Christo Zhelyazkov, Atanas Davarski, Tanya Kitova, Ivo Kehayov, Borislav Kitov


Objective: To analyze and present cases of tandem compression of medulla spinalis and cauda equina.

Material and Methods: The subjects of observation were four patients with simultaneous compression of medulla spinalis and cauda equina, admitted to the Neurosurgery Clinic of the St George University Hospital, Plovdiv, Bulgaria during the period March 2012 March 2014. The average age of the patients was 60.5 years (4772). In one case, left-sided paramedian herniated discs were found at levels L12 and L45 combined with a concomitant stenosis, in another case right-sided paramedian herniated discs on the level of Th12 L1 and a degenerative stenosis at level of L34, in the third case pronounced degenerative compression at level Th78 and a central stenosis at level of L45, and in the last case degenerative stenosis at level L35 and spinal meningioma at level Th910.

Results: The clinical signs of the simultaneous compression of the spinal cord and cauda equina have been examined. These signs may mislead the physician in the diagnosis of the spinal lesion, thus, resulting in inappropriate surgical strategy.

Conclusion: The involvement of the spinal cord must be clinically confirmed to rule out lesions in the thoracic region. When the lumbar imaging examinations are inconclusive or cannot explain the clinical symptoms of a certain patient, it is advisable to perform a magnetic resonance imaging of the entire spine.

Key words: tandem compression, spinal tumor, thoracic stenosis, lumbar stenosis.

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Teng P, Papatheodorou C. Combined cervical andlumbar spondylosis. Arch Neurol.1964; 10: 298–307.

Hioki A, Miyamoto K, Hosoe H, Fukuta S, Shimizu K. Two-stage decompression for combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis of the thoracolumbar spine: a case report. Arch Orthop Trauma Surg. 2008; 128(9): 955–8.

Takeuchi A, Miyamoto K, Hosoe H, Shimizu K. Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery: report of three cases. J Neurosurg. 2004; 100 (1 Suppl Spine): 71–4.

Kim BS, Kim J, Koh HS, et al. Asymptomatic cervical or thoracic lesions in elderly patients who have undergone decompressive lumbar surgery for stenosis. Asian Spine J.2010; 4(2): 65–70.

Valls PL, Naul LG, Kanter SL. Paraplegia after a routine lumbar laminectomy: report of a rare complication and successful management. Neurosurgery.1990; 27(4): 638–40.

Ko SB, Lee SW, Shim JH. Paraplegia due to missed thoracic meningioma after laminotomy for lumbar spinal stenosis: report of two cases. Asian Spine J. 2011; 5(4): 253–7.

Fushimi K, Miyamoto K, Hioki A, Hosoe H, Takeuchi A, Shimizu K. Neurological deterioration due to missedthoracic spinal stenosis after decompressivelumbal surgery:A report of six cases of tandem thoracic and lumbar spinal stenosis. Bone Joint J.2013; 95–B(10): 1388–91.

Toribatake Y, Baba H, Kawahara N, Mizuno K, Tomita K.The epiconus syndrome presenting with radicular-type neurological features. Spinal Cord. 1997; 35(3): 163–70.

Lee S-Ho, Seokmin Choi S. L1-2 Disc Herniations: Clinical Characteristics and Surgical Results. J Korean Neurosurg Soc. 2005 (38): 196–201.

Wood KB, Garvey TA, Gundry C, Heithoff KB. Magnetic resonance imaging of thethoracic spine: evaluation of asymptomatic individuals. J Bone Joint Surg.1995; 77(11): 1631–8.

Barnett GH, Hardy RW Jr, Little JR, Bay JW, Sypert GW. Thoracic spinal canal stenosis. J Neurosurg.1987; 66(3): 338–44.

DOI: http://dx.doi.org/10.24125/sanamed.v10i1.19


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