Conus Medullaris Syndrome occurs due to injury or trauma to the conus medullaris and lower lumbar nerve roots. The signs and symptoms of conus medullaris syndrome are similar to cauda equina syndrome. As well as there are other medical conditions with the same symptoms are also present. Therefore, to distinguish conus medullaris syndrome from others, physical examination and diagnostic tests are required.
Complications of Conus Medullaris Syndrome
There are several complications of conus medullaris syndrome. These are as follows:
- Thromboembolic phenomena
- Erectile dysfunction
- Pressure ulcers
- Bladder calculi
- Spasticity/contractures
- Heterotopic ossification
- Neurogenic bladder/bowel
- Osteoporosis
- Depression
- Chronic neuropathic pain
- Recurrent urinary tract infections
- Urethral stricture
Diagnosis of Conus Medullaris Syndrome
Diagnosis of Conus Medullaris Syndrome
It includes the physical examination and the diagnostic tests to confirm the diagnosis of conus medullaris syndrome.
Physical Examination
- Patient history and physical examination are necessary to determine the injury’s nature and location.
- Muscle tenderness, muscle atrophy, muscle weakness, sensory and motor function, and reflexes are assessed in physical examination.
- ASIA Impairment scale is also used in physical examination.
Other Ways to Diagnose Conus Medullaris Syndrome
After the medical history and physical examination, diagnostic tests are performed. These tests include the following:
- Blood Tests
- Imaging Tests
- Other tests and procedures
Blood Tests
To rule out the associated complications such as anemia, infection, retroperitoneal mass, or renal dysfunction. The following blood tests are performed:
- CBC count
- Blood Glucose
- Blood Urea Nitrogen (BUN)
- Electrolytes and Creatinine
- Erythrocyte sedimentation rate (ESR) – An increase in its average value indicates inflammation
- Syphilis serology (to rule out meningovascular syphilis)
Imaging Tests
Imaging tests are performed to determine the injury’s nature and severity, such as compression or disruption in function. These include the following:
- Chest or Spine X-ray
- Magnetic Resonance Imaging (MRI)
- Computed Tomography (CT Scan)
- Myelogram
- Other Tests
Chest or Spine X-ray
It indicates destructive changes in the chest or lumbosacral spine.
Magnetic Resonance Imaging (MRI)
It is considered a gold standard test for conus medullaris syndrome. MRI imaging with sagittal and axial T1 and T2 sequences is generally suggested. In this kind of MRI, the use of gadolinium contrast is preferred. In case of infectious conditions, imaging may display the abnormal appearance of the nerve roots to one side of the dural sac.
Computed Tomography (CT Scan)
This imaging is used to determine the condition of bones thoroughly. It also helps to evaluate the anatomy of the region.
Myelogram
It is an X-ray of the spinal canal after injecting contrast material into the CSF. It shows the displacement of the spinal cord, or spinal nerves, herniated discs, bone spurs, and tumors, etc.
Other Tests and Procedures
Other tests and procedures used to diagnose conus medullaris syndrome are as follows:
- Electromyography (Needle EMG)
- Nerve Conduction Studies
- Somatosensory evoked potentials (SSEPs)
- Duplex ultrasound of peripheral vessels
- Lumbar puncture
Differential Diagnosis of Conus Medullaris Syndrome
Several diseases have the same sign and symptoms as conus medullaris syndrome. Due to this reason, there are several differential diagnoses for this syndrome. These are as follows:
- Acute Inflammatory Demyelinating
- Spinal Cord Infarct
- Polyradiculoneuropathy
- Syringomyelia
- HIV-related Myelopathy
- Amyotrophic Lateral Sclerosis in Physical Medicine and Rehabilitation
- Diabetic Neuropathy
- Guillain-Barré Syndrome
- Multiple Sclerosis
- Neoplasms, Spinal Cord
- Neurosarcoidosis
- Spinal Cord Infections
- Traumatic Peripheral Nerve Lesions
- Transverse Myelitis
- Spinal Arteriovenous Malformation
Treatment Of Conus Medullaris Syndrome
Treatment of Conus Medullaris Syndrome
After the diagnosis of the syndrome, the next step is treatment. Depending on the syndrome’s cause, the doctor plans and gives treatment. Treatment options include the following:
- Medication
- Radiotherapy
- Surgery
- Physical Therapy
Medication
Antibiotics and NSAIDs are prescribed to combat infections and manage inflammation.
Radiotherapy
Radiations help with conus medullaris syndrome if the symptoms are due to cancer or a severe infection.
Surgery
Spinal decompression surgery is performed to alleviate the symptoms. In addition, it is done to remove any compression caused by tumors or a remnant of the bullet.
Physical Therapy
After the surgery, physical therapy is necessary to regain function and quality of life.
Prognosis of Conus Medullaris Syndrome
The prognosis for this syndrome depends on the following:
- Timing of patient presentation
- Severity of deficits
- Underlying Pathology
Early diagnosis and treatment help in the improvement of the condition. Approximately 10% of patients regain functional recovery after the treatment.