Kingwell Stephen P, Curt Armin, Dvorak Marcel F
Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Neurosurg Focus. 2008;25(5):E7. doi: 10.3171/FOC.2008.25.11.E7.
The purpose of this review was to describe the relevant factors that influence neurological outcomes in patients who sustain traumatic conus medullaris injuries (CMIs) and cauda equina injuries (CEIs). Despite the propensity for spinal trauma to affect the thoracolumbar spine, few studies have adequately characterized the outcomes of CMIs and CEIs. Typically the level of neural axis injury is inferred from the spinal level of injury or the presenting neurological picture because no study from the spinal literature has specifically evaluated the location of the conus medullaris with respect to the level of greatest canal compromise. Furthermore, the conus medullaris is known to have a small but important variable location based on the spinal level. Patients with a CMI will typically present with variable lowerextremity weakness, absent lower-limb reflexes, and saddle anesthesia. The development of a mixed upper motor neuron and lower motor neuron syndrome may occur in patients with CMIs, whereas a CEI is a pure lower motor neuron injury. Many treatment options exist and should be individualized. Posterior decompression and stabilization offers at least equivalent neurological outcomes as nonoperative or anterior approaches and has the additional benefits of surgeon familiarity, shorter hospital stays, earlier rehabilitation, and ease of nursing care. Overall, CEIs and CMIs have similar outcomes, which include ambulatory motor function and a variable persistence of bowel, bladder, and potentially sexual dysfunctions.
本综述的目的是描述影响创伤性脊髓圆锥损伤（CMI）和马尾神经损伤（CEI）患者神经功能转归的相关因素。尽管脊柱创伤易累及胸腰椎，但很少有研究充分描述CMI和CEI的转归情况。通常，神经轴损伤的平面是根据脊柱损伤平面或所呈现的神经学表现推断出来的，因为脊柱文献中没有研究专门评估脊髓圆锥相对于椎管狭窄最严重平面的位置。此外，已知脊髓圆锥的位置会因脊柱平面而存在小但重要的变异。CMI患者通常会出现不同程度的下肢无力、下肢反射消失和鞍区感觉缺失。CMI患者可能会出现混合性上运动神经元和下运动神经元综合征，而CEI是单纯的下运动神经元损伤。存在多种治疗选择，应个体化。后路减压和内固定与非手术或前路手术相比，至少能带来相当的神经功能转归，且具有术者熟悉、住院时间短、康复早及护理方便等额外优势。总体而言，CEI和CMI具有相似的转归，包括步行运动功能以及肠道、膀胱和可能的性功能障碍的不同程度持续存在。
