The Level of Conus Medullaris in 629 Healthy Japanese Individuals

Distinctive Characteristics of Thoracolumbar Junction Region Stenosis

STUDY DESIGN

Retrospective case series and systemic literature meta-analysis.

BACKGROUND

Thoracolumbar junction region stenosis produces spinal cord compression just above the conus and may manifest with symptoms that are not typical of either thoracic myelopathy or neurogenic claudication from lumbar stenosis.

OBJECTIVE

As few studies describe its specific pattern of presenting symptoms and neurological deficits, this investigation was designed to improve understanding of this pathology.

METHODS

A retrospective review assessed surgically treated cases of T10-L1 degenerative stenosis. Clinical outcomes were evaluated with the thoracic Japanese Orthopedic Association score. In addition, a systematic review and meta-analysis was performed in accordance with guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

Of 1069 patients undergoing laminectomy at 1477 levels, 31 patients (16M/15F) were treated at T10-L1 a mean age 64.4 (SD=11.8). Patients complained of lower extremity numbness in 29/31 (94%), urinary dysfunction 11/31 (35%), and back pain 11/31 (35%). All complained about gait difficulty and objective motor deficits were detected in 24 of 31 (77%). Weakness was most often seen in foot dorsiflexion 22/31 (71%). Deep tendon reflexes were increased in 10 (32%), decreased in 11 (35%), and normal 10 (32%); the Babinski sign was present 8/31 (26%). Mean thoracic Japanese Orthopedic Association scores improved from 6.4 (SD=1.8) to 8.4 (SD=1.8) ( P <0.00001). Gait subjectively improved in 27/31 (87%) numbness improved in 26/30 (87%); but urinary function improved in only 4/11 (45%).

CONCLUSIONS

Thoracolumbar junction stenosis produces distinctive neurological findings characterized by lower extremity numbness, weakness particularly in foot dorsiflexion, urinary dysfunction, and inconsistent reflex changes, a neurological pattern stemming from epiconus level compression and the myelomeres for the L5 roots. Surgery results in significant clinical improvement, with numbness and gait improving more than urinary dysfunction. Many patients with thoracolumbar junction stenosis are initially misdiagnosed as being symptomatic from lumbar stenosis, thus delaying definitive surgery.

High-Riding Conus Medullaris Syndrome: A Case Report and Literature Review-Its Comparison with Cauda Equina Syndrome

INTRODUCTION

Conus medullaris syndrome (CMS) is a distinctive spinal cord injury (SCI), which presents with varying degrees of upper motor neuron signs (UMNS) and lower motor neuron signs (LMNS). Herein, we present a case with a burst fracture injury at the proximal Conus Medullaris (CM).

CASE PRESENTATION

A 48-year-old Taiwanese male presenting with lower back pain and paraparesis was having difficulty standing independently after a traumatic fall. An Imaging survey showed an incomplete D burst fracture of the T12 vertebra. Posterior decompression surgery was subsequently performed. However, spasticity and back pain persisted for four months after surgical intervention. Follow-up imaging with single photon emission computed tomography (SPECT) and a whole body bone scan both showed an increased uptake in the T12 vertebra.

CONCLUSION

The high-riding injury site for CMS is related to a more exclusive clinical representation of UMNS. Our case's persistent UMNS and scintigraphy findings during follow-up showcase the prolonged recovery period of a UMN injury. In conclusion, our study provides a different perspective on approaching follow-up for CM injuries, namely using scientigraphy techniques to confirm localization of persistent injury during the course of post-operative rehabilitation. Furthermore, we also offered a new technique for analyzing the location of lumbosacral injuries, and that is to measure the location of the injury relative to the tip of the CM. This, along with clinical neurological examination, assesses the extent to which the UMN is involved in patients with CMS, and is possibly a notable predictive tool for clinicians for the regeneration time frame and functional outcome of patients with lumbosacral injuries in the future.

