What is Conus Medullaris Syndrome?

The conus medullaris — a Latin term that means “medullary cone” — is a cluster of spinal cord nerves with a tapered end. It is found near the first two lumbar vertebrae in the back (L1 and L2). The conus medullaris stops at the cauda equina, where nerves and nerve roots are no longer protected and the spinal cord terminates.

In turn, issues with the conus medullaris typically affect the cauda equina. Conus medullaris syndrome is a type of spinal cord damage caused by lumbar vertebrae trauma. 

This condition generally results from a spinal cord injury or loss of sensation below the injured area. While it shares similar symptoms with cauda equina syndrome, conus medullaris requires different treatment.

Now that you’re familiar with the conus medullaris definition, learn more about the condition that affects this area, including causes, symptoms, diagnostic methods and treatment options.

Causes of Conus Medullaris Syndrome

Conus medullaris syndrome isn’t necessarily a disease but more so a product of spinal trauma. A blow to the lower back is generally the culprit, but it can also stem from other spinal cord infections and diseases. Some common conus medullaris syndrome causes are:

• Spinal fractures: A spinal fracture occurs when your spine’s vertebrae collapse. It can result from falls, lifting heavy objects, sports injuries, automotive accidents or other trauma.
• Herniated discs: A herniated disc occurs when the rubbery spinal disc’s soft center pushes through a crack in the tough exterior casing.
• Tumors: Spinal tumors are abnormal masses of tissue in or around the spinal column. They can be cancerous or noncancerous. These growths can develop along the lumbar spinal canal and compress the conus medullaris.
• Trauma: Severe trauma to the lower back from a hard blow, car accident, gunshot wound or another incident can lead to conus medullaris syndrome.

Symptoms of Conus Medullaris Syndrome

People with conus medullaris syndrome usually experience abrupt symptoms on both sides of the body — unlike cauda equina, which develops over time and produces uneven symptoms on one side. Below are some common indicators of conus medullaris syndrome:

• Severe lower back pain
• Abnormal sensations in the back, like buzzing, numbness or tingling
• Weakness, tingling or numbness in the lower extremities
• Sexual dysfunction
• Bladder and bowel dysfunction

Conus Medullaris Syndrome Diagnosis

To diagnose conus medullaris syndrome, a medical professional will likely perform a magnetic resonance imaging (MRI) scan of your lower back and spine. The doctor will consider the type, cause and severity of your spinal injury when identifying this condition.

Treatments for Conus Medullaris Syndrome

Treatment can vary depending on the cause and extent of the spinal injury. For instance, radiation therapy may help if your symptoms arose from a cancerous tumor. If your symptoms resulted from a spinal infection — or the severity of your injury led to infection — your doctor might recommend intravenous (IV) or oral antibiotics.

Spinal decompression surgery usually helps treat this condition. Should a physical hindrance remain — like remnants of a bullet or tumor — a surgeon can remove these to restore spinal function. Physical therapy may also be necessary to regain function in your lower back and legs.

Below are two common treatment routes for conus medullaris syndrome.

1. Spinal Decompression Surgery

Surgical intervention is usually necessary to help decompress the conus medullaris, reduce pain and numbness in the lower extremities, and increase space in the spinal canal. It’s typically recommended when non-surgical treatments are unsuccessful. Different types of spinal decompression surgery include:

• Laminectomy: During a laminectomy, a surgeon removes a portion of the vertebrae compressing your nerves. They can either conduct an open surgery through one large cut or a minimally invasive procedure using several small incisions. This involves compact cameras and lights to see inside the body.
• Microdiscectomy: Also called spinal microdecompression surgery, a microdiscectomy is a minimally invasive spine procedure. It’s often used for patients with sciatica — irritation of the sciatic nerve felt in the lower back, buttocks or legs — or a herniated disc in the lumbar section of the spine. During a microdiscectomy, a surgeon uses muscle-sparing incisions to remove portions of the herniated disc that is compressing the spinal nerve and causing pain.

Following surgery, be sure to reduce strenuous activities like bending and twisting, lifting heavy items, yardwork, housework and intense exercise. 

Your doctor will clarify specific activities to limit and avoid during recovery. They can help you determine an appropriate time to resume regular activities. It’s also important to avoid prolonged sitting, as it can weaken your muscles and stunt the healing process. In most cases, pain and discomfort will subside within four to six weeks after spinal decompression surgery.

If you’re returning to a job involving long periods of sitting, continue to care for your back and support spine health. Good posture and an ergonomic chair can help you maintain a comfortable work environment and avoid putting stress on your surgical site.

2. Physical Therapy

Your doctor will likely recommend physical therapy sessions to relieve your conus medullaris symptoms, improve mobility and strengthen your muscles. Physical therapy is also an important part of post-surgery recovery. A physical therapist can show you different range-of-motion and strengthening exercises to restore function in the lower extremities. 

Depending on your pain levels and symptoms, physical therapy sessions might include:

• Balance and proprioception exercises
• Flexibility exercises
• Stabilization-based exercises
• Functional mobility exercises
• Electrical stimulation

Physical therapy usually runs two or three times a week for a month or slightly more. Your doctor and therapist will evaluate your progress and determine if additional sessions are needed beyond this point.

Contact New York Spine Institute for Conus Medullaris Syndrome Treatment

You don’t have to let conus medullaris syndrome interfere with your daily activities and life. If you’re seeking relief from this condition, turn to our experienced team at New York Spine Institute. 

We offer an array of specialized orthopedic services including diagnostics, neurosurgery, pain management and physical therapy. We can tailor a comprehensive treatment plan to your condition, symptoms, pain levels and needs, paving the road to your recovery.

Our in-house physical therapists and pain management physicians will coordinate with your medical providers, aiming to treat your condition with the most nonintrusive methods. Should you require spinal decompression surgery, our world-class orthopedic spine specialists will guide you through the process and ensure you feel comfortable during the procedure.

When you’re pursuing treatment for spine-related conditions on or near Long Island, New York Spine Institute is the place to turn. Schedule your consultation appointment today to begin treatment for conus medullaris syndrome.