From the Guidelines
Conus medullary syndrome is primarily caused by damage to the conus medullaris, resulting from trauma, tumors, vascular disorders, inflammatory conditions, infections, and congenital abnormalities, with early diagnosis through MRI imaging being crucial for prompt treatment and prevention of permanent neurological deficits. The causes of Conus Medullaris syndrome can be broadly categorized into several groups, including:
- Trauma, such as spinal fractures at the T12-L1 level, which can cause direct damage to the conus medullaris [no direct reference in provided evidence, but general medical knowledge].
- Tumors, both primary spinal cord tumors and metastatic lesions, which can compress or infiltrate the conus medullaris, as suggested by the usefulness of MRI in evaluating the spinal cord and its contents 1.
- Vascular disorders, such as arteriovenous malformations or infarctions, which can lead to ischemia of the conus medullaris, with MRI being useful in cases where spinal cord ischemia is suspected 1.
- Inflammatory conditions, including transverse myelitis, which can cause demyelination and damage to the conus medullaris, with MRI detection of spinal cord lesions being important for diagnosis 1.
- Infections, such as epidural abscesses, which can compress or directly damage the conus medullaris, with MRI being useful for evaluating the spinal canal and its contents 1.
- Congenital abnormalities, such as tethered cord syndrome, which can cause traction on the conus medullaris and lead to damage, with MRI being the reference standard for imaging of the spinal cord in cases of suspected demyelinating disease 1. Early diagnosis and treatment are essential to prevent permanent neurological deficits, as the conus medullaris has limited capacity for recovery after injury, highlighting the importance of prompt MRI imaging and intervention 1.
From the Research
Causes of Conus Medullaris Syndrome
The causes of Conus Medullaris syndrome can be attributed to various factors, including:
- Traumatic injuries, such as burst fractures of the first lumbar vertebra 2, 3, 4, 5
- Arteriovenous malformations (AVMs) in the conus medullaris region 6
- Other spinal vascular lesions that cause progressive debilitating myeloradiculopathy 6
Traumatic Injuries
Traumatic injuries, particularly those occurring at the thoracolumbar junction, can lead to Conus Medullaris syndrome 2, 3, 4, 5. These injuries can result in:
- Burst fractures of the first lumbar vertebra 2, 3
- Incomplete burst fractures of the T12 vertebra 5
- Other types of traumatic injuries that affect the conus medullaris region
Arteriovenous Malformations (AVMs)
AVMs in the conus medullaris region can also cause Conus Medullaris syndrome 6. These lesions can lead to:
- Progressive debilitating myeloradiculopathy 6
- Symptoms such as back pain, unilateral or bilateral leg pain, paresthesias, and weakness 6
Other Factors
Other factors, such as the location and severity of the injury, can also influence the development of Conus Medullaris syndrome 5. For example:
- High-riding conus medullaris syndrome can present with varying degrees of upper motor neuron signs (UMNS) and lower motor neuron signs (LMNS) 5
- The location of the injury relative to the tip of the conus medullaris can affect the extent to which the upper motor neuron (UMN) is involved in patients with Conus Medullaris syndrome 5