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PubMed1990

Reduction in human bladder wall compliance following decentralization.

The urodynamic records of patients who presented with voiding symptoms and/or incontinence, and who had areflexia after conal-cauda equina injury (33) or a radical pelvic operation (31) were examined. In contrast to reported experimental and clinical evidence, we found a higher prevalence of decreased compliance in the patients who had undergone a radical pelvic operation than in those who had sustained conal-cauda equina injury.

Adolescent↗
PubMed1990

Myeloscopic study on lumbar spinal canal stenosis with special reference to intermittent claudication.

Twenty-five cases of lumbar spinal canal stenosis were investigated by dynamic myeloscopy to explain the pathophysiologic mechanism of intermittent claudication, one of the characteristic signs of the disorder. Myeloscopic examination revealed that, in accordance with postural alteration, the diameter of blood vessels on the cauda equinae showed significant changes in many patients in the stenosis group, but showed no changes in control group. In this series, it was suggested that the microcirculatory disturbance of vessels on cauda equinae might play an important role in the development of intermittent claudication.

Adult↗
PubMed1995

A complication of spinal decompression. A case report.

STUDY DESIGN: This case study is designed to report the previously unreported specific complication of acute cauda equina compression after decompression surgery for spinal stenosis. OBJECTIVES: To inform others of the possibility of such a complication; to suggest a possible mechanism for this situation, namely hourglass constriction of the cauda causing ischemia to distal nerve roots; and to suggest a management plan--immediate magnetic resonance imaging to identify the problem and return to the operating room for further decompression--which was successful in this case. SUMMARY OF BACKGROUND DATA: Previous reports of causes of paraparesis or paraplegia after surgery are listed, and previous theories on the etiology of acute cauda compression are discussed. METHODS: The clinical findings of spinal stenosis in a 32-year-old man are presented, and subsequent details of the surgery, complications after surgery, investigation, and future surgery, including magnetic resonance imaging scans before and after surgery, are provided. RESULTS: The result in this case was a patient free of symptoms. CONCLUSIONS: Incomplete decompression in surgery for spinal stenosis can result in acute cauda equina compression. In these circumstances, magnetic resonance imaging can reveal the cause, and in this case, immediate surgery was successful in relieving the symptoms and signs.

Acute Disease↗
PubMed2005

Assessment of lesion evolution in experimental autoimmune neuritis by gadofluorine M-enhanced MR neurography.

Experimental autoimmune neuritis (EAN) represents an animal model of acute inflammatory nerve injury mirroring pathophysiological aspects of the human Guillain-Barré syndrome. In the present study, we for the first time visualized the spatiotemporal evolution of autoimmune nerve injury and recovery by magnetic resonance imaging (MRI) by use of the novel micellar magnetic resonance (MR) contrast agent gadofluorine M (Gf). EAN was induced in Lewis rats by T-cell transfer (AT-EAN) leading to severe axonal damage, and Gf was applied intravenously at various disease stages mostly 24 h before MRI. In naive rats, Gf enhancement was present solely in the vascular compartment. In AT-EAN, clinically asymptomatic rats already showed consistent Gf uptake in spinal nerves on day 3, while sciatic nerves were spared. The cauda equina correspondingly exhibited massive T-cell infiltration. Gf enhancement further extended to the plexus lumbosacralis on day 4. On days 5 and 6, the entire peripheral neuraxis from the cauda equina, along the sciatic down to the tibial and peroneal nerves, showed strong Gf enhancement. Spinal and peripheral nerves now exhibited massive inflammation and axonal injury on parallel histological analysis. Gf enhancement persisted in the afflicted nerves until complete recovery and disappeared with a proximodistal gradient. In conclusion, Gf-enhanced MR neurography opens a new avenue for monitoring nerve damage in-vivo during an immune attack.

Animals↗
PubMed2005

Evaluation and management of high-grade spondylolisthesis in adults.

