DOCSLIB.ORG

I the Surg Cal Technologist

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
I the Surg Cal Technologist 14 The Surgi cal Technologist OCTOBER 2005 Cauda Equina Lipoma Resection with Spinal Cord Untethering in an Adult JEFFR EY J CORTESE, CST, BHSA ormally the spinal cord is a freely Spi nal cord anatomy moving structure within the spi- The spinal cord is a cylindrical bundle of nerve nal canal. The term “tethered spi- pathways that is 42 to 45 cm long and 2.5 cm Nnal cord” describes a condition in wide in the normal adult. Its rostral (cranial) end which the spinal cord is abnormally fastened is continuous with the brain stem, whereas the to an immovable structure, such as a lipoma, distal end forms a conical tapering, the conus vertebra, dura or skin. Although often initially medullaris. This is usually located at the border asymptomatic, any lesion that tethers the spi- of the first lumbar vertebrae. On occasion, it may nal cord puts the individual at risk of eventual reach only to the body of T12 or extend to the L2 neurological dysfunction. This dysfunction may level in the adult. From the conus medullaris, the occur during periods of axial growth in children lumbar and sacral nerve roots descend in a bun- or during periods of adipose deposition, which dle known as the cauda equina. The most termi- in the case of tethering may cause lipomatous nal portion of the spinal cord is the filum ter- structures to enlarge. Although the signs and minale. This connective tissue filament extends symptoms may include pain, most often they from the tip of the conus medullaris and attaches include loss of control of bowel or bladder, loss to the first segment of the coccyx (Figure 1). At of sensation in the feet, or motor dysfunction in birth, the conus medullaris is located near the L3 the sacral and lower lumbar segments. Surgical vertebrae; in the adult, it sits between the L1 and intervention of any of the lesions is directed at L2 vertebrae and occupies only the upper two- release of the tethering. One such case is pre- thirds of the vertebral canal. sented in this article. OCTOBER 2005 The Surgical Technol og i st 15 262 OCTOBER 2005 1 CE CREDIT Thickened filum terminale The most elementary form of tethering of the spinal cord occurs when the filum terminale is excessively thickened.2 In these cases, the filum terminale is often infiltrated with fatty tis- Conus medull ar is sue. Normally the filum is a fibrous structure that is a continuation of the arachnoid, which becomes the conus medullaris. A diameter greater than 2 mm, excluding fatty elements, is considered abnormal.5 Cauda equi na Lipoma Even though lumbosacral lipomas account for 29% of occult spinal dysraphisms, the embryo- logical development of spinal cord lipoma is not well understood.4 As in other forms of spinal dysraphism, normal elements are present, but are found in abnormal locations. One hypothe- sis is that disruption occurs during embryologi- cal development after the neural tube is formed, l i and subcutaneous fat is allowed to herniate into Thomson-De marLearn ng.©2004 the region of the neural tube. The lipomatous tis- sue fuses with the neural tissue, and the result- ing lipoma tethers the spinal cord. Tethering may result in neurological dysfunction. The frequency of fat infiltrate within the filum terminale has been identified by several authors Filum term i na le Coccyx as described by Marchiori and Firth. Emery and i l l f i l l i : iti Lendon found fat infiltrate in 4% to 6% of nor- Surg ca Techno ogy theSurgor ca Techno og stPos A Approach.Care ve mal adult subjects at postmortem. Modic et al i f Repr nted rom reported that 5% of the population exhibits this condition, and Guiffre identified the condition FIGURE 1: The 31 pairs of spinal nerves associated with in less than 2%.5 localized regions of the spinal cord produce Spinal cord external segmentation. On this basis, the spi- Symptoms anatomy. nal cord is considered to consist of 31 segments, The symptoms of adult tethered cord syndrome each of which is traversed by paired dorsal and (TCS) have been described previously by Chap- ventral root filaments (Figure 2). man.1 The predominant symptom of adult TCS is pain in the lower back and legs that is exacerbated Physiology by physical activity, particularly flexion and exten- Neurons, glia, and pia mater have their own elas- sion of the lumbar spine. In practically all-adult ticities and viscosities. The interlacing fibers of patients with TCS, lower back and leg pain is char- these tissues resist traction in the longitudinal acterized by the “three B signs.”These are: inability direction. If the traction is sufficient to stretch the to sit with their legs crossed (like Buddha);difficul- spinal cord, the viscoelasticity of each structure ty bending slightly over the sink for dishwashing, can provide some protection to neurons, and glia or the podium while preaching or teaching classes; cells and can help maintain neuronal function. 