Factors affecting neurological outcome in traumatic conus medullaris and cauda equina injuries

Neurosurgical Focus

Volumn 25, Issue 5, 2008, Pages

  Kingwell, Stephen P ^a   Curt, Armin ^a   Dvorak, Marcel F ^a  

^a UNIVERSITY OF BRITISH COLUMBIA   (Canada)

Author keywords

Cauda equina injury; Conus medullaris injury; Neurological outcome; Trauma

Indexed keywords

ANIMAL; BLADDER; HUMAN; NUCLEAR MAGNETIC RESONANCE IMAGING; PATHOLOGY; PATHOPHYSIOLOGY; PHYSIOLOGY; RADICULOPATHY; REVIEW; SEXUALITY; SPINAL CORD COMPRESSION;

ANIMALS; HUMANS; MAGNETIC RESONANCE IMAGING; POLYRADICULOPATHY; SEXUALITY; SPINAL CORD COMPRESSION; URINARY BLADDER;

EID: 63849184489     PISSN: None     EISSN: 10920684     Source Type: Journal    
DOI: 10.3171/FOC.2008.25.11.E7     Document Type: Article

References (61)

1. Aebi M, Mohler J, Zach G, Morscher E: Analysis of 75 operated thoracolumbar fractures and fracture dislocations with and without neurological deficit. Arch Orthop Trauma Surg 105:100-112, 1986
2. Been HD, Bouma GJ: Comparison of two types of surgery for thoraco-lumbar burst fractures: combined anterior and posterior stabilisation vs. posterior instrumentation only. Acta Neurochir (Wien) 141:349-357, 1999
3. Benson DR, Burkus JK, Montesano PX, Sutherland TB, McLain RF: Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord 5:335-343, 1992
4. Boerger TO, Limb D, Dickson RA: Does 'canal clearance' affect neurological outcome after thoracolumbar burst fractures? J Bone Joint Surg Br 82:629-635, 2000
5. Boriani S, Palmisani M, Donati U, Tella G, de Lure F, Bandiera S, et al: The treatment of thoracic and lumbar spine fractures: a study of 123 cases treated surgically in 101 patients. Chir Organi Mov 85:137-149, 2000
6. Braakman R: The value of more aggressive management in traumatic paraplegia. Neurosurg Rev 9:141-147, 1986
7. Braakman R, Fontijne WP, Zeegers R, Steenback JR, Tanghe HL: Neurological deficit in injuries of the thoracic and lumbar spine. A consecutive series of 70 patients. Acta Neurochir (Wien) 111:11-17, 1991
8. Bradford DS, McBride GG: Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res 218:201-216, 1987
9. Burns AS, Rivas DA, Ditunno JF: The management of neurogenic bladder and sexual dysfunction after spinal cord injury. Spine 26:S129-S136, 2001
10. Chuang TY, Cheng H, Chan RC, Chiang SC, Guo WY: Neurourologic findings in patients with traumatic thoracolumbar vertebra junction lesions. Arch Phys Med Rehabil 82:375- 379, 2001
11. Cigliano A, Scarano E, De Falco R, Profeta G: The posterolateral approach in the treatment of post-traumatic canalar stenosis of the thoraco-lumbar spine. J Neurosurg Sci 41:387-393, 1997
12. Clohisy JC, Akbarnia BA, Bucholz RD, Burkus JK, Backer RJ: Neurologic recovery associated with anterior decompression of spine fractures at the thoracolumbar junction (T12-L1). Spine 17:S325-S330, 1992
13. Dai LY, Wang XY, Jiang LS: Neurologic recovery from thoracolumbar burst fractures: is it predicted by the amount of initial canal encroachment and kyphotic deformity? Surg Neurol 67:232-237, 2007
14. Dall BE, Stauffer ES: Neurologic injury and recovery patterns in burst fractures at the T12 or L1 motion segment. Clin Orthop Relat Res 233:171-176, 1988
15. Daniels AH, Arthur M, Hart RA: Variability in rates of arthrodesis for patients with thoracolumbar spine fractures with and without associated neurologic injury. Spine 32:2334- 2338, 2007
16. Davies WE, Morris JH, Hill V: An analysis of conservative (non-surgical) management of thoracolumbar fractures and fracture-dislocations with neural damage. J Bone Joint Surg Am 62:1324-1328, 1980
17. Dendrinos GK, Halikias JG, Krallis PN, Asimakopoulos A: Factors influencing neurological recovery in burst thoracolumbar fractures. Acta Orthop Belg 61:226-234, 1995
18. Denis F: The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817-831, 1983
19. Dimar JR II, Wilde PH, Glassman SD, Puno RM, Johnson JR: Thoracolumbar burst fractures treated with combined anterior and posterior surgery. Am J Orthop 25:159-165, 1996
20. Ditunno JF Jr, Young W, Donovan WH, Creasey G: The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia 32:70-80, 1994
21. Dvorak MF, Kwon BK, Fisher CG, Eiserloh HL III, Boyd M, Wing PC: Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine 28:902-908, 2003
22. Ertekin C, Reel F, Mutlu R, Kerkuklu I: Bulbocavernosus reflex in patients with conus medullaris and cauda equina lesions. J Neurol Sci 41:175-181, 1979
23. Gertzbein SD: Scoliosis Research Society. Multicenter spine fracture study. Spine 17:528-540, 1992
24. Gertzbein SD, Court-Brown CM, Marks P, Martin C, Fazl M, Schwartz M, et al: The neurological outcome following surgery for spinal fractures. Spine 13:641-644, 1988
25. Harris MB, Sethi RK: The initial assessment and management of the multiple-trauma patient with an associated spine injury. Spine 31:S9-S15, 2006
26. Harrop JS, Hunt GE Jr, Vaccaro AR: Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles. Neurosurg Focus 16(6):e4, 2004
27. Hashimoto T, Kaneda K, Abumi K: Relationship between traumatic spinal canal stenosis and neurologic deficits in thoracolumbar burst fractures. Spine 13:1268-1272, 1988
