Friday, December 11, 2020

Conus medullaris syndrome vs. Cauda equina syndrome

Both of these are orthopedic/neurosurgical emergencies! But in general, CM syndrome is more severe than CE syndrome.

Here's a comparison between the two...


Pro tip: Think of CM syndrome as a clean cut through the conus medullaris (although it's not).

 

Conus medullaris syndrome

Cauda equina syndrome

 

    bilateral

    unilateral or bilateral

Motor

    symmetrical weakness

    asymmetrical most often

Sensory

    symmetrical numbness

        'Perianal anesthesia' common

    asymmetrical most often

    ‘Saddle anesthesia’ common

Reflexes

    at the level:          HYPOreflexia

    below the level:   HYPERreflexia

    HYPOreflexia

Impotence

    common

    rare

Sphincter dysfunction

    EARLY

    Both, urinary and fecal incontinence

    LATE

    urinary retention only

Radicular pain

    absent

    present

Back pain

    more

    less

*Cauda equina includes L2 to Coccygeal-1 pair of spinal nerves.

*The nucleus of Onuf (or Onufrowicz) is a small group of neurons in the ventral horn of the S2 (and S3 too according to some authors) segment of the spinal cord. These are motor neurons that supply the external urethral & anal sphincters; also the levator ani and perineal (bulbospongiosus & ischiocavernosus [erector clitoridis in females]) muscles.

PS: I have skipped the anatomical details from the diagram like the dorsal & ventral roots of the spinal nerves, etc. for the purpose of simplicity of concept. :)



[- Dr. Suneet Patel

Happy studying, peeps! :)]


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