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Conus-cauda syndrome

[edit]
Conus-cauda syndrome
MRI scan of the lumbosacral spine, depicting compression on the conus medullaris and cauda equina
SymptomsBack pain, sciatica-type pain, lower limb weakness, saddle anaesthesia, rectal incontinence, urinary incontinence, sexual dysfunction
CausesCompression of CM and/or CE – blunt/penetrating trauma, tumors, disc herniation, spinal stenosis
Diagnostic methodMRIs, CT scans, X-rays, urinary ultrasound
TreatmentLaminectomy and discectomy

Conus-cauda syndrome is a rare combined neurological disorder of conus medullaris syndrome (CMS) and cauda equina syndrome (CES) affecting the lower spinal cord and nerves, leading to lower back pain, weakness or numbness in the legs and feet, and often bowel or bladder problems.[1][2] The syndrome was first described by Otto Veraguth in 1929 in his published report about the successful procedure in resecting a herniated lumbar disc.[3]

The display of symptoms is mainly caused by the compression of nerves and nerve roots in the lumbosacral region of the spine, where the conus medullaris (CM) and cauda equina (CE) are situated.[3] Various factors contribute to the mechanical compression on the spinal nerves, such as spinal disc herniations, spinal tumors, and trauma to the thoracolumbar junction or lumbosacral regions.[4] Upon the onset of symptoms, patients are advised to seek immediate medical attention, as surgical decompression is often required for a better prognosis.[1]

Conus-cauda syndrome is diagnosed based on the observed clinical presentation of symptoms and further verified by medical imaging and classification of the injury.[5][6] Once the diagnosis is confirmed, it is treated via laminectomy or discectomy in addition to post-operative rehabilitation for the recovery of neurological functions and reduced radicular pain.[7][8] The prevalence of the conus-cauda syndrome is uncommon, with 1 in every 100,000 people being diagnosed every year and an annual incidence of 1.5 to 3.4 per million people.[1][5]

Signs and symptoms

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Symptoms of conus-cauda syndrome are linked to the onset of CMS and CES. The neurological symptoms include:

Patients with damage to the CM are more likely to exhibit both upper and lower motor neuron symptoms associated with spinal cord compression. In contrast, damage to the CE typically results in lower motor neuron symptoms.[5][6]

Causes

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Trauma

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X-ray of trauma-induced burst fracture on the thoracolumbar junction on the L4 vertebrae.

Blunt and penetrating trauma occurring in the thoracolumbar junction or lumbosacral regions is the most common type of trauma resulting in conus-cauda syndrome.[6] Such trauma typically causes vertebral fractures known as burst fractures, a type of compression fracture often found in conus-cauda patients.[6][9] The bone fragments from burst fractures of the vertebrae can narrow the spinal canal and physically compress the CM and CE within the spinal canal,[4] leading to neurological deficits characteristic of conus-cauda syndrome.[1][4]

Tumors

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MRI scan displaying disc herniations of the L4 and L5 vertebrae protruding onto the spinal cord

Untreated tumors in the lumbar spine could grow to a significant size and compress the nerve roots, causing radiculopathy in the CE and myelopathy in the CM in severe cases.[10] Tumors that develop in the L1-L5 spinal regions can be classified as either primary or metastatic, and further identified as benign or malignant.[10][11]

Primary intramedullary tumors, particularly ependymomas (myxopapillary subtype) and astrocytomas, commonly develop in the neural tissues within the CM.[12] As for the CE, extramedullary tumors such as schwannomas, meningiomas and neurofibromas arise in tissues around the neural tissues.[12][13] Tumors that are found in the CE are typically seen as metastatic lesions originating from the breast, lungs, kidney and prostate.[10]  

Spinal disc herniations

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The age-related degeneration of the spinal disc involves progressive dehydration and weakening of the nucleus pulposus, compromising its structural integrity.[14][15][16] The weakened nucleus pulposus protrudes out of the outer fibrocartilaginous ring of the spinal disc,[16] also known as the annulus fibrosus, and compresses onto the spinal cord, leading to disc herniation.[14] As the spinal disc herniation exacerbates, it gradually pushes onto the CM and CE within the lumbosacral spine, causing radiculopathy and spinal cord dysfunction.[11][14]