16 The Surgical Technologist OCTOBER 2005 and difficulty holding a baby or light object (5 lb or rofibromatosis, meningiomas, dermoid or less) at waist level while standing.1 epidermoid tumors Neurologic signs are motor and sensory defi- ● polyneuropathy or isolated peripheral neu- cits in the lower extremities, hyporeflexia of one ropathy or more tendons, increased urinary retention, ● incomplete forms of viral infection of the and musculoskeletal deformities. These include peripheral nerve scoliosis, hyperlordosis, and deformities of the ● Guillain-Barre lower extremities, such as atrophy, hammertoes, ● early stages of degenerating diseases and and high-arched feet.1 familial spastic paraplegia ● any disorder that causes incontinence Differential Diagnosis ● scoliosis of other etiology, such as tuberculo- Chapman described a vast array of differential sis of vertebrae and epidural space diagnoses and other possible causes of symp- ● congenital or acquired deformities due to toms that must be ruled out. These include:1 musculoligamentous or bony abnormalities, ● intrinsic spinal cord tumors (ependymomas, particularly those of the lumbar vertebrae astrocytomas) ● articular facets that cause referred pain in the ● multiple sclerosis groin, buttock, or greater trochanteric area ● lumbosacral syringomyelia ● skeletal system disorders, such as herniated ● arteriovenous malformations disc (Table 1), spondylosis, spondylolisthesis, ● poliomyelitis osteoarthritic spondylosis, and lumbar canal ● an epidural or intradural mass compressing stenosis the spinal cord, such as schwannomas, neu- FIGURE 2: Anterior view of the spinal Gray matter Filaments of dorsa l root cord. Whi te matter Anteri or med i an f i ssure l i Filaments o f ventral root Thomson-De marLearn ng.©2004 Ventral root Spi na l gangli on Spi na l nerve i l l f i l l i : iti Surg ca Techno ogy theSurgor ca Techno og stPos A Approach.Care ve i f Repr nted rom OCTOBER 2005 The Surgical Technologist 17 Imaging studies tion, the dura is found to be significantly thinner Imaging studies are useful for making the than in normal individuals. diagnosis of TCS: plain film studies, MRI, and myelography combined with CT and ultraso- Surgicaltechnique nography. Magnetic resonance imaging is cur- The surgical release of the tethered cord presents rently the most useful imaging study for patients a challenge to even the most experienced neuro- with TCS. There are several imaging clues used surgeon. Complete understanding of the anato- to help in the diagnosis: my involved and meticulous microsurgical tech- ● a thick filum terminale (>2 mm in diameter), niques are called upon. ● the presence of structures that suggest lack The goal of surgery is to release the tethered of viscoelasticity, such as fibroadipose tis- neural elements and reduce the bulk of the associ- sue in the filum terminale, and obliteration ated lipoma.1 This is more easily achieved in dor- of the subarachnoid space, which suggests sal or caudal lesions than with traditional ones. adhesion around the caudal spinal cord or With the latter, the presence of important neural nerve roots elements within the lipoma may make it impos- ● an elongated spinal cord sible to safely achieve complete untethering. ● a posteriorly displaced conus medullaris or The risk of neural injury is also affected by filum, directly attached to the posterior the- the confusing relationships between neural ele- cal lining at or near the L5 lamina ments, lipoma, and the extent of the dural defect in cases of extensive lateral asymmetry of the A capacious sacral subarachnoid space is found lesion with distortion of the conus. In such cases, in 50% of patients and is associated with posteri- there is little normal anatomy to provide the sur- or displacement of the filum.4 During the opera- geon with adequate intraoperative orientation. The surgeon must rely on neurophysiological FIGURE 3: monitoring techniques to avoid neural injury. Bipolar The patient is administered general anesthe- sia via endotracheal intubation, and a Foley cath- coagulation eter is placed. He or she is rotated into the prone of epidural position onto a well-padded operating table fitted with a Wilson frame or a similar type of device. vessels. Extreme attention is paid to the protection of all pressure points, as the surgery can last sev- eral hours. If needed, the head can be suspend- ed in a Mayfield or Sugita head-holding device to reduce the risk of direct intraocular pressure. The patient should receive 1 gram of Cefazolin, FIGURE 4: 2 grams of Solumedrol, 250 cc of 20% Mannitol, Durotomy and 40 mg of Lasix prior to the incision. Contin- uous monitoring of the somatosensory evoked started at potential (SSEP), as well as the motor evoked upper level potentials (MEP) should be employed during the resection of the lipoma due to dissection around of lipoma.
