Department of Orthopaedic Surgery, Akita Red Cross Hospital.
Department of Orthopaedic Surgery, Akita University Graduate School of Medicine.
Acta Med Okayama. 2023 Oct;77(5):499-509. doi: 10.18926/AMO/65972.
This study aimed to clarify neurological differences among the epiconus, conus medullaris, and cauda equina syndromes. Eighty-seven patients who underwent surgery for acute thoracolumbar spinal injuries were assessed. We defined the epiconus as the region from the terminal end of the spinal cord to the proximal 1.0 to 2.25 vertebral bodies, the conus medullaris as the region proximal to < 1.0 vertebral bodies, and the cauda equina as the distal part of the nerve roots originating from the spinal cord. On the basis of the distance from the terminal end of the spinal cord to the narrowest level of the spinal canal, the narrowest levels were ordered as follows: the epiconus followed by the conus medullaris and cauda equina. The narrowest levels were the epiconus in 22 patients, conus medullaris in 37 patients, and cauda equina in 25 patients. On admission, significantly more patients had a narrowed epiconus of Frankel grades A-C than a narrowed cauda equina. At the final follow-up, there were no significant differences in neurological recovery among those with epiconus, conus medullaris, or cauda equina syndrome. Anatomically classifying the narrowest lesion is useful for clarifying the differences and similarities among these three syndromes.
本研究旨在阐明脊髓圆锥、马尾和终丝综合征之间的神经学差异。对 87 例接受急性胸腰椎脊柱损伤手术的患者进行了评估。我们将终丝定义为脊髓末端到近端 1.0 到 2.25 个椎体的区域，圆锥为小于 1.0 个椎体的区域，马尾为脊髓起源的神经根的远端部分。根据脊髓末端到椎管最窄水平的距离，最窄水平的顺序如下：终丝、圆锥和马尾。22 例患者最窄水平为终丝，37 例患者为圆锥，25 例患者为马尾。入院时，Frankel 分级 A-C 的终丝狭窄患者明显多于马尾狭窄患者。在最终随访时，终丝、圆锥和马尾综合征患者的神经恢复无显著差异。对最窄病变进行解剖学分类有助于阐明这三种综合征之间的差异和相似之处。