Spinal stenosis

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Spinal stenosis refers to the narrowing of the spinal canal,[17] which often occurs due to degenerative processes, trauma or iatrogenic causes.[18] As the canal space for the spinal cord and nerve roots constricts,[17] it impinges on the thecal sac encompassing the CM and CE, giving rise to symptoms of conus-cauda syndrome.[19] Another factor that affects the dimensions of the spinal canal are genetic factors which would influence an individual's vulnerability to spinal stenosis.[20]

Diagnosis

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The presentation of symptoms listed above in the context of a patient’s traumatic or non-traumatic background warrants suspicion for spinal cord injuries.[1] Patients suspected of having spinal cord injuries such as conus-cauda lesions may first be evaluated with a neurologic exam to test for abnormalities in sensory function, reflexes and movement.[21][22]

Diagnostic methods

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CT scan of the lumbar spine depicting a spinal disc herniation

MRI scans (magnetic resonance imaging scans) are the standard protocol for diagnostic testing of patients with suspected conus-cauda syndrome.[5] MRIs can detect the compression of both CM and CE structures, conferring a deeper understanding of the root cause of the disease.[23] The scans may reveal the severity of disc herniation, ligamentous damage and presence of intradural tumors– common causes of conus-cauda lesions.[6] This imaging technique is less invasive and more sensitive to detecting changes in the spinal nerves and the presence of a hemorrhage.[6][24] However, a majority of patients presenting with symptoms of conus-cauda syndrome appear scan-negative for compression.[25][26]

CT scans (computerised tomography scans) provide a detailed assessment of the bone anatomy and any occlusions of the spinal canal, which could be compressing the nerves of the CE or CM.[6][27][28] CT scans are best suited for assessing the damage caused by bone fragments from burst fractures and are commonly used as an imaging technique secondary to MRIs.[28]

Urinary tract ultrasound scan of an undiseased bladder

X-ray or projectional radiography of the lumbosacral spine allows for the visualisation of spinal alignment and detection of any traumatic disruptions along the bones and ligaments of the spinal column.[6] Spine radiography also enables medical professionals to check for erosions of the spine caused by tumors, infectious diseases and bone degenerative disorders.[5][29]

Urinary tract ultrasound is also routinely used to measure post-void residual volume (PVR) in the diagnosis of conus-cauda syndrome.[25][30] PVR shows the volume of urine left in the bladder after voluntary urination.[30] The measurement of PVR is used in clinical assessment for urinary incontinence in conus-cauda syndrome as it indicates a patient’s bladder functionality.[31][32] The PVR of a patient is taken using devices such as urinary catheters and bladder scanners with reference to the American Urological Association Symptom score.[30]

Classification

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Spinal cord impairments such as conus-cauda lesions are classified using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) or the American Spinal Cord Injury Association (ASIA) impairment scale. The impairment scale comprises of motor and sensory examinations to assess the neurological levels of the spinal injury.[2][33]

The scale aids medical professionals in diagnosis by defining the level and degree of conus-cauda lesions and categorising the injuries. A "complete" spinal cord injury is defined as a total loss of sensory and motor function below the injured spinal region.[34] In an “incomplete” lesion, partial sensation and movement are preserved below the level of injury, notably in areas correlated to the S4 and S5 nerves.[34][35]

Neurological levels of spinal cord injury scale[5][33]
Score/Severity Description of injury
A Complete lesion; absence of sensory and motor function in the sacral segments of the spine at S4-S5 levels.
B Sensory incomplete/incomplete lesion; sensory function remains intact below the neurological level in the sacral segments of the spine at S4-S5 levels. But motor function is absent.
C Motor incomplete/incomplete lesion; motor function remains intact below the neurological level with over 50% of key muscles capable of visible muscle contraction, active movement and perform a full range of motion (neglecting the presence of gravity).
D Motor incomplete/incomplete lesion; motor function remains intact below the neurological level with over 50% of key muscles capable of visible muscle contraction, active movement and perform a full range of motion against gravity and full resistance.
E Normal; sensory and motor functions are performing normally.

