Department of Medical Education, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan.
School of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei 114201, Taiwan.
Tomography. 2023 Oct 27;9(6):1999-2005. doi: 10.3390/tomography9060156.
Conus medullaris syndrome (CMS) is a distinctive spinal cord injury (SCI), which presents with varying degrees of upper motor neuron signs (UMNS) and lower motor neuron signs (LMNS). Herein, we present a case with a burst fracture injury at the proximal Conus Medullaris (CM).
A 48-year-old Taiwanese male presenting with lower back pain and paraparesis was having difficulty standing independently after a traumatic fall. An Imaging survey showed an incomplete D burst fracture of the T12 vertebra. Posterior decompression surgery was subsequently performed. However, spasticity and back pain persisted for four months after surgical intervention. Follow-up imaging with single photon emission computed tomography (SPECT) and a whole body bone scan both showed an increased uptake in the T12 vertebra.
The high-riding injury site for CMS is related to a more exclusive clinical representation of UMNS. Our case's persistent UMNS and scintigraphy findings during follow-up showcase the prolonged recovery period of a UMN injury. In conclusion, our study provides a different perspective on approaching follow-up for CM injuries, namely using scientigraphy techniques to confirm localization of persistent injury during the course of post-operative rehabilitation. Furthermore, we also offered a new technique for analyzing the location of lumbosacral injuries, and that is to measure the location of the injury relative to the tip of the CM. This, along with clinical neurological examination, assesses the extent to which the UMN is involved in patients with CMS, and is possibly a notable predictive tool for clinicians for the regeneration time frame and functional outcome of patients with lumbosacral injuries in the future.
圆锥部脊髓综合征（CMS）是一种独特的脊髓损伤（SCI），表现为不同程度的上运动神经元体征（UMNS）和下运动神经元体征（LMNS）。在此，我们报告一例圆锥部近侧爆裂性骨折损伤病例。
一位 48 岁的台湾男性，因创伤性跌倒后出现腰痛和下肢瘫痪前来就诊，无法独立站立。影像学检查显示 T12 椎体不完全 D 型爆裂性骨折。随后进行了后路减压手术。然而，手术干预后四个月仍存在痉挛和背痛。单光子发射计算机断层扫描（SPECT）和全身骨扫描的随访影像学检查均显示 T12 椎体摄取增加。
CMS 的高位损伤部位与更独特的 UMNS 临床表现有关。我们病例的持续性 UMNS 和随访中的闪烁扫描结果表明 UMN 损伤的恢复期较长。总之，我们的研究为 CM 损伤的随访提供了一个不同的视角，即使用闪烁扫描技术来确认术后康复过程中持续性损伤的定位。此外，我们还提出了一种分析腰骶部损伤部位的新技术，即测量损伤相对于圆锥部尖端的位置。这与临床神经系统检查相结合，评估 CMS 患者中 UMN 受累的程度，可能是未来腰骶部损伤患者再生时间框架和功能结果的重要预测工具。