Load more

Recommended publications
  • Intramedullary Cystic Lesions Ofthe Conus Medullaris
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.31.2.106 on 1 April 1968. Downloaded from J. Neurol. Neurosurg. Psychiat., 1968, 31, 106-109 Intramedullary cystic lesions of the conus medullaris SAMI I. NASSAR, JAMES W. CORRELL, AND EDGAR M. HOUSEPIAN From the Department of Neurosurgery, College ofPhysicians and Surgeons, Columbia University, and the Neurological Institute of the Columbia-Presbyterian Medical Center, New York, U.S.A. Intramedullary cystic lesions of the conus medullaris of the aetiology, these cysts may simulate the clinical are rare. Although an extensive literature describes picture of syringomyelia. syringomyelia as being a frequent basis for cystic The cases of cysts of the conus medullaris re- cervico-thoracic lesions it is apparent that this ported here simulated the clinical picture of does not occur frequently in the lumbosacral region syringomyelia, tumour, or lumbar disc disease. (Kirgis and Echols, 1949; Netsky, 1953; Rand and The radiographic findings in each case were inter- Rand, 1960; Love and Olafson, 1966). Poser (1956), preted as indicating the presence ofan intramedullary in a review of 234 cases of syringomyelia, found tumour. The correct diagnosis was made in each that the cavity extended into the lumbosacral region case only at operation. in only 12-6% and in only five cases were the Protected by copyright. cavities restricted to the lumbosacral segments. Some authors (Thevenard, 1942; Andre, 1951) CASE REPORTS question the occurrence of syringomyelia in the lower spinal cord. Nevertheless a high incidence CASE 1 (F.T., NO. 179 16 92) A 22-year-old negro male of constitutional defects has been noted among was admitted complaining of weakness and pain in the syringomyelia patients and members of their legs for three years.
    [Show full text]
  • Split Spinal Cord Malformations in Children
    Split spinal cord malformations in children Yusuf Ersahin, M.D., Saffet Mutluer, M.D., Sevgül Kocaman, R.N., and Eren Demirtas, M.D. Division of Pediatric Neurosurgery, Department of Neurosurgery, and Department of Pathology, Ege University Faculty of Medicine, Izmir, Turkey The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients.
    [Show full text]
  • The Spinal Cord Is a Nerve Column That Passes Downward from Brain Into the Vertebral Canal
    The spinal cord is a nerve column that passes downward from brain into the vertebral canal. Recall that it is part of the CNS. Spinal nerves extend to/from the spinal cord and are part of the PNS. Length = about 17 inches Start = foramen magnum End = tapers to point (conus medullaris) st nd and terminates 1 –2 lumbar (L1-L2) vertebra Contains 31 segments à gives rise to 31 pairs of spinal nerves Note cervical and lumbar enlargements. cauda equina (“horse’s tail”) –collection of spinal nerves at inferior end of vertebral column (nerves coming off end of spinal cord) Meninges- cushion and protected by same 3 layers as brain. Extend past end of cord into vertebral canal à spinal tap because no cord A cross-section of the spinal cord resembles a butterfly with its wings outspread (gray matter) surrounded by white matter. GRAY MATTER or “butterfly” = bundles of cell bodies Posterior (dorsal) horns=association or interneurons (incoming somatosensory information) Lateral horns=autonomic neurons Anterior (ventral) horns=cell bodies of motor neurons Central canal-found within gray matter and filled with CSF White Matter: 3 Regions: Posterior (dorsal) white column or funiculi – contains only ASCENDING tracts à sensory only Lateral white column or funiculi – both ascending and descending tracts à sensory and motor Anterior (ventral) white column or funiculi – both ascending and descending tracts à sensory and motor All nerve tracts made of mylinated axons with same destination and function Associated Structures: Dorsal Roots = made
