Spinal cord is the backbone of our body. Due to its direct relation with brainstem and nephrons, any damage to the spinal cord can affect the body posture and other parts of the head. Spinal cord is one of the most vital parts of our body frame owing to which we can stand straight, tall and erect. The conus medullaris is one of the most important portions of the spinal cord.
The spinal cord has a cone shaped end which is termed as conus medullaris. It is located between the end points of thoracic vertebrae or T-12 and at the starting of lumbar vertebrae or L-1. Very rarely, it is also located between L-1 and L-2. The nerves passing via conus medullaris are known to influence the functioning of the genitals, bladder, legs and bowel. These nerves come to a pointed end whereby the nerve roots emanate and dangle from the spinal cord. This structure looks like a horsetail and is termed as cauda equina. Since, conus medullaris is placed in the lower back, lumbar spine injuries or disorders are bound to have an effect on this end portion of the spinal cord.
Sometimes constriction or unwanted pressure affects the functioning of nerves located in the conus medullaris. This condition is termed as medullaris syndrome. This external pressure can originate from a tumor or hematoma. The common symptoms of medullaris syndrome are pain in lower back, numbness in legs and feet, numbness in groin or thighs, difficulty in walking, impotence, loss of control over bladder and weakening of legs.
Many factors are responsible for the occurrence of conus medullaris syndrome. Some of them are:
Conus medullaris syndrome is evaluated primarily by physical examination. During physical examinations, doctors look out for regular symptoms such as weakening of legs and muscles, abnormalities in sensory organs, reduced anal sphincter tone and absence of flexibility in tendons of lower extremities. The tests usually recommended for final diagnosis include X-ray of bone and spinal cord, CT scanning, MRI scanning, bone scanning, Myelogram and tissue biopsy.
The common treatment regime for conus medullaris syndrome includes radiation therapy, corticosteroid medications and surgery. The cause of the syndrome is an important factor in determining the course of therapy or treatments. If the pressure on the nerves is caused by the presence of a foreign structure, surgical removal of the structure is the appropriate option. Similarly, if conus medullaris syndrome is caused due to accidental injury, the treatment focuses on healing the wound. In case of chronic syndrome, which is caused by gradually progressive constriction of nerves, surgery is not very useful. For such patients, corticosteroids such as Methylprednisolone are generally prescribed by doctors. If injury to the conus medullaris has caused a gap to form between two vertebrae of the spinal cord, a bone grafting operation is performed in order to stabilize the spinal cord back to its normal position.