![]() These patients must be given strict return precautions in the event they develop other symptoms pointing to CES/CMS. Patients presenting with sciatica and no other evidence of CES/CMS in the history or exam should receive counsel on the possible development of other related symptoms such as bladder or bowel dysfunction, impotence, and saddle anesthesia. Incomplete injuries tend to have better outcomes. The best predictors of outcome are neurological status at presentation and degree of injury. ![]() Sciatica was present in 47.5% of patients. Sexual dysfunction persisted in 53.3% of patients, and saddle anesthesia in 56.6%. Dysfunction with defecation decreased post-operatively significantly, but 41.8% of patients still had problems at 63 days post-operatively. Micturition deficits such as retention requiring self-catheterization or presence of suprapubic or indwelling catheters and incontinence still presented in 47.7% of patients. The data indicate that a large percentage of patients still experience residual symptoms irrespective of their time to surgical decompression. One study looked at 63-day outcomes on micturition, defecation, saddle anesthesia, sexual function, and sciatica in cauda equina syndrome. CMS and CES also carry a high risk of litigation as delays in diagnosis and management can lead to devastating life-long impairment.Ĭomplications in cauda equina syndrome and conus medullaris syndrome occur in a large percentage of those diagnosed. Both syndromes are neurosurgical emergencies as they can present with back pain radiating to the legs, motor and sensory dysfunction of the lower extremities, bladder and/or bowel dysfunction, sexual dysfunction and saddle anesthesia. Cauda equina syndrome (CES) results from compression and disruption of the function of these nerves and can be inclusive of the conus medullaris or distal to it, and most often occurs when damage occurs to the 元-L5 nerve roots. The cauda equina is a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels L1-L5 and contains axons of nerves that give both motor and sensory innervation to the legs, bladder, anus, and perineum. Conus medullaris syndrome (CMS) results when there is compressive damage to the spinal cord from T12-L2. The conus medullaris is the terminal end of the spinal cord, which typically occurs at the L1 vertebral level in the average adult. ![]() Therefore, for the purpose of this discussion, they will be grouped, and notable differences highlighted. Cauda equina and conus medullaris syndromes have overlap in anatomy and clinical presentation.
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