Asada Tomoyuki, Koda Masao, Funayama Toru, Takahashi Hiroshi, Noguchi Hiroshi, Miura Kousei, Mataki Kentaro, Yamazaki Masashi
Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN.
Cureus. 2021 Sep 4;13(9):e17708. doi: 10.7759/cureus.17708. eCollection 2021 Sep.
Objective This study aimed to analyze the neurological symptoms caused by thoracolumbar lesions according to their distance from where the spinal cord terminates for a better description of epiconus syndrome. Methods We retrospectively reviewed cases of patients with neurological symptoms caused by a thoracolumbar lesion in a single institute. Neurological symptoms were analyzed according to the distance from the proximal end of the lesion to where the spinal cord terminates using MRI or CT myelograms. The symptoms were classified into epiconus syndrome, thoracic myelopathy, and conus medullaris syndrome. The distance was described regarding the length of a vertebral body (VB). Results We included 19 patients in this series. The spinal cord terminates were at the lower third of the L1 vertebra most frequently (32%) in the range of T12 to L2 vertebra. The border between thoracic myelopathy and epiconus syndrome was 2VB proximal from where the spinal cord terminates, and that between epiconus syndrome and conus medullaris syndrome was 1VB. Mean disease duration until symptoms changed was 2.4 months in epiconus syndrome, while it was 25 months in thoracic myelopathy, and 10.3 months in conus medullaris syndrome. Conclusion Epiconus syndrome is caused by lesion 1-2VB proximal to where the spinal cord terminates. This study may provide further helpful information for clinical practice in the treatment of epiconus syndrome.
目的 本研究旨在根据胸腰段病变距脊髓末端的距离分析其所致神经症状，以便更好地描述圆锥上综合征。方法 我们回顾性分析了单中心胸腰段病变所致神经症状患者的病例。使用MRI或CT脊髓造影，根据病变近端至脊髓末端的距离分析神经症状。症状分为圆锥上综合征、胸段脊髓病和圆锥综合征。距离以椎体（VB）长度描述。结果 本系列共纳入19例患者。脊髓末端最常见于T12至L2椎体范围内的L1椎体下三分之一处（32%）。胸段脊髓病与圆锥上综合征的边界为距脊髓末端近端2个椎体，圆锥上综合征与圆锥综合征的边界为1个椎体。圆锥上综合征症状改变前的平均病程为2.4个月，胸段脊髓病为25个月，圆锥综合征为10.3个月。结论 圆锥上综合征由距脊髓末端近端1 - 2个椎体的病变引起。本研究可为圆锥上综合征的临床治疗提供进一步的有用信息。