Treatment

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Laminectomy; a surgical decompression method for the removal of the lamina from the vertebrae
Discectomy; a surgical decompression method for the removal of the herniated disc

The compressed nerves in the lumbar spine, giving rise to neurological deficit symptoms of the conus-cauda syndrome, require urgent surgical decompression by removing the pressure on the CM and CE.[1][8]

Laminectomy

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The most commonly used procedure to treat compression of CE is a full laminectomy.[7][8][36] Laminectomy is a surgical method that involves partial or total removal of the posterior portion of the vertebrae (lamina), which relieves physical pressure on the nerves.[7][37] An open laminectomy requires a larger incision, providing a superior view of the thecal sac as well as the option to extract disc fragments from either side of a disc herniation.[36][38] This surgical procedure could also be followed by an instrumented spinal fusion, where instruments such as plates and screws are fixed onto the spinal column to enhance spinal stability, as removing the roof of the vertebrae may lead to iatrogenic instability.[36][37]

Discectomy

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Another recommended surgical intervention is a minimally invasive discectomy (MID) or microdiscectomy, a procedure done as a stand-alone or in conjunction with a laminectomy.[7][36] A discectomy involves the removal of herniated disc material that impinges on the lumbar spinal nerves.[7] MID is performed with a small incision, minimising tissue trauma and the risk of post-operation complications.[36] These surgical procedures have resulted in enhanced neurological recovery, such as regaining bladder continence and muscle function, as well as relieving back and radicular pain.[36][39]

Post-operative care

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Patients would undergo post-operative rehabilitation including physiotherapy and exercise programmes (e.g., weight lifting and mobilisation exercises) to facilitate recovery from such spinal injuries.[40] The programmes typically lasts six to eight weeks,[41] proven to be effective for improved mobility, quality of life and prevention of permanent disability.[41][42]

The quality of recovery of conus-cauda syndromes from surgical decompression depends on whether the surgery can successfully relieve the mechanical compression on the nerve roots and restore the blood supply to the spinal cord to prevent ischemic damage.[10]

Prognosis

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The prognosis of CES and CMS is heavily influenced by several factors, such as the level of injury and the timing of surgical intervention.[32][43] Sustaining a complete or incomplete lesion of the CM and CE has been shown to have drastically different outcomes,[44] as patients diagnosed with incomplete conus-cauda injury have a better prognosis and a higher chance of enhanced neurological recovery after surgical intervention in comparison to patients presenting with complete lesions.[8][43][44] Early intervention by decompression of the CE and CM nerves leads to a better prognosis, particularly within the 48-hour window upon presentation of symptoms.[1]

Most patients would regain urological function and see improvements in radicular pain symptoms after surgical intervention.[43][44] In contrast, motor and sensory loss are only partially restored amongst these patients, with occasional outcomes of chronic back pain.[45]

Approximately one-fifth of patients treated for CES may present with suboptimal outcomes following surgery,[44] which requires them to undergo prolonged treatment. Such outcomes include sexual dysfunction, catheterisation issues and psychosocial problems. CM lesions are also more susceptible to unexpected outcomes following surgery.[46]

Epidemiology

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Conus-cauda syndrome is a rare classification of spinal cord syndromes that could be induced traumatically or non-traumatically, with an incidence of 1 in every 100,000 people every year.[1][5] Conus-cauda syndrome is not age or sex specific, however, it is more frequently seen in young male adults, as it is suspected that this specific demographic is more prone to participating in activities that may cause injuries.[1]

