Redundant nerve roots of the cauda equina

Four cases of redundant nerve roots of the cauda equina are reported, and the pertinent literature is reviewed. This disorder mainly affects males. The clinical history ranges from months to decades. The illness often starts with low back pain or sciatica, or both. Motor and sensory impairment of the legs dominate the further course of the disease. Serpentine filling defects in the column of contrast are a characteristic (but inconstant) feature on myelograms. Abatement of signs and symptoms occurs following adequate decompression of the redundant roots.

Neurogenic claudication due to narrowing of the lumbar canal by extradural metastatic tumor

Neurogenic claudication has been described in association with bony constriction of the lumbar canal. but has not previously been reported in association with extradural metastasis. We report the case of a 69-year-old who developed neurogenic claudication due to narrowing of the lumbar canal by metastatic adenocarcinoma of the prostate, Radiation therapy resulted in tumor regression and resolution of the claudication.

Cauda equina syndrome in ankylosing spondylitis. Anatomical, diagnostic, and therapeutic considerations

This article describes a case of cauda equina syndrome associated with ankylosing spondylitis, and reviews 28 additional cases in the literature. The neurological symptoms appear late in the evolution of spondylitis, when it is at an inactive stage. The diagnosis is easily confirmed by myelography, with watersoluble contrast and performed in a supine position, and by computerized tomography (CT) scan of the lumbar spine. The typical features are dilated lumbar sac with multiple dorsal diverticula. The pathogenesis of this entity remains the subject of speculation. Arachnoiditis with subsequent adhesions is the most likely explanation. No treatment has proved helpful so far. Surgery is not indicated.

Biomechanics of lumbosacral dural sac. A study of flexion-extension myelography

Measurements were performed on 40 lateral lumbar myelograms in flexion and extension with the object of analyzing changes in position and shape of the dural sac in spinal movements. There proved to be an anterior displacement of the entire lumbar dural sac in lumbar extension, most likely caused by shortening and thickening of the flaval ligaments. In addition, the anterior dural surface was indented at the L3-4 and L4-5 interspaces by posterior bulging of the discs in extension. This encroachment was partially compensated by dural bulging into areas with a rich and compressible venous plexus: behind the vertebral bodies and the L5-S1 disc. While the patterns of dural movements showed individual variations, these trends were found in all diagnostic and anatomic subgroups. One subgroup (with root involvement at L4-5) showed marked dorsal encroachment upon the dural sac in extension at the same level. The clinical implications of these findings are discussed.

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.

Clinical and morphological investigations on ependymomas and their tissue cultures

A morphological investigation was carried out on 56 ependymomas cultivated in vitro as short-term cultures in roller tubes. The tumours had been histologically classified as cellular and fibrillary ependymomas, subependymomas, myxopapillary and malignant ependymomas (Table 1). A very good growth was detected in 32 cases, most of them being cellular and malignant ependymomas (Table 2). The prevailing growth pattern was epithelial in type, i.e. proliferating cells forming a carpet. In some cases, in the first stages of growth elongated bipolar cells did appear, but they evolved later as flattened epithelial elements. In four cases, a mixed proliferation of piloid astrocytes and ependymal cells was seen; these tumours were regarded as mixed gliomas. In 46 cases an exact evaluation of the history was possible. Although no correlation could be found between histology and survival time (Table 4), the longest survival was observed in spinal tumours (Table 3). Tumours in children had a slightly worse prognosis in comparison with adults (Table 5). A radical removal of the tumour was generally followed by a longer survival time (Table 6), although the operative procedure employed did not seem to influence the development of recurrences (Table 7).

Intradural spinal metastases

A medullary cone metastasis from an adenocarcinoma of esophagus, and a solitary lumbar spinal nerve root metastasis from a breast carcinoma, gave rise to two cases of cauda equina syndrome. Muscle strength in the lower limbs improved postoperatively, while the disturbances of bladder, bowel, and pelvic floor function remained unchanged in the 1st case. The second patient benefited from operation, and regained useful life despite vertebral osseous involvement. It is suggested that tumour cells reached the spinal cord and the subarachnoid space by haematogeneous spread and by way of perineural lymphatics respectively.

Spinal cord involvement in leukemia: a review of the literature and a case of Ph1+ acute myeloid leukemia presenting with a conus medullaris syndrome

A 21-year-old male with Ph1 positive acute myeloid leukemia (AML) became constipated, experienced pain in the sacral area and retained urine. These were the principle presenting complaints of his disease. With local radiotherapy and systemic chemotherapy, all neurologic symptoms and signs disappeared within three days. A conus medullaris syndrome is uncommon in leukemia, as we were able to find only three other such patients in the literature and three others with the closely related cauda equina syndrome. A literature review of spinal cord involvement in leukemia in general revealed 67 reasonably well-described cases. Compilation of data from these suggests it is most often seen in patients with AML and that it is most common in the second decade of life. Tumors extrinsic to but compressing the cord are the most common finding and the thoracic cord is the most common site of involvement.

Suggested pathological basis of "redundant nerve root syndrome" of the cauda equina

A clinical entity described as "redundant nerve root syndrome" of the cauda equina is reviewed. Eighteen reported cases with typical gross features are analyzed. Considerable speculation has existed regarding the pathogenesis of this syndrome, chiefly because the involved nerve root was not biopsied in the majority of instances. In one reported case, when the redundant root was examined histologically, a plexiform neurofibroma was found to be the cause of the thickening and redundancy of the nerve. In the case presented here, the enlarged nerve roots were part of a malignant plexiform neurofibroma with a short clinical course, and the tumor led to the death of the patient. It is suggested that biopsy of the involved nerve root is crucial in establishing the definitive diagnosis.

Radiation induced sarcoma

A case of radiation induced sarcoma presenting seven years after radiotherapy for a conus cauda equina astrocytoma is reported.

Epidural angiolipoma producing compression of the cauda equina

Epidural angiolipomas are rare tumours and are histologically benign, but their myelographic and macroscopic appearance is malignant. Surgical results are satisfactory. A case is reported in a 48-year-old woman with a slowly progressive cauda equina compression syndrome in whom an epidural angiolipoma was successfully removed. The special feature of this case was a generalized severe spinal osteoporosis with a pathological fracture of a vertebral body at the level of the tumour.