin and 5-HTRA, blood vessel diameter was not reduced and was significantly larger than that in the compression group receiving only serotonin (p<0.05). Likewise, the blood flow was not reduced in sham and compression animals receiving serotonin and 5-HTRA and was significantly greater in the compression group treated only with serotonin. 5-HTRA inhibited vasoconstriction and the reduction of blood flow in chronically compressed nerve roots challenged with serotonin. This fact suggests that 5-HTRA might be effective at improving blood flow in chronically compressed nerve roots in patients with spinal canal stenosis and changes in circulation levels of serotonin.

Animals↗

PubMed2003

Intraoperative urodynamics in spinal cord surgery: a study of feasibility.

Intraoperative monitoring (IOM) of bladder function in spinal cord surgery is a challenging task due to vegetative influences, multilevel innervation and numerous supraspinal modulating factors. Despite routine use of urodynamics in neurosurgery for implantation of bladder stimulators or denervation of nerve fibres in spastic reflex bladders, application of IOM in patients with spinal cord tumours or tethered-cord syndrome is not widespread. Combining urodynamics with sphincter electromyography (EMG) in IOM enables identification of bladder efferents responsible for contraction and continence. We monitored four patients with ependymoma of the Cauda equina, one patient with tethered-cord syndrome and two patients with cervical intramedullary tumours. In all patients undergoing operations of the Cauda equina, identification of bladder efferents responsible for detrusor contraction was possible. There was good correlation between preoperative bladder dysfunction, preoperative urodynamics and intraoperative pressure increase by bladder contraction or latency between stimulation and contraction. This method proved unsuitable for intramedullary tumours where no contraction of the bladder could be observed while stimulating the spinal cord. Intraoperative monitoring of urodynamics is an effective tool for identifying bladder efferents in the Cauda equina. Intraoperative conclusions on bladder dysfunction through registration of pressure increase and latency are possible.

Adult↗

PubMed1978

[Spinal meningeal hemorrhage due to tumors: a report on 5 cases with arteriography (author's transl)].

Meningeal hemorrhages in 5 patients with tumors of the cauda equina are reported. In each case there were signs from the brain area which led to a false diagnosis of ruptured intracranial aneurism, before attention was drawn to the cauda equina by a relapse with hemorrhage or other signs. The value of medullary arteriography for positively diagnosing cauda equina tumors, and their differential diagnosis from medullary arteriovenous malformations--principal cause of spinal meningeal hemorrhages--is discussed, as well as the necessity for systematically evoking this topography in children and young adults when arteriographic exploration is negative.

Adolescent↗

PubMed2005

Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature.

BACKGROUND AND PURPOSE: Hemangioblastomas (HBs) are rare lesions accounting for 1-5% of all spinal cord tumors. Seventy-five percent of spinal HBs are intramedullary. Lesions of the conus medullaris and the cauda equina are uncommon, and the filum terminale location is very rare. HBs of the lower spinal region are highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding. In the literature, there are few reports concerning preoperative embolization of HBs, and only few cases are reported in spinal location. Presurgical embolization of HBs located in the lower spinal region has not been described. Although lower spinal HBs are predominantly fed by the anterior spinal artery (ASA), embolization of these lesions is possible and can reduce tumor vascular supply, thus facilitating surgery. We report our experience in four rare cases of solitary HBs occurring in the lower spinal region. METHODS: Clinical charts and radiologic studies of four patients with a preoperatively embolized HB of the lower spinal region were retrospectively reviewed. The lesions were located in the conus medullaris in one case, at the level of the cauda equina in another, and in the filum terminale in two. In the conus medullaris case, the neoplasm was associated with a syrinx. In three patients, the HB was sporadic, while the patient with the HB of the cauda equina had Von Hippel-Lindau disease. Devascularization of the tumor was performed through the ASA in all cases and also through the posterior spinal artery in one by using non reabsorbable calibrated microspheres in three cases and polyvinyl alcohol particles in the other one. RESULTS: Embolization caused no permanent complications, although one patient with a cauda equina HB mildly worsened after the endovascular procedure but recovered before surgery. At surgery, the tumor was completely removed in all cases. Blood loss was reported to be less than usually observed (100, 200, 200, and 400 mL). In addition, manipulation and removal of the tumor was reported to be easy in three of four tumors. Histologic examination confirmed the diagnosis. At 1-year postsurgical follow-up, two patient recovered completely from neurologic deficits, and two showed significant recovery. No tumor recurred during a follow-up period of 1-6 years (mean, 3.5 years). CONCLUSION: Our results indicate that preoperative embolization of HBs of the lower spinal region is an useful procedure in aiding surgical resection of these highly vascular tumors. With a meticulous technique, embolization can be performed through the ASA.