    [Show full text]
  • Spinal Cord Organization
    Lecture 4 Spinal Cord Organization The spinal cord . Afferent tract • connects with spinal nerves, through afferent BRAIN neuron & efferent axons in spinal roots; reflex receptor interneuron • communicates with the brain, by means of cell ascending and descending pathways that body form tracts in spinal white matter; and white matter muscle • gives rise to spinal reflexes, pre-determined gray matter Efferent neuron by interneuronal circuits. Spinal Cord Section Gross anatomy of the spinal cord: The spinal cord is a cylinder of CNS. The spinal cord exhibits subtle cervical and lumbar (lumbosacral) enlargements produced by extra neurons in segments that innervate limbs. The region of spinal cord caudal to the lumbar enlargement is conus medullaris. Caudal to this, a terminal filament of (nonfunctional) glial tissue extends into the tail. terminal filament lumbar enlargement conus medullaris cervical enlargement A spinal cord segment = a portion of spinal cord that spinal ganglion gives rise to a pair (right & left) of spinal nerves. Each spinal dorsal nerve is attached to the spinal cord by means of dorsal and spinal ventral roots composed of rootlets. Spinal segments, spinal root (rootlets) nerve roots, and spinal nerves are all identified numerically by th region, e.g., 6 cervical (C6) spinal segment. ventral Sacral and caudal spinal roots (surrounding the conus root medullaris and terminal filament and streaming caudally to (rootlets) reach corresponding intervertebral foramina) collectively constitute the cauda equina. Both the spinal cord (CNS) and spinal roots (PNS) are enveloped by meninges within the vertebral canal. Spinal nerves (which are formed in intervertebral foramina) are covered by connective tissue (epineurium, perineurium, & endoneurium) rather than meninges.
    [Show full text]
  • The Conus Medullaris: a Comprehensive Review
    THE SPINE SCHOLAR VOLUME 1, NUMBER 2, 2017 SEATTLE SCIENCE FOUNDATION REVIEW The Conus Medullaris: A Comprehensive Review Garrett Ng1, Anthony V. D’Antoni1, R. Shane Tubbs2 1 The CUNY School of Medicine, New York, NY 10031, USA 2 Department of Anatomical Sciences, St. George’s University, Grenada http:thespinescholar.com https:doi.org/10.26632/ss.10.2017.1.2 Key Words: anatomy, embryology, spinal cord, spine ABSTRACT The position of the conus medullaris within the vertebral canal varies. Given its role in sensory and motor function, a comprehensive understanding of the conus medullaris is necessary. PubMed and Google Scholar were used to review the literature on the conus medullaris. Pathological states and traumatic injury relating to the conus medullaris should be studied further. Spine Scholar 1:93-96, 2017 INTRODUCTION The conus medullaris (Fig. 1), also known as the medullary cone, is the distal end of the spinal cord. Its location varies, and in adults it tapers at approximately the first or second lumbar vertebra, ranging from T11 and L3 (Neel, 2016). Derived from the neural tube, the structure ascends in the vertebral canal because the growth rates of the spinal cord and the vertebral column differ during development (Salbacak et al., 2000). Figure 1: Schematic drawing of the conus medullaris and distal nerve roots in relation to the sacrum. The conus contains the sacral and coccygeal segments of the spinal cord (Taylor and Coolican, 1988). Criteria for recognizing the conus on computed tomography (CT) scans have been published by Grogan et al. (1984). The radiological properties of the structure have been studied through magnetic resonance imaging (MRI) (Saifuddin et al., 1997).