References

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  1. ^ a b c d e f g h i Rider, Loana S.; Marra, Erin M. (2025), "Cauda Equina and Conus Medullaris Syndromes", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30725885, retrieved 2025-04-03
  2. ^ a b c d Ko, Hyun-Yoon (2023), "Understanding Cauda Equina and Conus Medullaris Injuries", A Practical Guide to Care of Spinal Cord Injuries, Singapore: Springer Nature Singapore, pp. 367–379, doi:10.1007/978-981-99-4542-9_19, ISBN 978-981-99-4541-2, retrieved 2025-04-02
  3. ^ a b Stienen, Martin Nikolaus; Surbeck, Werner; Tröhler, Ulrich; Hildebrandt, Gerhard (2013-12-01). "Little-known Swiss contributions to the description, diagnosis, and surgery of lumbar disc disease before the Mixter and Barr era: Historical vignette". Journal of Neurosurgery: Spine. 19 (6): 767–773. doi:10.3171/2013.8.SPINE121008. PMID 24074509.
  4. ^ a b c Heary, Robert F.; Kumar, Sanjeev (October 2007). "Decision-making in burst fractures of the thoracolumbar and lumbar spine". Indian Journal of Orthopaedics. 41 (4): 268–276. doi:10.4103/0019-5413.36986. ISSN 0019-5413. PMC 2989512. PMID 21139777.
  5. ^ a b c d e f g h Dawodu, Segun (2013). "Cauda Equina and Conus Medullaris Syndromes". Medscape Journal of Medicine – via ResearchGate.
  6. ^ a b c d e f g h Harrop, James S.; Hunt, Gabriel E.; Vaccaro, Alexander R. (2004-06-01). "Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles". Neurosurgical Focus. 16 (6): 1–23. doi:10.3171/foc.2004.16.6.4. ISSN 1092-0684. PMID 15202874.
  7. ^ a b c d e Yankang, Liu; Leiming, Zhang; Lewandrowski, Kai-Uwe; Xiangyu, Tang; Zexing, Zhu; Jianbiao, Xu; Lin, Zhang; Heng, Yuan; Xifeng, Zhang (February 2021). "Full Endoscopic Lumbar Discectomy Versus Laminectomy for Cauda Equina Syndrome". International Journal of Spine Surgery. 15 (1): 105–112. doi:10.14444/8014. ISSN 2211-4599. PMC 7931698. PMID 33900963.
  8. ^ a b c d Gleave, J. R. W.; and MacFarlane, R. (2002-01-01). "Cauda equina syndrome: what is the relationship between timing of surgery and outcome?". British Journal of Neurosurgery. 16 (4): 325–328. doi:10.1080/0268869021000032887. ISSN 0268-8697. PMID 12389883.
  9. ^ Wood, Kirkham B.; Li, Weishi; Lebl, Darren S.; Ploumis, Avraam (2014-01-01). "Management of thoracolumbar spine fractures". The Spine Journal. 14 (1): 145–164. doi:10.1016/j.spinee.2012.10.041. ISSN 1529-9430. PMID 24332321.
  10. ^ a b c d Burton, Matthew R.; De Jesus, Orlando; Mesfin, Fassil B. (2025), "Conus and Cauda Equina Tumors", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28722908, retrieved 2025-04-03
  11. ^ a b Alexander, Christopher E.; Weisbrod, Luke J.; Varacallo, Matthew A. (2025), "Lumbosacral Radiculopathy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28613587, retrieved 2025-04-03
  12. ^ a b Ottenhausen, Malte; Ntoulias, Georgios; Bodhinayake, Imithri; Ruppert, Finn-Hannes; Schreiber, Stefan; Förschler, Annette; Boockvar, John A.; Jödicke, Andreas (2019-06-01). "Intradural spinal tumors in adults—update on management and outcome". Neurosurgical Review. 42 (2): 371–388. doi:10.1007/s10143-018-0957-x. ISSN 1437-2320. PMID 29455369.
  13. ^ Wein, Sara; Campos, Arlene; Saber, Mohamed (2012-10-05), "Neoplasms of the cauda equina (differential)", Radiopaedia.org, doi:10.53347/rID-19697, archived from the original on 2024-05-01, retrieved 2025-04-03
  14. ^ a b c Dydyk, Alexander M.; Ngnitewe Massa, Ruben; Mesfin, Fassil B. (2025), "Disc Herniation", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28722852, retrieved 2025-04-02
  15. ^ Alonso, F.; Hart, D. J. (2014-01-01), "Intervertebral Disk", in Aminoff, Michael J.; Daroff, Robert B. (eds.), Encyclopedia of the Neurological Sciences (Second Edition), Oxford: Academic Press, pp. 724–729, ISBN 978-0-12-385158-1, retrieved 2025-04-03