Adult↗

PubMedDate not supplied

MRI of AIDS-related polyradiculomyelitis.

OBJECTIVE: We describe the unusual syndrome of cytomegalovirus (CMV) polyradiculomyelitis and its MR findings in two patients with AIDS. MATERIALS AND METHODS: The clinical records and MRI studies of two patients with AIDS and CMV polyradiculomyelitis were reviewed. The MR images were performed on a Picker 1.0 or 1.5 T MR unit. Axial and sagittal T1-weighted images of the lumbar spine were obtained, pre- and post-Gd-DTPA (0.1 mmol/kg) administration. Gradient echo sagittal images were also obtained. RESULTS: Precontrast images demonstrated a thickened cauda equina in both patients. In one patient the conus was ill defined on precontrast images. Post-contrast images demonstrated diffuse enhancement of the cauda equina in both patients as well as enhancement along the surface of the conus. In one patient the nerve roots were clumped and adherent to the walls of the thecal sac as well as to other nerve roots. CONCLUSION: The clinical presentation of urinary retention, flaccid paraparesis, back and/or leg pain, and "saddle anesthesia" in a patient with AIDS should suggest the diagnosis of CMV polyradiculomyelitis. Although diffuse enhancement of the cauda equina on postcontrast MRI is a nonspecific finding, it would strongly support this diagnosis in the appropriate clinical setting. The diagnosis may be easily missed without the use of a contrast agent.

AIDS-Related Opportunistic Infections↗

PubMed1978

[Two neurinomas of the cauda in a patient with a suspected disk lesion (author's transl)].

Multiple neurinomas in the cauda equina were found in a 56-year-old patient, who had been suffered from left-sided sciatica for about one and half years. The origins were suspected in right L3 nerve root and left L4 nerve root. Multiple tumours in the cauda equina are not common; therefore, the authors discuss in this paper how rare the case is and about the difficulties of the differential diagnosis between herniated disk and tumour in the cauda equina.

Cauda Equina↗

PubMed2000

Should intrathecal lidocaine be used in the 21st century?

Hyperbaric 5% lidocaine has been available for intrathecal use since 1954. The initial studies concluded that it was a safe drug for short procedures. Recently, the use of this drug for spinal anesthesia has been questioned. There were cases of cauda equina syndrome following its use for continuous spinal anesthesia. Following these occurrences, it was felt that lidocaine should not be used for continuous spinal anesthesia, rather for single-shot spinal anesthesia only. Intense follow-up of patients receiving intrathecal lidocaine for single-shot spinal anesthesia revealed a higher incidence of back pain radiating to the thighs and legs as compared to other drugs or general anesthesia. Although these symptoms have been linked to the drug, there were other factors affecting the incidence. Lithotomy position was a more significant predictor for developing these symptoms. Furthermore, there are seven cases of cauda equina syndrome following single-shot hyperbaric lidocaine. Cauda equina syndrome is a permanent disability. It occurred in patients of varying ages and with doses ranging from 60 mg to 120 mg. There are safe alternatives to lidocaine for outpatient spinal anesthesia, such as bupivacaine, prilocaine, or mepivacaine. These drugs have a lower incidence of transient neurologic symptoms and do not delay discharge. Given the possibility of permanent neurologic injury and given that safe alternatives exist, one has to question whether intrathecal lidocaine should still be used in the 21st century.