    [Show full text]
  • 227 INTRODUCTION: Diastematomyelia (Also Known As a Split Cord Malformation) Is a Rare Dysraphic Lesion of the Spinal Cord in W
    Role of rehabilitation a case of diastematomyelia Stanescu Ioana¹, Kallo Rita¹, Bulboaca Adriana³, Dogaru Gabriela ² 1.Rehabilitation Hospital Cluj, Neurology Department 2.Rehabilitation Hospital Cluj, Physical Medicine and Rehabilitation Department 3.University of Medecine and Pharmacy Cluj - Physiopathology Department Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2017.156 Vol.8, No.4, December 2017 p: 227 – 230 Corresponding author: Gabriela Dogaru, E-mail address: [email protected] Abstract Diastematomyelia (split cord malformation) is a rare dysraphic lesion in which a part of the spinal cord is split in the sagittal plane into two hemicords, a bony, cartilagenous or fibrous spur projecting through the dura mater is visible in 33% of cases. Vertebral anomalies (spina bifida) are common. It occurs usually between D9 and S1. Classificatin includes two types: type 1 with a duplicated dural sac, with common midline spur, usually symptomatic, and type 2 with a single dural sac and usually less symptomatic. The majority of patients are presenting with tethered cord syndrome (neurologic deficits in the lower limbs and perineum). MRI is the modality of choice for diagnosis. In symptomatic cases, surgical release of the cord and resection of spur with repair of dura are performed, with good results. We present a case of a pauci-symptomatic type 1 dyastematomyelia, manifested by intermittent and resistant lumbar pain, in which physiotherapy during rehabilitation program have shown to improve pain intensity. Key words: spinal cord malformation, dyastematomyelia, lumbar spine, INTRODUCTION: Diastematomyelia (also Intramedullary tumours associated with known as a split cord malformation) is a rare diastematomyelia have been rarely described and dysraphic lesion of the spinal cord in which a part associated conditions like a tethered cord, inclusion of the spinal cord is split in the sagittal plane into dermoid, lipoma, syringo-hydromyelia and Chiari two hemicords.
    [Show full text]
  • Spinal Cord, Spinal Nerves, and the Autonomic Nervous System
    ighapmLre21pg211_216 5/12/04 2:24 PM Page 211 impos03 302:bjighapmL:ighapmLrevshts:layouts: NAME ___________________________________ LAB TIME/DATE _______________________ REVIEW SHEET Spinal Cord, Spinal Nerves, exercise and the Autonomic Nervous System 21 Anatomy of the Spinal Cord 1. Match the descriptions given below to the proper anatomical term: Key: a. cauda equina b. conus medullaris c. filum terminale d. foramen magnum d 1. most superior boundary of the spinal cord c 2. meningeal extension beyond the spinal cord terminus b 3. spinal cord terminus a 4. collection of spinal nerves traveling in the vertebral canal below the terminus of the spinal cord 2. Match the key letters on the diagram with the following terms. m 1. anterior (ventral) hornn 6. dorsal root of spinal nervec 11. posterior (dorsal) horn k 2. arachnoid materj 7. dura materf 12. spinal nerve a 3. central canalo 8. gray commissure i 13. ventral ramus of spinal nerve h 4. dorsal ramus of spinald 9. lateral horne 14. ventral root of spinal nerve nerve g l 5. dorsal root ganglion 10. pia materb 15. white matter o a b n c m d e l f g k h j i Review Sheet 21 211 ighapmLre21pg211_216 5/12/04 2:24 PM Page 212 impos03 302:bjighapmL:ighapmLrevshts:layouts: 3. Choose the proper answer from the following key to respond to the descriptions relating to spinal cord anatomy. Key: a. afferent b. efferent c. both afferent and efferent d. association d 1. neuron type found in posterior hornb 4. fiber type in ventral root b 2.
