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Spinal CordAnatomical and Physiological Features
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
It is located within the vertebral canal which provides structural protection and encloses the central canal of the spinal cord which contains cerebrospinal fluid. It is held in place by spinal roots, the denticulate ligaments and strands of pia mater. The spinal cord extends from the foramen magnum to the level of the L2 vertebra. Caudally, the spinal cord tapers to form the conus medullaris. Beyond the L2 vertebra, the spinal canal is filled with spinal roots descending caudally to exit from their intervertebral foramina. In the caudal canal at the sacral region, the spinal roots fan out to form the cauda equina.
Life Care Planning for Spinal Cord Injury
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
David J. Altman, Dan M. Bagwell
The human spinal cord is divided into 31 segments, and each segment projects a pair of mixed sensory and motor nerves, which combine before passing through spaces (foramina) between the vertebrae. The spinal cord generally terminates at the level of the first lumbar vertebra (L1), below which nerve roots within the vertebral column are referred to as the cauda equina (so named because the elongated nerve roots have the appearance of a horse's tail). The terminal spinal cord is referred to as the conus medullaris.
Clinical Management of Spasticity and Contractures in Spinal Cord Injury
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
Conus medullaris syndromes amount to 1.7% and posterior cord syndrome to less than 1% in the analysis of McKinley and coworkers [43]. Data on these groups are sparse. In general, spinal syndromes tend to need shorter rehabilitation length of stay, indicating that sufficient functional outcome is reached after shorter duration of rehabilitation, which is likely secondary to an in-complete pattern of lesion and high proportion of preserved spinal nerve fibres [43]. Spasticity usually only occurs in the plantar-flexors and digital muscles where there is an epi-conus lesion leaving intact ventral horn motoneuron cells that are disconnected from supraspinal input.
Fetal Tethered Spinal Cord: Diagnostic Features and Its Association with Congenital Anomalies
Published in Fetal and Pediatric Pathology, 2023
Xiaomei Yang, Shiyu Sun, Yizheng Ji, Yasong Xu, Li Sun, Qichang Wu
A PHILIPS iu22 and Volusson E8 color Doppler ultrasound with 2 D probe (1-4 MHz), high-frequency probe (5-12 MHz), 9 L probe, 3 D volume probe (4-8 MHz), and 6-D probe were used for a prenatal ultrasound examination. The examination included fetal growth, measurement of development indicators, amniotic fluid, and placenta, and scanning of fetal structural malformations. Examination of the fetal spinal and conus medullaris position and spinal sagittal plane was conducted for the observation of the physiological curvature, vertebral body and vertebral arch arrangement, ossification center, and the position of the conus medullaris. The conus medullaris is identified as a hypoechoic dark triangular structure which is surrounded by two echogenic lines at the inferior tip of the spinal cord [6]. Conus medullaris below L4 level after 21 weeks gestational age can be diagnosed as fetal tethered cord [2]. The location and level of the vertebrae was determined in sagittal and coronal longitudinal sections. The ribs and the lumbosacral junction were used as a reference. The position of T12 was determined based on the location of the 12th lower rib [3]. The conus medullaris level was determined by counting the lumbar vertebrae starting from T12 downwards. Additional verification was performed by counting the vertebra upwards starting at the lumbosacral junction [8]. A high-frequency probe was used in case of suspected low-lying conus medullaris to locate it precisely. 3 D volume data were used for further analysis.
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
A 61-year-old ambulatory female with neurogenic bladder related to conus medullaris injury was unable to self-catheterize due to morbid obesity and wished to avoid chronic indwelling catheterization. This patient was treated with an ileovesicostomy and pubovaginal sling due to stress incontinence at a different institution. Baseline urodynamics prior to ileovesicostomy are not available. Three years following this surgery, after work with a dietician and physical trainer, she was able to achieve a forty-pound weight loss through a structured program. At this point, she was motivated and physically able to begin intermittent catheterization. Video urodynamic evaluation prior to undiversion showed a maximum cystometric capacity of 171 mL with a stomal leak point pressure of 8 cm H2O.
Effect of untethering on occult tethered cord syndrome: a systematic review
Published in British Journal of Neurosurgery, 2022
Hamid Rezaee, Ehsan Keykhosravi
Some studies indicated the clinical benefits of surgical release in occult tight filum syndrome;2,3,8 while critics emphasize the acquisition of adequate data on the surgical release in such cases due to the unknown natural history of occult tight filum syndrome.38 The possible benefits of surgery for patients with occult tight filum syndrome are unknown. Moreover, there are different views about the expected spinal level of the normal conus medullaris.