Anesthesia, Spinal↗

PubMed1994

Effects of methylprednisolone on nucleus pulposus-induced nerve root injury.

STUDY DESIGN: The effects of intervention by intravenous injection of methylprednisolone to reduce the nerve root injury after epidural application of autologous nucleus pulposus was studied in an experimental model on the pig cauda equina in 20 animals. METHODS: Nucleus pulposus was harvested from a lumbar disc. After lowering the pH of the nucleus pulposus to 3.5 it was placed onto the sacrococcygeal cauda equina. Fifteen of the pigs received a single intravenous injection of 30 mg/kg methylprednisolone, 5 minutes, 24 hours, or 48 hours, respectively, after the application. After 7 days, the nerve conduction velocity was determined, and biopsies of the cauda equina was examined by lightmicroscopy. RESULTS: In the five pigs that did not receive any methylprednisolone treatment, nerve conduction velocity was reduced, whereas it was normal in the pigs treated 5 minutes and 24 hours after nucleus pulposus application. In pigs treated after 48 hours, nerve conduction velocity was reduced only slightly. At the light microscopic level, significant changes occurred in all series. CONCLUSIONS: This study indicates that the nucleus pulposus-induced effects on nerve function in an experimental pig model may be reduced dramatically by high-dose methylprednisolone administration within 24-48 hours after epidural application of autologous nucleus pulposus. The light microscopic changes were probably not significant for the nerve function. Instead, a morphologic explanation on a subcellular level should probably be sought.

Animals↗

PubMed2000

Migration of an intraspinal schwannoma documented by intraoperative ultrasound: case report.

BACKGROUND: Tumors of the cauda equina may shift with positioning on the operating table. Accurate localization at surgery is important to facilitate appropriate laminectomy and durotomy. CASE DESCRIPTION: We report a case of a 28-year-old man with a schwannoma of the cauda equina at L4 on preoperative MRI. Intraoperative ultrasound revealed that the tumor had migrated cephalad, and was now located at L3. CONCLUSION: Intraoperative ultrasound is a valuable technique in localization of tumors of the cauda equina.

Adult↗

PubMed1990

Neuropathic bladder in ankylosing spondylitis with spinal diverticula.

Cauda equina type of syndrome with neuropathic bladder is a rare but known complication of long-standing ankylosing spondylitis. From 1968 until now, diverticula from the subarachnoid space eroding into the bodies of the lumbosacral vertebrae have been reported in 46 cases of ankylosing spondylitis with cauda equina syndrome and neuropathic bladder. We report 3 cases of neuropathic bladder and ankylosing spondylitis with cauda equina symptoms. In 1 of the 3 patients, these rarely encountered spinal diverticula were demonstrated by computerized tomography (CT) scan. The etiology of these diverticula and their treatment are reviewed.

Adult↗

PubMed2001

Dorsal compression of the epidural cord due to free sequestral lumbar prolapse. Diagnostic problems in magnetic resonance imaging and computed tomography.

Due to the anatomical situation, intervertebral disc herniation usually results in compression of the anterior epidural space, with lateral or medial irritation of nerve root or cauda equina. Rare locations are an intra- or extraforaminal position or dislocation dorsally. Three patients with dorsal cauda equina compression caused by a sequestered herniated nucleus pulposus (HNP) are reported. The patients complained mainly of severe back pain. In two patients nondermatome-related leg pain was observed; one patient suffered additionally from incomplete cauda equina syndrome. In all cases magnetic resonance imaging and computed tomography diagnosed neoplastic tissue.

Adult↗

PubMed2006

Acute implantation of an avulsed lumbosacral ventral root into the rat conus medullaris promotes neuroprotection and graft reinnervation by autonomic and motor neurons.