STUDY DESIGN: A retrospective review was performed on 21 adult patients surgically treated with high-grade spondylolisthesis (Grade III, IV, or V). Additionally, the natural history, classification, and surgical alternatives for high-grade spondylolisthesis in the adult are discussed through literature review. OBJECTIVES: The purpose of this article is to review the clinical and radiographic outcomes of surgical treatment of high-grade spondylolisthesis in the adult from a single institution. The natural history and treatment options for these adults are described in this review. SUMMARY OF BACKGROUND DATA: High-grade spondylolisthesis is typically diagnosed and treated in the child or adolescent. Most patients with high-grade spondylolisthesis received surgical treatment during their adolescence. Some patients, however, remain minimally symptomatic for life without surgery. Little has been written on the natural history or treatment of adults with high grades of spondylolisthesis. Most of the published reports on the surgical treatment of high-grade spondylolisthesis pertain to skeletally immature patients and maybe include a few adults in their series. Nonetheless, the different techniques of surgical treatment for high-grade spondylolisthesis that have been described in these studies can help the spinal surgeon in treatment options for this rare but difficult spinal deformity. METHODS: A literature review of the published manuscripts on the treatment of high-grade spondylolisthesis was performed with particular attention to the natural history and surgical treatment involving adult patients. Adult patients (older than 21 years) with high-grade spondylolisthesis treated surgically were retrospectively reviewed. Patients' clinical charts and radiographs were reviewed before and after surgery. Determination of fusion success, clinical outcome, and complications were performed. RESULTS: Twenty-one consecutive adults with high-grade spondylolisthesis who underwent lumbar spinal surgery were review retrospectively between 1990 and 2004. There were 13 females and 8 males with an average age of 35 years (range, 21-68 years). The average follow-up was 6.6 years. There were 11 Grade III, 6 Grade IV, and 4 Grade V slips, including 4 acquired and 17 developmental spondylolistheses. There were no pseudarthroses or significant instrumentation failures. There was 1 case of a complete cauda equina syndrome on a patient with preoperative symptoms of an incomplete cauda equina syndrome. CONCLUSIONS: Adult patients with high-grade spondylolisthesis not responding to nonoperative treatment can be stabilized in situ with posterior instrumentation from L4 to S1. The use of adjunctive fixation with iliac screws and/or transvertebral screws is recommended for the adult patient, particularly in revision or unstable cases. Reduction of the slipped vertebrae remains controversial for all grades of spondylolisthesis and more so for the adult patient. Partial reduction of the slip angle, decreasing the lumbosacral kyphosis, should be considered if significant sagittal malalignment is present or to improve arthrodesis success. Anterior column support should be performed, particularly when reduction has been obtained. Anterior column support can be performed, anteriorly or posteriorly, either by using inter vertebral body structural strut support or with a transsacral fibular dowel to improve stability and success of arthrodesis.

Adult↗
PubMed1997

[Axonal Guillain-Barré syndrome associated with antibodies to Ga1NAc-GD1a and unidentified acidic glycolipids].

A 19-year-old male student with Guillain-Barré syndrome (GBS) was described. Neurologic examination revealed severe and moderate degrees of weakness in the distal and proximal muscles, respectively, in both upper and lower limbs. He was unable to walk even with support. Both superficial and deep sensations were normal. Serial electrophysiologic studies indicated that the predominant pathologic process of the peripheral nerve was axonal degeneration of motor nerves. Enzyme-linked immunosorbent assay showed that serum from the patient had markedly high titer of IgG antibody to Ga1NAc-GD1a (1:204,800). Thin-layer chromatography with immunostaining revealed that his serum IgG strongly reacted with Ga1NAc-GD1a prepared from both bovine brain and cauda equina, and additionally with unidentified acidic glycolipids prepared only from bovine cauda equina. Serum containing antibody to Ga1 NAc-GD1a and the unidentified acidic glycolipids may be responsible for axonal degeneration of motor nerves in this patient.

Acetylgalactosamine↗
PubMed1984

Myelography in severe lumbosacral spondylolisthesis.

The radiological and myelographic appearances of 14 patients with severe lumbosacral spondylolisthesis have been reviewed in relation to compression of the cauda equina and their clinical symptomatology. Patients could be separated into two groups as defined by the position of the L5 neural canal. In Group 1, the arch was displaced downwards and the cauda equina compression was due to pressure from the L5/S1 disc and was related to the degree of listhesis. L5 root sheath abnormalities predominated in this group. In Group 2 the neural arch maintained a more normal position and the compression, which was unrelated to the degree of slip, occurred between the arch and the posterior aspect of the sacrum. S1 root lesions occurred in these patients due to pressure from the arch. Clinical symptoms and signs were also more prominent in this group.

Adolescent↗
PubMed2005

[Primary sacral epidural hydatid cyst: a case report].

Primary epidural hydatid cyst of the spinal canal without bone involvement is very rare. The authors report the case of a 35 year old man presenting with lower cauda equina compression. MRI showed a cystic lesion with signal characteristics similar to cerebrospinal fluid. Surgical exploration through a midline posterior approach was used which confirmed the hydatid nature of the cyst. There was no bone lesion. Histological examination confirmed the diagnosis. Hydatid cyst should be suspected in case of cystic lesion causing cord compression or cauda equina syndrome.

Adult↗
PubMed1998

Cytokeratin expression in adrenal phaeochromocytomas and extra-adrenal paragangliomas.