  16. ^ a b Castro, A. L.; Ribeiro-Machado, C.; Oliveira, C. M.; Teixeira, G. Q.; Neidlinger-Wilke, C.; Pereira, P.; Vaz, R.; Barbosa, M. A.; Gonçalves, R. M. (2022-01-17). "Fibrotic alterations in human annulus fibrosus correlate with progression of intervertebral disc herniation". Arthritis Research & Therapy. 24 (1): 25. doi:10.1186/s13075-021-02690-w. ISSN 1478-6362. PMC 8762926. PMID 35039075.
  17. ^ a b Kobayashi, Shigeru (2014-04-18). "Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis". World Journal of Orthopedics. 5 (2): 134–145. doi:10.5312/wjo.v5.i2.134. ISSN 2218-5836. PMC 4017306. PMID 24829876.
  18. ^ Raja, Avais; Hoang, Stanley; Patel, Parini; Mesfin, Fassil B. (2025), "Spinal Stenosis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28723018, retrieved 2025-04-03
  19. ^ Storm, Phillip B.; Chou, Dean; Tamargo, Rafael J. (August 2002). "Lumbar spinal stenosis, cauda equina syndrome, and multiple lumbosacral radiculopathies". Physical Medicine and Rehabilitation Clinics of North America. 13 (3): 713–733, ix. doi:10.1016/s1047-9651(02)00013-x. ISSN 1047-9651. PMID 12380555.
  20. ^ Battié, Michele C.; Ortega-Alonso, Alfredo; Niemelainen, Riikka; Gill, Kevin; Levalahti, Esko; Videman, Tapio; Kaprio, Jaakko (December 2014). "Lumbar spinal stenosis is a highly genetic condition partly mediated by disc degeneration". Arthritis & Rheumatology (Hoboken, N.J.). 66 (12): 3505–3510. doi:10.1002/art.38823. ISSN 2326-5205. PMC 4308556. PMID 25155712.
  21. ^ "How is SCI diagnosed? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development". www.nichd.nih.gov. 2022-01-25. Retrieved 2025-04-02.
  22. ^ "Spinal cord injury - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2025-03-29.
  23. ^ "Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning?". Read by QxMD. Retrieved 2025-04-03.
  24. ^ Schaefer, D. M.; Flanders, A.; Northrup, B. E.; Doan, H. T.; Osterholm, J. L. (October 1989). "Magnetic resonance imaging of acute cervical spine trauma. Correlation with severity of neurologic injury". Spine. 14 (10): 1090–1095. doi:10.1097/00007632-198910000-00011. ISSN 0362-2436. PMID 2588058.
  25. ^ a b Vaishya, Sandeep; Pojskic, Mirza; Bedi, Manbachan Singh; Oertel, Joachim; Sippl, Christoph; Robertson, Scott; Zygourakis, Corinna (2024-04-01). "Cauda equina, conus medullaris and syndromes mimicking sciatic pain: WFNS spine committee recommendations". World Neurosurgery: X. 22: 100274. doi:10.1016/j.wnsx.2024.100274. ISSN 2590-1397. PMC 10943478. PMID 38496349.
  26. ^ Hoeritzauer, Ingrid; Carson, Alan; Statham, Patrick; Panicker, Jalesh N.; Granitsiotis, Voula; Eugenicos, Maria; Summers, David; Demetriades, Andreas K.; Stone, Jon (2021-01-19). "Scan-Negative Cauda Equina Syndrome". Neurology. 96 (3): e433 – e447. doi:10.1212/WNL.0000000000011154. PMID 33177221.
  27. ^ Robinson, Dale L.; Tse, Kwong Ming; Franklyn, Melanie; Ackland, David C.; Richardson, Martin D.; Lee, Peter Vee Sin (2020-10-01). "Occlusion of the lumbar spine canal during high-rate axial compression". The Spine Journal. 20 (10): 1692–1704. doi:10.1016/j.spinee.2020.05.095. hdl:11343/249515. ISSN 1529-9430. PMID 32442519.
  28. ^ a b Peacock, J. G.; Timpone, V. M. (February 2017). "Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome". AJNR. American Journal of Neuroradiology. 38 (2): 391–397. doi:10.3174/ajnr.A4974. ISSN 1936-959X. PMC 7963836. PMID 27789449.
  29. ^ Shtaya, Anan; Hettige, Samantha (February 2019). "Disco vertebral osteomyelitis causing intradural spinal abscess with cauda equina compression". British Journal of Neurosurgery. 33 (1): 104–106. doi:10.1080/02688697.2017.1297769. ISSN 1360-046X. PMID 28637119.
  30. ^ a b c Ballstaedt, Levi; Leslie, Stephen W.; Woodbury, Blair (2025), "Bladder Post Void Residual Volume", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30969661, retrieved 2025-04-03
  31. ^ "Post-void bladder scanning in acute cauda equina syndrome". Health Research Authority. Retrieved 2025-04-03.