Trauma to the conus medullaris and cauda equina may result in autonomic, sensory, and motor dysfunctions. We have previously developed a rat model of cauda equina injury, where a lumbosacral ventral root avulsion resulted in a progressive and parallel death of motoneurons and preganglionic parasympathetic neurons, which are important for i.e. bladder control. Here, we report that an acute implantation of an avulsed ventral root into the rat conus medullaris protects preganglionic parasympathetic neurons and motoneurons from cell death as well as promotes axonal regeneration into the implanted root at 6 weeks post-implantation. Implantation resulted in survival of 44+/-4% of preganglionic parasympathetic neurons and 44+/-4% of motoneurons compared with 22% of preganglionic parasympathetic neurons and 16% of motoneurons after avulsion alone. Retrograde labeling from the implanted root at 6 weeks showed that 53+/-13% of surviving preganglionic parasympathetic neurons and 64+/-14% of surviving motoneurons reinnervated the graft. Implantation prevented injury-induced atrophy of preganglionic parasympathetic neurons and reduced atrophy of motoneurons. Light and electron microscopic studies of the implanted ventral roots demonstrated a large number of both myelinated axons (79+/-13% of the number of myelinated axons in corresponding control ventral roots) and unmyelinated axons. Although the diameter of myelinated axons in the implanted roots was significantly smaller than that of control roots, the degree of myelination was appropriate for the axonal size, suggesting normal conduction properties. Our results show that preganglionic parasympathetic neurons have the same ability as motoneurons to survive and reinnervate implanted roots, a prerequisite for successful therapeutic strategies for autonomic control in selected patients with acute conus medullaris and cauda equina injuries.

Animals↗

PubMed1997

Imaging findings in patients with ventral dural defects and herniation of neural tissue.

The aim of this paper is to describe clinical and imaging findings in three patients with ventral dural defects and herniation of the spinal cord or cauda equina. The literature is reviewed and the clinical, radiological and operative findings are compared. Three patients with ventral dural defects of different etiologies are presented. One patient gave a longstanding history of ankylosing spondylitis, the second patient presents 37 years after spinal trauma, and the third patient presents with spontaneous spinal cord herniation. All patients had typically slowly progressive neurological symptoms with multiple hospitalizations until diagnosis was made. Characteristic findings in postmyelographic CT included a ventral or ventrolateral displacement with deformation of the spinal cord or the cauda equina. Sagittal MRI showed this abrupt and localized anterior deviation of the spinal cord or the cauda equina to the posterior portions of a vertebral body with or without a bony vertebral defect optimally. Additionally, due to the ventral displacement of the spinal cord, the dorsal subarachnoid space was relatively enlarged without evidence of an arachnoid cyst, in all patients. Magnetic resonance imaging and postmyelographic CT can diagnose ventral dural defects with spinal cord herniation or nerve root entrapment. Dural defects must be considered in the presence of neurological symptoms in cases of longstanding ankylosing spondylitis, late sequelae of fractures of vertebral bodies, and without history of spinal trauma or surgery.

Aged↗

PubMed2006

Novel repair strategies to restore bladder function following cauda equina/conus medullaris injuries.

Trauma to the thoracolumbar junction or lumbosacral spine may result in a conus medullaris or cauda equina syndrome. In both conditions, symptoms typically include paraparesis or paraplegia, sensory impairment, pain, as well as bladder, bowel, and sexual dysfunctions. We present in this review a series of neural repair strategies that have been developed to address the unique features and challenges of subjects with a conus medullaris or cauda equina syndrome. We address, in particular, neural repair strategies that may have a translational research potential to restore bladder function. Recent animal injury models have suggested that a progressive retrograde death of both autonomic and motor neurons may contribute to the neurological deficits in subjects with conus medullaris and cauda equina injuries. For subjects with acute injuries, we present novel strategies to promote neuroprotection, axonal regeneration, and functional reinnervation of the lower urinary tract. For subjects with chronic injuries, we discuss new approaches to replace lost autonomic and motor neurons. A brief discussion on a variety of outcome measures that may be suitable to evaluate the function of the lower urinary tract in rodent neural repair models is also provided.

Animals↗