AIM: To examine whether adrenal phaeochromocytomas and extra-adrenal paragangliomas are immunoreactive for commercially available and routinely used cytokeratin antibodies. METHODS: 18 extra-adrenal paragangliomas and seven adrenal phaeochromocytomas were stained with CAM 5.2, AE1/3, and 34 beta E12 following microwave antigen retrieval of formalin fixed tissue. RESULTS: A single case from the cauda equina was positive for both CAM 5.2 and AE1/3. In addition, two other cases--an intravagal and an orbital paraganglioma--also showed strong immunopositivity with CAM 5.2 and AE1/3. All phaeochromocytomas were negative with all epithelial markers. CONCLUSIONS: Cauda equina paragangliomas are known to stain with cytokeratins; however, occasional paragangliomas from other sites may also be immunoreactive with cytokeratins. If the results of immunohistochemistry are not interpreted in the clinical and morphological context, the failure to recognise that extra-adrenal paragangliomas may on occasion react with anticytokeratin antibodies may lead to their being confused with metastatic carcinomas.

Adolescent↗
PubMed2004

MR imaging findings of spinal posterior column involvement in a case of Miller Fisher syndrome.

SUMMARY: The site of lesions causing ataxia in Miller Fisher syndrome (MFS) remains in dispute. A 43-year-old man manifested rapidly progressive left-sided ptosis, bilateral abducens palsy, areflexia, and severe ataxia. Initial MR imaging showed confined lesions of the cauda equina with gadolinium enhancement. A diagnosis of MFS was made, and the patient underwent immunotherapy. His ophthalmoplegia disappeared, but other symptoms remained. Five months after onset, MR imaging disclosed lesions confined to the spinal posterior column, which were considered to result from involvement of posterior nerve roots of the cauda equina and to be responsible for his remaining severe ataxia.

Adult↗
PubMed2001

A congenital dermal sinus presenting the muscle fasciculation and hypertrophy.

OBJECTIVE: To report unique and unknown clinical features of muscle fasciculation and muscle hypertrophy in a case of congenital dermal sinus. PATIENTS: A 16-year-old girl presented with continuous fasciculation, often cramp, and hypertrophy of the left calf muscle. The radiography showed spina bifida of L4, L5 and S1. MRI revealed dermal sinus tract from the skin dimple of the back to the dura mater, and connected to the intradural inclusion tumor. At surgery the inclusion tumor contained many short hairs, and the cauda equina were severely adherent. Microdissection of the tumor and the adhesion was performed. At 2 years after surgery fasciculation decreased but continued; however, painful cramps of the calf muscle do not occur. CONCLUSIONS: Short hairs of dermoid and the adherence might be irritative to the cauda equina. The hyperactivity of the stimulated motor neuron may cause the muscle fasciculation leading to hypertrophy of the calf muscle.

Adolescent↗
PubMed1995

Continuous spinal anaesthesia--early experience in University Hospital, Kuala Lumpur.

Continuous spinal anaesthesia using the incremental technique was used in nineteen high risk patients with multiple medical problems, seventeen of whom were elderly, for lower limb orthopaedic and pelvic surgery. An intrathecal catheter (18G/28G) was inserted under local anaesthesia via the lumbar interspinous space. Spinal anaesthesia was induced with small incremental doses of 0.5% bupivacaine hydrochloride through the intrathecal catheter to achieve the level of analgesia required for surgery. The duration of surgery ranged from 45 to 300 minutes (mean + S.D 100 + 37 min). The initial volume of 0.5% bupivacaine required for surgery ranged from 0.8 ml-2.0 ml (1.2 + 0.7 ml) and the total volume ranged from 0.9 ml to 3.1 ml (mean + S.D 1.4 + 0.7 ml). Haemodynamic stability was well maintained perioperatively. Only two patients required 6 mg of ephedrine and 1 mg of aramine respectively for a greater than 25% reduction in systolic blood pressure with induction of spinal anaesthesia. Intrathecal morphine 0.1-0.3 mg was administered to 15 patients at the end of surgery for postoperative pain relief with good effect. One patient developed late respiratory depression from an inadvertent overdose of intrathecal morphine. No neurological sequelae were noted and no patient developed a postdural puncture headache. The use of the microcatheter was discontinued in the U.S.A and Australia following four case reports of cauda equina syndrome with this technique. Current opinion, however, is that the reported cauda equina syndrome was due to the neurotoxic effects of lignocaine 5% that was used and not due to the microcatheter per se. Continuous spinal anaesthesia is now used widely in Europe when cardiovascular stability is desired in poor risk patients undergoing lower limb and lower abdominal surgery.

