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Moon, Baik, and Lee: The Usefulness of Lumbar Spine MRI for Cauda Equina Syndrome
Neuroradiology
Original Article

Journal of the Korean Society of Radiology 2011; 64(5): 423-428.

Published online: 31 May 2011

DOI: https://doi.org/10.3348/jksr.2011.64.5.423

The Usefulness of Lumbar Spine MRI for Cauda Equina Syndrome

Tae Yong Moon, M.D.1, Seung Kug Baik, M.D.1, In Sook Lee, M.D.2

1Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.

2Department of Radiology, Pusan National University Hospital, Medical Research Institute, Pusan National University Hospital, Busan, Korea.

Address reprint requests to: Tae Yong Moon, M.D., Department of Radiology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongnam 626-770, Korea. Tel. 82-55-360-1831, Fax. 82-55-360-1846, tymn@pusan.ac.kr

Received 10 January 2011       Accepted 1 March 2011

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

To understand the usefulness of the lumbar MRI studies to establish therapeutic plans for cauda equina syndrome (CES) including the management of rectal and bladder dysfunction symptoms.

Materials and Methods

We retrospectively reviewed the lumbar MRI studies of 10 patients with CES. Their diagnoses included four adhesive arachnoiditis of cauda equina (CE), three conus medullaris atrophies, three spinal canal stenoses, one tuberculous leptomeningitis, one metastatic tumor on the sacral canal, and one dural arteriovenous fistula with venous congestion of the conus medullaris.

Results

In 6 of the 10 total cases the symptoms of rectal and bladder dysfunction were resolved by decompression laminectomies (n=2), irradiation (n=1), glue embolization (n=1), anticholine and steroid infusion (n=1), and anti-tuberculous medication (n=1) within at least 5 days. The 4 other cases were settled by lumboperitoneal shunting and neural stem cell implants.

Conclusion

The study results indicate that lumbar MRI is the modality of choice in search for the causative lesion and to subsequently set up the best therapeutic plans for patients with CES.

Keywords: Cauda Equina, Polyradiculopathy, Magnetic Resonance Imaging, Spinal Stenosis, Motor Neuron Disease

Figures and Tables

Fig. 1

66-year-old male with metastatic tumor on the 2nd sacral spine complained of cauda equina syndrome. Sagittal contrast enhanced T1 weighted MR image reveals bony destruction of the 2nd sacral spine body (arrow).

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Fig. 2

31-year-old male with dural arteriovenous fistula at the level of the L2 spine. Sagittal contrast enhanced T1-weighted MR image reveals multifocal enhancing high signal area in the conus medullaris (white arrow) due to venous congestion and multifocal dark signal void area in the cauda equina (black arrow) due to rapid blood flow of arteriovenous fibula.

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Fig. 3

59-year-old male confirmed to tuberculous leptomeningitis with caudal equina syndrome including acontractile neurogenic bladder, constipation, and right lower leg pain. Sagittal (A) and axial (B) contrast enhanced T1-weighted MR images reveals ringlike peripheral enhancement lesions (arrows) in the conus medullaris.

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Fig. 4

63-year-old female with segmental cord atrophy at the level above the conus medullaris (CM). Sagittal T2-weighted MR image reveals abnormal slender portion (white arrows) at the cord above the CM consistent with cord atrophy required neural stem cell implant therapy.

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Table 1

Background Data of Ten Patients with Cauda Equina Syndrome

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Note.─ Symptoms*; A = low back pain, B = unilateral or bilateral sciatica, C = bilateral weakness of the lower extremities, D = saddle or perianal hypoesthesia or anesthesia, E = rectal and/or bladder sphincter dysfunction

Table 2

Lumbar MRI Findings and Therapeutic Plans in the Patients with Cauda Equina Syndrome

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Note.─ CM = conus medullaris, CE = cauda equina, DISH = diffuse idopathic skeletal hyperostosis

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