    [Show full text]
  • Functional Anatomy of the Spinal Cord
    European Course in Neuroradiology Module 1 - Anatomy and Embryology 16th Cycle Module 1 Functional Anatomy of the Spinal Cord No disclosures Johan Van Goethem Spinal Cord Spinal nerves • vertebral canal • conus medullaris: adult Th12- L1 • ventral and dorsal roots • filum terminale • cauda equina • intervertebral foramen • gray matter: anterior and posterior horns • each pair (31) innervates a • white matter: anterior, lateral and posterior tracts body segment: dermatomes • cervical (8 p.), thoracic (12 p.), lumbar (5 p.), sacral (5 p.) and coccygeal (1 p.) Dorsal Root Ganglion Dorsal Root Ganglion Elliot S. Krames et al 2014 Tiantian Guo et al 2019 Spinal cord anatomy Spinal cord anatomy Source: Prometheus • 3 ascending pathways Anatomical atlas • 2 descending pathways Source: Wikipedia 40-year-old woman So what is this? • gradual and uniform onset of • Lichtheim's disease • diminished pressure, vibration and touch sense • Lou Gehrig's disease • tingling and numbness of legs, arms and trunk that progressively worsens • Lyme disease • pain and temperature sense are normal • Devic’s disease • motor function is preserved, but slight ataxia And the answer is ... Let’s go back ... • gradual and uniform onset of • Lichtheim's disease • diminished pressure, vibration and touch sense • Lou Gehrig's disease • tingling and numbness of legs, arms and trunk that progressively worsens • Lyme disease • pain and temperature sense are normal • Devic’s disease • motor function is preserved, but slight ataxia Spinothalamic tract Spinothalamic tract • 3
    [Show full text]
  • Definitions of Traumatic Conus Medullaris and Cauda
    Spinal Cord (2017) 55, 886–890 & 2017 International Spinal Cord Society All rights reserved 1362-4393/17 www.nature.com/sc ORIGINAL ARTICLE Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review E Brouwers1, H van de Meent2, A Curt3, B Starremans4, A Hosman5 and R Bartels1 Study design: A systematic review. Objectives: Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are well-known neurological entities. It is assumed that these syndromes are different regarding neurological and functional prognosis. However, literature concerning spinal trauma is ambiguous about the exact definition of the syndromes. Methods: A MEDLINE, EMBASE and Cochrane literature search was performed. We included original articles in which clinical descriptions of CMS and/or CES were mentioned in patients following trauma to the thoracolumbar spine. Results: Out of the 1046 articles, we identified 14 original articles concerning patients with a traumatic CMS and/or CES. Based on this review and anatomical data from cadaveric and radiological studies, CMS and CES could be more precisely defined. Conclusion: CMS may result from injury of vertebrae Th12–L2, and it involves damage to neural structures from spinal cord segment Th12 to nerve root S5. CES may result from an injury of vertebrae L3–L5, and it involves damage to nerve roots L3–S5. This differentiation between CMS and CES is necessary to examine the hypothesis that CES patients tend to have a better functional outcome. Spinal Cord (2017) 55, 886–890; doi:10.1038/sc.2017.54; published online 23 May 2017 INTRODUCTION described clinical symptoms that were caused by compression of the Traumatic injuries of the thoracolumbar spine can result in conus CE and named this as ‘cauda equina compression syndrome’.20 From medullaris syndrome (CMS) or cauda equina syndrome (CES).
    [Show full text]
  • Clinical Article Results of the Section of the Filum Terminale in 20 Patients with Syringomyelia, Scoliosis and Chiari Malformat
    Acta Neurochir (Wien) (2005) 147: 515–523 DOI 10.1007/s00701-005-0482-y Clinical Article Results of the section of the filum terminale in 20 patients with syringomyelia, scoliosis and Chiari malformation M. B. Royo-Salvador1, J. Sole´-Llenas2, J. M. Dome´nech3, and R. Gonza´lez-Adrio4 1 Barcelona Neurological Institute, Barcelona, Spain 2 Department of Neuroradiology, Universitat Autoonoma de Barcelona, Barcelona, Spain 3 Department of Anatomy, Universitat Autoonoma de Barcelona, Barcelona, Spain 4 FIATC Foundation, Barcelona, Spain Published online February 24, 2005 # Springer-Verlag 2005 Summary ing of a tight and thick filum. Jones and Love [14] used Background. Spinal cord traction caused by a tight filum terminale the term ‘tight filum terminale syndrome’ and reported may be considered a pathogenic mechanism involved in the develop- six patients with spina bifida occulta the symptoms of ment of syringomyelia, the Chiari malformation (type I) and scoliosis. which were attributed to an anchored conus medullaris. Section of the filum terminale is proposed as a useful surgical approach In all cases, symptomatic improvement was obtained in these conditions. Methods. Between April 1993 and July 2003, a total of 20 patients after intradural lumbosacral exploration and resection (8 men and 12 women) with a mean age of 33.5 years underwent section of the filum terminale. Hamilton [10] and Roth [25, of the filum terminale with or without opening of the dural sac through 26] established the hypothesis that stretching of the a standard sacrectomy. Eight patients suffered from scoliosis, 5 from syringomyelia, 2 from Chiari malformation and 5 with a combination of spinal cord was involved in the aetiopathogenesis these conditions.