28. Herndon WA, Galloway D: Neurologic return versus crosssectional canal area in incomplete thoracolumbar spinal cord injuries. J Trauma 28:680-683, 1988
29. Hu SS, Capen DA, Rimoldi RL, Zigler JE: The effect of surgical decompression on neurologic outcome after lumbar fractures. Clin Orthop Relat Res 288:166-173, 1993
30. Jodoin A, Dupuis P, Fraser M, Beaumont P: Unstable fractures of the thoracolumbar spine: a 10-year experience at Sacre-Coeur Hospital. J Trauma 25:197-202, 1985
31. Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M: Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am 79:69-83, 1997
32. Katonis PG, Kontakis GM, Loupasis GA, Aligizakis AC, Christoforakis, JI, Velivassakis: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. Spine 24:2352-2357, 1999
33. Kaya RA, Aydin Y: Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures. Spine J 4:208-217, 2004
34. Kesler H, Dias MS, Kalapos P: Termination of the normal conus medullaris in children: a whole-spine magnetic resonance imaging study. Neurosurg Focus 23(2):E7, 2007
35. Kim NH, Lee HM, Chun IM: Neurologic injury and recovery in patients with burst fracture of the thoracolumbar spine. Spine 24:290-293, 1999
36. Lee HM, Kim HS, Kim DJ, Suk KS, Park JO, Kim NH: Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures. Spine 25:2079-2084, 2000
37. Lifeso RM, Arabie KM, Kadhi SK: Fractures of the thoracolumbar spine. Paraplegia 23:207-224, 1985
38. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S: A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184-201, 1994
39. Maiman DJ, Larson SJ, Benzel EC: Neurological improvement associated with late decompression of the thoracolumbar spinal cord. Neurosurgery 14:302-307, 1984
40. Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, et al: International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord 35:266-274, 1997
41. McAfee PC, Bohlman HH, Yuan HA: Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach. J Bone Joint Surg Am 67:89-104, 1985
42. McDonough PW, Davis R, Tribus C, Zdeblick TA: The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine 29:1901-1908, 2004
43. McKinley W, Santos K, Meade M, Brooke K: Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med 30:215-224, 2007
44. McLain RF, Burkus JK, Benson DR: Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J 1:310-323, 2001
45. Meves R, Avanzi O: Correlation among canal compromise, neurologic deficit, and injury severity in thoracolumbar burst fractures. Spine 31:2137-2141, 2006
46. Mohanty SP, Venkatram N: Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise? Spinal Cord 40:295-299, 2002
47. Rahimi-Movaghar V, Vaccaro AR, Mohammadi M: Efficacy of surgical decompression in regard to motor recovery in the setting of conus medullaris injury. J Spinal Cord Med 29:32-38, 2006
48. Rath SA, Kahamba JF, Kretschmer T, Neff U, Richter HP, Antoniadis G: Neurological recovery and its influencing factors in thoracic and lumbar spine fractures after surgical decompression and stabilization. Neurosurg Rev 28:44-52, 2005
49. Rechtine GR, Cahill D, Chrin AM: Treatment of thoracolumbar trauma: comparison of complications of operative versus nonoperative treatment. J Spinal Disord 12:406-409, 1999
50. Rutges JP, Oner FC, Leenen LP: Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome. Eur Spine J 16:579-587, 2007
51. Saifuddin A, Burnett SJ, White J: The variation of position of the conus medullaris in an adult population. A magnetic resonance imaging study. Spine 23:1452-1456, 1998
52. Sasso RC, Cotler HB: Posterior instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. A comparative study of three fixation devices in 70 patients. Spine 18:450-460, 1993
53. Schunemann HJ, Jaeschke R, Cook DJ, Bria WF, El-Solh AA, Ernst A, et al: An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 174:605-614, 2006
54. Soleiman J, Demaerel P, Rocher S, Maes F, Marchal G: Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender. Spine 30:1875-1880, 2005
55. Tezeren G, Kuru I: Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech 18:485-488, 2005
56. Todd NV: Cauda equina syndrome: the timing of surgery probably does influence outcome. Br J Neurosurg 19:301- 306, 2005
57. Transfeldt EE, White D, Bradford DS, Roche B: Delayed anterior decompression in patients with spinal cord and cauda equina injuries of the thoracolumbar spine. Spine 15:953- 957, 1990
58. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al: A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 30:2325-2333, 2005
59. Wall EJ, Cohen MS, Abitbol JJ, Garfin SR: Organization of intrathecal nerve roots at the level of the conus medullaris. J Bone Joint Surg Am 72:1495-1499, 1990
60. Waters RL, Adkins RH: The effects of removal of bullet fragments retained in the spinal canal. A collaborative study by the National Spinal Cord Injury Model Systems. Spine 16:934-939, 1991
61. Willen J, Dahllof AG, Nordwall A: Paraplegia in unstable thoracolumbar injuries. A study of conservative and operative treatment regarding neurological improvement and rehabilitation. Scand J Rehabil Med Suppl 9:195-205, 1983