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Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. [2] Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. [1] Onset may be rapid or gradual. [1]
The cauda equina (from Latin tail of horse) is a bundle of spinal nerves and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth sacral nerve pairs, and the coccygeal nerve, all of which arise from the lumbar enlargement and the conus medullaris of the spinal cord.
The thecal sac or dural sac is the membranous sheath (theca) or tube of dura mater that surrounds the spinal cord and the cauda equina.The thecal sac contains the cerebrospinal fluid which provides nutrients and buoyancy to the spinal cord. [1]
It is indicated relatively early in the course of evaluation (<8 weeks) when the patient presents with relative indications like significant pain, neurological motor deficits, and cauda equina syndrome. Diffusion tensor imaging is a type of MRI sequence used for detecting microstructural changes in the nerve root.
This procedure is to look for the level of spinal cord disease such as lumbar nerve root compression, cauda equina syndrome, conus medullaris lesions, and spinal stenosis. This is done for those who are unwilling or unable to do MRI scan of the spine. Lumbar puncture is done before injected contrast into the thecal sac.
Dural ectasia is defined as a ballooning or outpouching of the dura with a dural volume greater than two standard deviations above the mean value in controls. [9] It is usually identified by MRI or CT Scan, [7] which can be used to distinguish it from tumors. [16]
Such severe spinal stenosis symptoms are virtually absent in lumbar stenosis, however, as the spinal cord terminates at the top end of the adult lumbar spine, with only nerve roots (cauda equina) continuing further down. [15] Cervical spinal stenosis is a condition involving narrowing of the spinal canal at the level of the neck.
The filum terminale is situated centrally [2] amid the spinal nerve roots of the cauda equina [3] [2] (but is not itself a part of the cauda equina [2]).. The inferior-most spinal nerve, the coccygeal nerve, leaves the spinal cord at the level of the conus medullaris via respective vertebrae through their intervertebral foramina, superior to the filum terminale.