Morphometric Analysis of Spinal Cord and Its Termination Within the Vertebral Canal: An Observational Study in the Fetuses of Third Trimester Gestational Age

Background & aim The spinal cord is the continuation of the brain from the lower point of the medulla and the terminal portion of the developing neural tube. The spinal cord develops within the bony canal, called the vertebral canal, formed by the union of individual vertebrae in the vertebral column. Initially, the development of the length of the vertebral column and spinal cord are the same but later on undergo alterations. The growth of the vertebral column is faster than that of the spinal cord because the spinal cord appears to terminate early within the vertebral canal. To measure the length of the spinal cord and lowermost point of conus medullaris in the third trimester gestational age fetuses. Material and methods The present cross-section observational study was carried out on 30 fetuses collected from the museum of the Anatomy Department and Obstetrics and Gynecology Department. Before starting the study, permission and approval from the university's ethical committee were received. The dissection of fetuses includes the incision of the skin, removal of superficial and deep muscles, and a laminectomy. The meninges were cut and removed to note the vertebra level of the termination of the spinal cord. The spinal cord was taken out, and the total length of the spinal cord was measured. The fetuses were categorized into three groups determined by their gestational age (the first group was 28-31 weeks, the second group was 32-35 weeks, and the third group was 36-40 weeks). Observation In the present study, 81.8% of male fetuses were in the 36-40 weeks gestational age group, and 52.6 % of female fetuses were in the 32-35 weeks, gestational age group. The mean length of the spinal cords was 14.74±1.45cm, with a range of 10.95 cm to a maximum of 16.60 cm. In the full-term gestational age group, male fetuses had a greater length of spinal cord than female fetuses. Sixteen fetuses had a spinal cord termination at level L2, followed by eight fetuses at the L3 level and six fetuses at the L4 level. Out of 11 male fetuses, eight fetuses had spinal cord termination at the L2 vertebra level, two at the L3 level, and one fetus at the L4 level. In female fetuses, eight had a spinal cord termination at the L2 level, six at the L3 level, and five at the L4 level. Conclusion The spinal cord length and level of conus medullaris depend on the age of the fetuses. In prenatal diagnosis for different spinal cord pathology, these values can be used as reference values in future studies.

Influence of Age and Gender on Intervertebral Disk Degeneration and Height in the Thoracolumbar Spine

Introduction

Intervertebral disk degeneration is a universal and natural process. However, no reports have summarized anatomical age-related intervertebral disk height and disk degenerative changes in the thoracolumbar spine or examined sex-specific differences. This study aimed to establish age-related changes and gender-specific differences of intervertebral disk height and disk degeneration of the thoracolumbar spine in a large cohort of relatively healthy subjects and also to evaluate the relationship between the degree of thoracolumbar disk height and disk degeneration.

Methods

Six hundred and twenty-seven relatively healthy subjects (307 males and 320 females; average age, 49.6±16.5 years) were enrolled. We included at least 50 males and 50 females in each decade of life between the 20s and the 70s. We measured intervertebral disk height from T10/T11 to L5/S1, vertebral body height from T10 to S1 on lateral neutral radiographs. Lumbar disk degeneration was defined according to the Pfirrmann classification in sagittal plane magnetic resonance imaging.

Results

Age-related decreases in intervertebral disk height were most prominent at L4/L5 in middle-aged and elderly individuals of both sexes. The grade of disk degeneration significantly increased with age in both genders at every level. Mild disk degeneration was observed even in the 20s. The disk degeneration occurred around the L4/L5 level. Although grade V disk degeneration was not identified for males in the 20s and the 30s, it appeared after the 40s and then increased further with age. The intervertebral disk height at the lower lumbar disks decreased with a progression in the disk degeneration grade in both genders.

Conclusions

This large-scale cross-sectional analysis of the thoracolumbar spine in relatively healthy subjects demonstrated that lumbar disk height narrowing progresses with age and is correlated with the progression of disk degeneration.