  32. ^ a b Katzouraki, Galateia; Zubairi, Akbar Jaleel; Hershkovich, Oded; Grevitt, Michael P. (June 2020). "A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome". The Bone & Joint Journal. 102-B (6): 677–682. doi:10.1302/0301-620X.102B6.BJJ-2020-0195.R1. ISSN 2049-4408. PMID 32475252.
  33. ^ a b "International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)". Physiopedia. Retrieved 2025-04-03.
  34. ^ a b "Complete vs incomplete spinal cord injury: What to know". www.medicalnewstoday.com. 2020-05-05. Retrieved 2025-04-03.
  35. ^ Klebine, Phil. "What is an "incomplete" spinal cord injury? - Spinal Cord Injury Model System". www.uab.edu. Retrieved 2025-04-03.
  36. ^ a b c d e f Khashan, Morsi; Ofir, Dror; Grundshtein, Alon; Kuzmenko, Boris; Salame, Khalil; Niry, Dana; Hochberg, Uri; Lidar, Zvi; Regev, Gilad J. (2022). "Minimally invasive discectomy versus open laminectomy and discectomy for the treatment of cauda equina syndrome: A preliminary study and case series". Frontiers in Surgery. 9: 1031919. doi:10.3389/fsurg.2022.1031919. ISSN 2296-875X. PMC 9597079. PMID 36311945.
  37. ^ a b "Laminectomy". Archived from the original on 2025-01-24. Retrieved 2025-04-03.
  38. ^ "Posterior Decompression and Instrumented Fusion » Hamilton Orthopaedics, Spine & Sports Medicine". Hamilton Orthopaedics, Spine & Sports Medicine. Retrieved 2025-04-03.
  39. ^ Olivero, William C.; Wang, Huan; Hanigan, William C.; Henderson, John P.; Tracy, Patrick T.; Elwood, Patrick W.; Lister, J. Richard; Lyle, Lynne (May 2009). "Cauda Equina Syndrome (CES) From Lumbar Disc Herniations". Clinical Spine Surgery. 22 (3): 202–206. doi:10.1097/BSD.0b013e31817baad8. ISSN 2380-0186. PMID 19412023.
  40. ^ Aherrao, Samruddhi; Tikhile, Priya; Phansopkar, Pratik; Ambade, Ratnakar (September 2024). "Clinical Presentation and Physiotherapy Rehabilitation of Cauda Equina Syndrome with Urinary Incontinence: A Case Report". Cureus. 16 (9): e70236. doi:10.7759/cureus.70236. ISSN 2168-8184. PMC 11512668. PMID 39463676.
  41. ^ a b Oosterhuis, Teddy; Costa, Leonardo O. P.; Maher, Christopher G.; de Vet, Henrica C. W.; van Tulder, Maurits W.; Ostelo, Raymond W. J. G. (2014-03-14). "Rehabilitation after lumbar disc surgery". The Cochrane Database of Systematic Reviews. 2014 (3): CD003007. doi:10.1002/14651858.CD003007.pub3. ISSN 1469-493X. PMC 7138272. PMID 24627325.
  42. ^ Aherrao, Samruddhi; Tikhile, Priya; Phansopkar, Pratik; Ambade, Ratnakar (September 2024). "Clinical Presentation and Physiotherapy Rehabilitation of Cauda Equina Syndrome with Urinary Incontinence: A Case Report". Cureus. 16 (9): e70236. doi:10.7759/cureus.70236. ISSN 2168-8184. PMC 11512668. PMID 39463676.
  43. ^ a b c Kuris, Eren O.; McDonald, Christopher L.; Palumbo, Mark A.; Daniels, Alan H. (2021-12-01). "Evaluation and Management of Cauda Equina Syndrome". The American Journal of Medicine. 134 (12): 1483–1489. doi:10.1016/j.amjmed.2021.07.021. ISSN 0002-9343. PMID 34473966.
  44. ^ a b c d Gardner, Alan; Gardner, Edward; Morley, Tim (May 2011). "Cauda equina syndrome: a review of the current clinical and medico-legal position". European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 20 (5): 690–697. doi:10.1007/s00586-010-1668-3. ISSN 1432-0932. PMC 3082683. PMID 21193933.
  45. ^ Gleave, J. R.; MacFarlane, R. (1990). "Prognosis for recovery of bladder function following lumbar central disc prolapse". British Journal of Neurosurgery. 4 (3): 205–209. doi:10.3109/02688699008992725. ISSN 0268-8697. PMID 2397046.
  46. ^ Kostuik, J. P.; Harrington, I.; Alexander, D.; Rand, W.; Evans, D. (March 1986). "Cauda equina syndrome and lumbar disc herniation". The Journal of Bone and Joint Surgery. American Volume. 68 (3): 386–391. doi:10.2106/00004623-198668030-00011. ISSN 0021-9355. PMID 2936744.
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