Conus Medullaris Syndrome Following Traumatic Thoracolumbar Burst Fractures: Clinical Presentation, Surgical Management, and Early Outcomes in Three Cases.
R Ajay, B Vijay Anand, C Rishab et al.
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Case in brief
Three patients with traumatic thoracolumbar burst fractures had conus medullaris syndrome with differing neurological presentations. A 57-year-old man with an L1 fracture had bowel and bladder incontinence despite preserved leg power; a 25-year-old man with an L1 fracture and sacral involvement had impaired voiding and defecation with reduced S3–S5 sensation. A 62-year-old woman had a 2-month-old D12 nonunion, paraparesis, and multilevel disc protrusion. All underwent surgical decompression and stabilization and showed neurological improvement. One regained continence early; the other two had symptomatic improvement while continuing rehabilitation.
What made this case unusual
The presentations ranged from isolated sphincter dysfunction with preserved leg power to paraparesis, illustrating that conus injury may not present with prominent lower-limb weakness.
Diagnostic / clinical pearl
In thoracolumbar burst fractures, assess sacral sensation and sphincter function even when leg power is preserved; conus medullaris syndrome can be missed if examination focuses on limb strength.
Why it matters
Bladder and sphincter recovery was variable in these cases, despite neurological improvement after surgery, underscoring the uncertainty of functional recovery.