    [Show full text]
  • The Spinal Cord and Spinal Nerves
    14 The Nervous System: The Spinal Cord and Spinal Nerves PowerPoint® Lecture Presentations prepared by Steven Bassett Southeast Community College Lincoln, Nebraska © 2012 Pearson Education, Inc. Introduction • The Central Nervous System (CNS) consists of: • The spinal cord • Integrates and processes information • Can function with the brain • Can function independently of the brain • The brain • Integrates and processes information • Can function with the spinal cord • Can function independently of the spinal cord © 2012 Pearson Education, Inc. Gross Anatomy of the Spinal Cord • Features of the Spinal Cord • 45 cm in length • Passes through the foramen magnum • Extends from the brain to L1 • Consists of: • Cervical region • Thoracic region • Lumbar region • Sacral region • Coccygeal region © 2012 Pearson Education, Inc. Gross Anatomy of the Spinal Cord • Features of the Spinal Cord • Consists of (continued): • Cervical enlargement • Lumbosacral enlargement • Conus medullaris • Cauda equina • Filum terminale: becomes a component of the coccygeal ligament • Posterior and anterior median sulci © 2012 Pearson Education, Inc. Figure 14.1a Gross Anatomy of the Spinal Cord C1 C2 Cervical spinal C3 nerves C4 C5 C 6 Cervical C 7 enlargement C8 T1 T2 T3 T4 T5 T6 T7 Thoracic T8 spinal Posterior nerves T9 median sulcus T10 Lumbosacral T11 enlargement T12 L Conus 1 medullaris L2 Lumbar L3 Inferior spinal tip of nerves spinal cord L4 Cauda equina L5 S1 Sacral spinal S nerves 2 S3 S4 S5 Coccygeal Filum terminale nerve (Co1) (in coccygeal ligament) Superficial anatomy and orientation of the adult spinal cord. The numbers to the left identify the spinal nerves and indicate where the nerve roots leave the vertebral canal.
    [Show full text]
  • Brain, Spinal Cord and Spinal Tracts Definitions to Bring Home
    Brain, spinal cord and spinal tracts Definitions to bring home Nerve Ganglion Neuron Nucleus Tract Collection neurons Collection of nerve A single cell Collection of Collection of axons that transmits cell bodies in the transmitting nerve cell bodies in traveling up or sensation or motor PNS, typically linked electrical impluses. the CNS, typically down the spinal impulses depending by synapses. linked by synapses. cord, depending on the function and Location: both on function destination. Location: PNS Location: CNS and destination. Location: PNS Location: CNS ANS Characteristic Sympathetic Parasympathetic Nuclei of CNIII, VII, IX, X Origin of Preganglionic Nerve Nuclei of Spinal Cord segs T1-T12, L1-L3 Spinal Cord S2-S4 Length of Preganglionic n. Axon Short Long Receptor type in ganglion Nicotinic Nicotinic Neurotransmitter in ganglion Acetylcholine Acetylcholine Length of Postganglionic nerve axon Long Short Effector Organs Smooth + cardiac muscle, glands Smooth + cardiac muscle, glands Neurotransmitter in effector organs Norepinephrine (ACh in glands) Acetylcholine Receptor types in effector organs A1, A2, B1, B2, B3 M1, M2, M3 BRAIN 1. CEREBRUM • Higher brain functions 2. CEREBELLUM • Little brain • Posture and balance • Coordinate movement 3. BRAIN STEM • Connects cerebrum/cerebellum and spinal cord • CN III – XII nuclei • 3 parts: • Midbrain / Mesencephalon • Pons • Medulla oblongata CEREBRUM • Left and right hemisphere • 4 lobes: • Frontal = motor + speech • Parietal = sensory (homunculus) • Temporal = memory + understanding • Occipital = vision SPINAL CORD • Signal to and from the brain • Grey matter = cell bodies + unmyelinated axons • White matter = myelinated axons • Central canal = CSF • Bell-Magendie Law • Ventral = motor • Ventral horn • Dorsal = sensory • Dorsal root ganglia Spinal cord terminations • Spinal cord: lower border of L1-L3 • Subarachnoid space (with CSF): lower border of S2 • Cauda equina: L3 (adult age) • Filum terminale: fibrous string 3 main functions of the spinal cord: 1.
    [Show full text]