Conus Medullaris / Cauda Equina Syndrome

FACTS

Syndrome
Conus Medullaris
Cauda Equina
levels impacted
T12-L2 (conus)
below conus
neural elements impacted
cord + nerve roots
nerve roots
etiology
tumors, ischemia, herniations (L1-2), iatrogenic
usually discs
Motor symptoms
often less severe than cauda equina
severe
Laterality of symptoms
Symmetric (bilateral)
Asymmetric (unilateral)
Bowel/bladder involvement
usually early
usually late
Motor signs
UMN + LMN
LMN only
onset
sudden
gradual
pain
rare
severe, radicular type

HPI

universal ROS
  • LE motor/sensory dysfunction
  • bladder/bowel dysfunction
  • sexual dysfunction
  • saddle anesthesia
  • onset
  • sidedness of symptoms

PHYSICAL EXAM

universal spine exam
  • rectal exam
  • anal wink (usually lost)
  • bulbocavernous reflex (usually los)

IMAGING

  • MRI L-spine
A/P
  • STAT decompression

Greenburg Table 50.9

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