Anatomical and Pathophysiological Features of Cauda Equina

Do-Yeon Kim; Kwang-Bok Lee

doi:10.4184/jkss.2013.20.4.210

Journal List > J Korean Soc Spine Surg > v.20(4) > 1076006

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Kim and Lee: Anatomical and Pathophysiological Features of Cauda Equina

Review Article

Journal of Korean Spine Surg 2013;20(4):210-214.

Published online: 21 December 2013

DOI: https://doi.org/10.4184/jkss.2013.20.4.210

Anatomical and Pathophysiological Features of Cauda Equina

Do-Yeon Kim, M.D., Kwang-Bok Lee, M.D.

Department of Orthopedic Surgery, Chonbuk National Univeristy School of Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea

Corresponding author: Kwang-Bok Lee, M.D. Department of Orthopaedic Surgery, Chonbuk National University School of Medicine, Chonbuk National University Hospital, 634-18 Keumam-dong Deokjin-gu, Jeonju-shi, Jeonbuk 561-712, Korea TEL: 82-63-250-2658, FAX: 82-63-271-6538 E-mail: osdr2815@naver.com

Received 21 December 2012 Revised 8 March 2013 Accepted 12 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Review of literature on anatomical and pathophysiological features of cauda equina.

Objectives

To look into the anatomical and pathophysiological features of cauda equina and support their basic knowledge of treating cauda equina syndrome.

Summary of Literature Review

Cauda equina has different anatomical and pathophysiological features to peripheral nerve.

Materials and Methods

Review of literature.

Results

When compressing to cauda equina, the pathophysiologic mechanism develop as follows; increasing the vascular permiablity of nerve root, intraneural edema, and subsequent blood and nutritional impairment. Nerve root injury develops through this pathophysiologic mechanism.

Conclusions

Cauda equina has an extensive ateriovenous anastomosis and guaze-like pia mater, which supply blood and neutrition to it. These anatomical features prevent it from complete cauda equina syndrome when compressing to it under arterial blood pressure.

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Keywords: Cauda equina, Anatomy, Pathophysiology

REFERENCES

1. Konno S, Olmarker K, Byrod G, Rydevik B, Kikuchi S. Intermittent cauda equina compression: an experimental study of the porcine cauda equina with analyses of nerve impulse conduction properties. Spine (Phila Pa 1976). 1995; 20:1223–6.

2. Konno S, Yabuki S, Sato K, Olmarker K, Kikuchi S. A model for acute, chronic and delayed graded compression of the dog cauda equina. Presentation of the gross, microscopic and vascular anatomy of the dog cauda equina and accuracy in pressure transmission of the compression model. Spine (Phila Pa 1976). 1996; 20:2758–64.

3. Olmarker K, Rydevik B. Single versus double level nerve root compression: an experimental study on the porcine cauda equina with analyses of nerve impulse conduction properties. Clin Orthop. 1992; 279:35–9.

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7. Olmarker K, Takahashi K, Rydevik B. Anatomy and compression-pathophysiology of the nerve roots of the lumbar spine. Anderson G.B.J., MacNeill T., editors(Eds.),. Spinal Stenosis. St. Louis: Mosby Year Book;1992. p. 77–90.

8. Orendacova J, Cızkova D, Kafka J, et al. Cauda equina syndrome. Progress in Neurobiology. 2011. 613–37.

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10. Pedowitz RA, Garfin SR, Massie JB, et al. Effects of magnitude and duration of compression on spinal nerve root conduction. Spine (Phila Pa 1976). 1992; 17:194–9.

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Fig. 1.

Intradural arrangement of cauda equina. The most caudal roots (black arrow) is located in central and posterior position, and the most cephalad roots (asterix) is located in lateral and anterior position. In addition, motor fiber is located in medial and anterior to sensory fiber (Photography by Shinich Kikuchi, MD, PhD).

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Fig. 2.

Photo showing the differences between spinal nerve root (asterix) and cauda equine (black arrows). Cauda equina has no connective tissue, adipose tissue, perineurium, epineurium, and endonurium (VR: ventral root, DR: dorsal root, DRG: dorsal root ganglion, Photography by Shinich Kikuchi, MD, PhD).

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Fig. 3.

Inter- and intrafascicular arteries showing compensating coils to allow interfascicular movement (1:Radicular artery, 2: interfascicular artery, 3: intrafascicular artery). Cited from Parke WW, Watanabe R, Spine (Phila Pa 1976). 1985;10:508-15.

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Fig. 4.

Graphic complilation showing the structure of a typical lumbosacral nerve root derived from data obtained by injection studies. 1. Fas-cicular pia; 2. Inter- and intrafascicular arteries 3. Longitudinal radicular artery; 4. Large radicular vein; 5. Arteriovenous anastomosis; 6. Collateral radicular artery; 7. Gauzelike pia-arachnoid that permits percolation of CSF to assist in metabolic support. Cited from The Spine Fifth Ed. Page 49 Figure 2-42.

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