Adult↗
PubMed1985

Intercostal-lumbar-spinal nerve anastomoses for cord transection. A preliminary investigation.

Since 1978, 10 intercostal nerve-cauda equina anastomoses and 11 intercostal nerve-lumbar anastomoses were performed for thoracolumbar spinal cord transection. Three to four pairs of intercostal nerves above the traumatic level of the cord were anastomosed with two to four pairs of cauda equina or lumbar nerve roots below the traumatic level, using microsurgical technique. The surgical techniques used for the latter 11 cases were performed through an extraperitoneal approach. The operative technique is described in detail. These 21 cases have been followed-up for six to 48 months. Electromyography (EMG) shows that action potentials are present in several previously paralyzed muscles in 11 cases. Muscle strength of some previously paralyzed muscles in three cases recovered to Grades 1 to 3. There is evidence that intercostal-lumbar-spinal nerve anastomoses provide a chance for neuronal regeneration, but unsatisfactory functional results are still questions for further study.

Adult↗
PubMed1982

Early detection of neurogenic bladder dysfunction caused by protruded lumbar disk.

A case of cauda equina compression was suspected from urinary symptoms. The diagnosis was based on the presence of type A contraction on rapid cystometry and prolonged latency of the sacral evoked response. Such findings pointed to the need for myelography. Lumbar laminectomy, with removal of a ruptured intervertebral disk and cauda equina decompression, resulted in return of normal urination and normal cystometry and electromyogram of the perineal muscles.

Adult↗
PubMedDate not supplied

Postoperative cauda syndrome caused by Staphylococcus aureus.

Toxic shock syndrome (TSS) is a well-defined clinical syndrome attributed to certain exotoxins produced by Staphylococcus aureus. The acute episode is often characterized by a toxic encephalopathy, possibly caused by direct neurotoxicity of these exotoxins, although this mechanism has never been proven. We describe a patient who developed TSS, meningitis and cauda equina syndrome simultaneously several days after lumbar laminectomy. A space-occupying lesion was excluded. Enterotoxin C-producing S. aureus was cultured from the surgical wound and the cerebrospinal fluid (CSF). The patient recovered from TSS but remained partially paralyzed. Presumably the cauda equina syndrome was caused by neurotoxic effects of the intrathecally produced S. aureus exotoxins. This case provides evidence for the neurotoxic effects of TSS-associated S. aureus exotoxins.

Adult↗
PubMed1990

Infarction of the conus medullaris.

We encountered a patient with acute cauda equina syndrome. The clinical course, laboratory data and imaging study, including magnetic resonance imaging (MRI) strongly suggested that this episode was caused by a vascular disorder of the conus medullaris. We emphasized the diagnostic usefulness of MRI in the vascular disease of the conus medullaris as well as the clinical importance of this disease in the differential diagnosis of acute cauda equina syndrome.

Aged↗
PubMed1985

Motor conduction velocity in the human spinal cord: slowed conduction in multiple sclerosis and radiation myelopathy.

Transcutaneous electrical stimulation of the central nervous system was used to measure motor conduction velocity in the human spinal cord in 21 subjects aged 22 to 75 years (mean 55 years), none of whom had neurological disease. The motor conduction velocity between the sixth cervical (C6) and first lumbar (L1) vertebral levels was 67.4 +/- 9.1 m/s. This probably represents conduction velocity in the corticospinal tracts. In these subjects the motor conduction velocity in the cauda equina, between the first lumbar (L1) and fourth lumbar (L4) vertebral levels, was 57.9 +/- 10.3 m/s. In four of five patients with multiple sclerosis, all with corticospinal signs in the legs, motor conduction velocity between C6 and L1 was slowed (41.8 +/- 16.8 m/s), but cauda equina conduction was normal (55.8 +/- 7.8 m/s). Similar slowing of spinal cord motor conduction was found in a patient with radiation myelopathy. This method should provide a relevant, simple clinical test in patients with spinal cord disease.

Adenocarcinoma↗
PubMed1981

Symptomatic spinal epidural lipomatosis associated with Cushing's syndrome.

In cases of Cushing's syndrome, unusual amounts of fat may accumulate in the spinal epidural space, similar to centripetal fat deposits elsewhere in the body. The mass of excessive epidural fat may be responsible for neurological symptoms referable to compression of the spinal cord or cauda equina. We report three cases illustrating this unusual phenomenon and call attention to three cases reported previously. Although it is an unusual complication of Cushing's syndrome, epidural lipomatosis should be considered in the differential diagnosis of any such case with neurological symptoms referable to the spinal cord or cauda equina. The diagnosis may be confirmed by computed tomographic scanning in conjunction with myelography. Therapeutic considerations are discussed.

Adult↗