Abstract
The conus medullaris or “conus terminalis” is the terminal end of the spinal cord, which typically occurs at the L1 vertebral level in the adult that corresponds to the sacral cord segment between S1 and S5. The lower end of the conus medullaris is called “epiconus”. After the spinal cord ends caudally, the spinal nerves continue to branch out diagonally, creating the cauda equina nerve roots (Figs. 43.1, 43.2).
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Akhaddar A, el Hassani MY, Ghadouane M, Hommadi A, Chakir N, Jiddane M, Boukhrissi N. Dermoid cyst of the conus medullaris revealed by chronic urinary retention. Contribution of imaging. J Neuroradiol. 1999;26:132–6.
Artner J, Leucht F, Schulz C, Cakir B. Sciatica and incomplete paraplegia after spontaneous haematoma of the spinal cord due to a cumarine-induced coagulopathy: case report. Open Orthop J. 2012;6:189–93. https://doi.org/10.2174/1874325001206010189.
Asahar SF, Malek KA, Zohdi WNWM, Peter AB. Chronic back pain in a young female patient: a case of ependymoma originating from the conus medullaris. Korean J Fam Med. 2020;41:68–72. https://doi.org/10.4082/kjfm.18.0157.
Canbay S, Hasturk AE, Markoc F, Caglar S. Schwannoma of the conus medullaris: a rare case. Chin J Cancer. 2011;30:867–70. https://doi.org/10.5732/cjc.011.10213.
Candy N, Young A, Devadass A, Dean A, McMillen J, Trivedi R. Dual lumbar bronchogenic and arachnoid cyst presenting with sciatica and left foot drop. Acta Neurochir (Wien). 2017;159:2029–32. https://doi.org/10.1007/s00701-017-3284-z.
Chotmongkol V, Wanitpongpun C, Phuttharak W, Khamsai S. Intramedullary conus medullaris tuberculoma: a case report and review of the literature. Infect Dis Rep. 2021;13:82–8. https://doi.org/10.3390/idr13010010.
D'Angiolillo JC, Patel NV, Hernandez RN, Hanft S. Bilateral lumbar radiculopathy secondary to myxopapillary ependymoma: a case report. J Chiropr Med. 2021;20:170–5. https://doi.org/10.1016/j.jcm.2022.01.004.
Ebner FH, Roser F, Acioly MA, Schoeber W, Tatagiba M. Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management. Neurosurg Rev. 2009;32:287–300; discussion 300-1. https://doi.org/10.1007/s10143-008-0173-1.
el-Banhawy A, Elwan O, Taher Y. Bilharzial granuloma of the conus medullaris and cauda equina. Paraplegia. 1972;10:172–80. https://doi.org/10.1038/sc.1972.29.
Er U, Yigitkanli K, Simsek S, Adabag A, Bavbek M. Spinal intradural extramedullary cavernous angioma: case report and review of the literature. Spinal Cord. 2007;45:632–6. https://doi.org/10.1038/sj.sc.3101990.
Fujisawa H, Igarashi S, Koyama T. Acute cauda equina syndrome secondary to lumbar disc herniation mimicking pure conus medullaris syndrome—case report. Neurol Med Chir (Tokyo). 1998;38:429–31. https://doi.org/10.2176/nmc.38.429.
Haddad R, Hentzen C, Le Breton F, Sheikh Ismael S, Amarenco G. Lumbosacral radicular pain during micturition, defecation or orgasm. Eur J Pain. 2019;23:1091–7. https://doi.org/10.1002/ejp.1372.
Han IH, Kuh SU, Chin DK, Kim KS, Jin BH, Cho YE. Surgical treatment of primary spinal tumors in the conus medullaris. J Korean Neurosurg Soc. 2008;44:72–7. https://doi.org/10.3340/jkns.2008.44.2.72.
Hayashi F, Sakai T, Sairyo K, Hirohashi N, Higashino K, Katoh S, et al. Intramedullary schwannoma with calcification of the epiconus. Spine J. 2009;9:e19–23. https://doi.org/10.1016/j.spinee.2008.11.006.
Hsu KC, Li TY, Chu HY, Chen LC, Chang ST, Wu YT. Conus medullaris metastasis in breast cancer: report of a case and a review of the literature. Surg Today. 2013;43:910–4. https://doi.org/10.1007/s00595-012-0289-3.
Inoue T. Pure conus medullaris syndrome without lower extremity involvement caused by intradural disc herniation at L1/2: a case report. Spine Surg Relat Res. 2018;3:392–5. https://doi.org/10.22603/ssrr.2018-0032.
Kalsi P, Hassan MF, Scoones D, Bradey N, Tizzard S. An unusual case of ectopic prostate tissue in an intradural lipoma of the conus medullaris. Br J Neurosurg. 2011;25:757–8. https://doi.org/10.3109/02688697.2010.544792.
Kim JT, Bahk JH, Sung J. Influence of age and sex on the position of the conus medullaris and Tuffier's line in adults. Anesthesiology. 2003;99:1359–63. https://doi.org/10.1097/00000542-200312000-00018.
Naito K, Yamagata T, Nagahama A, Kawahara S, Ohata K, Takami T. Surgical management of solitary nerve sheath tumors originating around the epiconus or conus medullaris: a retrospective case analysis based on neurological function. Neurosurg Rev. 2018;41:275–83. https://doi.org/10.1007/s10143-017-0851-y.
Podnar S. Epidemiology of cauda equina and conus medullaris lesions. Muscle Nerve. 2007;35:529–31. https://doi.org/10.1002/mus.20696.
Prasad GL, Divya S. A comprehensive review of adult onset spinal teratomas: analysis of factors related to outcomes and recurrences. Eur Spine J. 2020;29:221–37. https://doi.org/10.1007/s00586-019-06037-7.
Saiful Azli MN, Abd Rahman IG, Md Salzihan MS. Ancient schwannoma of the conus medullaris. Med J Malaysia. 2007;62:256–8.
Steinberg JA, Gonda DD, Muller K, Ciacci JD. Endometriosis of the conus medullaris causing cyclic radiculopathy. J Neurosurg Spine. 2014;21:799–804. https://doi.org/10.3171/2014.7.SPINE14117.
Toda H, Okamoto T, Nishida N, Yuba Y, Iwasaki K. Idiopathic hematomyelia as a rare cause of epiconus syndrome. Clin Neurol Neurosurg. 2014;125:75–7. https://doi.org/10.1016/j.clineuro.2014.07.023.
Toribatake Y, Baba H, Kawahara N, Mizuno K, Tomita K. The epiconus syndrome presenting with radicular-type neurological features. Spinal Cord. 1997;35:163–70. https://doi.org/10.1038/sj.sc.3100369.
Tsuchiya A, Akiyama H, Hasegawa Y. Spinal sarcoidosis presenting with epiconus syndrome. Intern Med. 2014;53:2529–32. https://doi.org/10.2169/internalmedicine.53.1685.
Weng YC, Chin SC, Wu YY, Kuo HC. Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction. BMC Neurol. 2019;19:328. https://doi.org/10.1186/s12883-019-1566-1.
Wong JJ, Dufton J, Mior SA. Spontaneous conus medullaris infarction in a 79 year-old female with cardiovascular risk factors: a case report. J Can Chiropr Assoc. 2012;56:58–65.
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Akhaddar, A. (2023). Conus Medullaris Lesions. In: Atlas of Sciatica. Springer, Cham. https://doi.org/10.1007/978-3-031-44984-0_43
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DOI: https://doi.org/10.1007/978-3-031-44984-0_43
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