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Source: Keith L. Moore and Anne Agur. Essential Clinical Anatomy, 3rd Edition
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Etiology
Trauma - Fracture, subluxation - Penetrating trauma Herniated disc - 90% at L4-L5 and L5-S1
Spinal stenosis - Developmental abnormality - Degenerative disease
Picture from: Walter B. Greene. Netter's Orthopaedics 1st ed. 2006
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Neoplasm - Primary (schwannoma, paraganglioma) - Metastatic (intracranial, lung, breast and renal cell ca)
Inflammations and infections - Paget disease, epidural abscess - Pyogenic and non pyogenic
Picture from: http://emedicine.medscape.com/
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Reflexes Sensory
Illustration of saddle anesthesia; - The S5, S4, and S3 nerves provide sensory innervation to the rectum, perineum, and inner thigh.
Source: Journal of the American Academy of Orthopaedics Surgeons, http://www.jaaos.org
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Investigation
Radiology MRI Laboratory FBC, ESR Needle electromyography of the bilateral external anal sphincter muscles Lumbar puncture
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Sagittal and axial CT scans of thoracolumbar spine demonstrating an L4 burst fracture with retropulsion of bone into the spinal canal
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Source: Harrop, J. S., G. E. Hunt Jr, et al. (2004). "Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles." Neurosurgical Focus 16(6): 1-23. 23/09/2012
MRI image shows compression of the distal lumbar and sacral nerve rootles
Source: Harrop, J. S., G. E. Hunt Jr, et al. (2004). "Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles." Neurosurgical Focus 16(6): 1-23.
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Sagittal MRI images demonstrating large central disc extrusion at L5-S1 (arrows) with compression on the cauda equina.
Source: Levis, J. T. (2009). "Cauda equina syndrome." Western Journal of Emergency Medicine 10(1): 20.
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Discectomy - 1 2 Laminectomy
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Corpectomy
Source: http://www.spinesurgeon.co.uk/media/lumbar-corpectomy.jpg
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Prognosis
Important predictor of recovery - The extent of perineal or saddle sensory deficit Patients with unilateral deficits have a better prognosis than patients with bilateral deficits Females and patients with bowel dysfunction have been reported to have worse outcomes postoperatively
Source: - Shaw A, Anwar H, Targett J, Lafferty K. Cauda equina syndrome versus saddle embolism. Ann R Coll Surg Engl. Sep 2008;90(6):W6-8. - O'Laughlin SJ, Kokosinski E. Cauda equina syndrome in a pregnant woman referred to physical therapy for low back pain. J Orthop Sports Phys Ther. Nov 2008;38(11):721.
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Other references: - http://emedicine.medscape.com/article/1148690 - Oxford handbook of clinical medicine - Oxford handbook of clinical surgery - Apleys consice system of orthopaedics and fractures 3rd edition
THANK YOU
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