MRI Determination of Conus Medullaris Level in an Adult Population in Turkey

Sevinç, Özdemir; İş, Merih; Barut, Çağatay; Eryoruk, Nesrin; Kıran, Sibel; Arifoğlu, Yasin

doi:10.1177/197140090601900317

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…75 However, mean levels of CMt were stated to be at the level of L1 vertebra in the 39th edition of Gray's Anatomy 76 and Gray's Clinical Neuroanatomy, 71 between the L1 and L2 vertebrae in the 40th edition of Gray's Anatomy, 77 and at the level of L1M in the 41st edition of Gray's Anatomy, 4 showing variations. In the literature, the level of CMt has been examined in many studies 5,11,[17][18][19]21,[24][25][26][27][28][29][30][31]33,34,[36][37][38]45,[48][49][50][51]78 (Table 4). While some of these studies 5,17,19,21,24,25,28,37,[48][49][50][51] examined healthy individuals, some also included patients with pathologies such as lumbar spinal stenosis, 18 adolescent idiopathic scoliosis, 20 ankylosing spondylitis, 31 and Chiari I malformation.…”

Section: Discussionmentioning

confidence: 99%

Examination of the Level of Conus Medullaris Termination Using Magnetic Resonance Imaging

et al. 2021

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Introduction: Recognition of the level of the conus medullaris termination (CMt) is of clinical importance for avoiding iatrogenic injuries during spinal anesthesia and lumbar puncture. Although CMt levels have been examined in a variety of studies, they vary in classical textbooks and literature studies. The aim of this study was to investigate the level of CMt and its correlation to gender, age, and body mass index (BMI) using magnetic resonance imaging (MRI) in healthy individuals and those with lumbar disc herniation. Methods: The lumbar MRIs of 341 subjects, including healthy individuals (F: 123, M: 68) and those with lumbar disc herniation (F: 105, M: 45), were retrospectively examined, and the CMt levels were determined. Results: It was found that CMt levels were most commonly located at upper 1/3 of the L1 vertebral body in both healthy individuals and those with disc herniation groups. No statistically significant difference was observed between the two groups evaluated. In addition, no significant mean level of CMt, weight, height, and BMI difference existed between the two groups. Conclusion: In the literature, the highest level of CMt is seen as being at the intervertebral disc between T11 and T12 vertebrae, while the lowest level of the CMt is seen as being at lower 1/3 of the L3 vertebral body. Consequently, we are of the opinion that the L3-4 or L4-5 intervertebral spaces should be preferred to lower the complication rate in procedures such as spinal anesthesia and lumbar puncture.

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Section: Discussionmentioning

confidence: 99%

Examination of the Level of Conus Medullaris Termination Using Magnetic Resonance Imaging

et al. 2021

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“…This point was defined considering twelve in-vivo magnetic resonance imaging studies that reported the occurrence count of the termination level in relation to the upper, middle, or lower third of the respective vertebral body or to the respective intervertebral disc (bins), with a total of 4797 subjects (Demiryürek et al, 2002;Karabulut et al, 2016;Kim et al, 2003;Kwon et al, 2016;Liu et al, 2017;Moon et al, 2019;Moussallem et al, 2014;Nasr, 2016;Preeti and Chaturvedi, 2016;Rostamzadeh et al, 2015;Saifuddin et al, 1998;Sevinc et al, 2006). We constructed a distribution of occurrence counts from the data set of each study by normalizing the occurrence counts per bin to the total number of counts.…”

Section: Geometrical Model Of the Spine And The Lumbosacral Spinal Cordmentioning

confidence: 99%

Spinal motor mapping by epidural stimulation of lumbosacral posterior roots in humans

et al. 2021

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Epidural electrical stimulation of the spinal cord is an emergent strategy for the neurological recovery of lower-extremity motor function. Motoneuron pools are thought to be recruited by stimulation of posterior roots. Here, we linked electromyographic data of epidurally evoked lower-extremity responses of 34 individuals with upper motoneuron disorders to a population model of the spinal cord constructed using anatomical parameters of thousands of individuals. We identified a relationship between segmental stimulation sites and activated spinal cord segments, which made spinal motor mapping from epidural space possible despite the complex anatomical interface imposed by the posterior roots. Our statistical approach provided evidence for low-threshold sites of posterior roots and effects of monopolar and bipolar stimulation previously predicted by computer modeling and allowed us to test the impact of different upper motoneuron disorders on the evoked responses. Finally, we revealed a statistical association between intraoperative and postoperative mapping of the spinal cord.

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“…25 We found no significant relationship between gender and conus medullaris position, as also revealed in another study in Indonesia 19 and other studies in various countries (p>0.05). 20-22,24,26- 32 The conus medullaris positions are mostly located at L2-L3 or L3-L4, but there is still a risk of conus medullaris injury when performing spinal anesthesia. 1 The highest position of conus medullaris in this study are T11-T12 (n=5) (Table 2), which was similar as determined in two studies from Turkey.…”

Section: Discussionmentioning

confidence: 99%

Variation of conus medullaris location based on magnetic resonance imaging of the lumbar spine in Indonesia: A study at Dr Soetomo General Academic Hospital, Surabaya, Indonesia

Adhiatma¹,

Waloejo²,

Wirabuana³

et al. 2022

Bali Med J.

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Introduction: Recognition of conus medullaris position, contains lumbosacral plexuses which supply motor and sensory innervation to the whole lower limb, pelvic and perineal areas, is critical to avoid injury due to lumbar procedures, such as spinal anesthesia and lumbar punctures. This study aimed to investigate the position of conus medullaris among Indonesians through magnetic resonance imaging (MRI) of the lumbar spine at Dr. Soetomo General Academic Hospital in order to minimize the risk of conus medullaris trauma. Methods: A retrospective study was conducted to investigate the conus medullaris level and its correlation to gender and age Indonesian patients. The data were collected from lumbar MRI at Dr Soetomo General Academic Hospital during January 2020 and December 2021. The level variations of conus medullaris were recorded and determined as the highest, lowest and most common location descriptively. Results: A total of 257 patients (126 male and 131 female) were included. The highest level of conus medullaris was in T11-T12 vertebrae (five patients). There were 12 patients in T12 vertebrae, T12–L1 in 86 patients, L1 in 62 patients, L1–L2 in 76 patients, and L2 in 12 patients. The lowest level was in between L2 and L3 vertebrae in 4 patients. Gender and age had no association with conus medullaris level. Conclusion: The lowest level of conus medullaris was in between L2 and L3 vertebrae. The lumbar procedure such as punctures should be done below the L3 to avoid conus medullaris puncture trauma.

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MRI Determination of Conus Medullaris Level in an Adult Population in Turkey

Cited by 5 publications

References 11 publications

Examination of the Level of Conus Medullaris Termination Using Magnetic Resonance Imaging

Examination of the Level of Conus Medullaris Termination Using Magnetic Resonance Imaging

Spinal motor mapping by epidural stimulation of lumbosacral posterior roots in humans

Variation of conus medullaris location based on magnetic resonance imaging of the lumbar spine in Indonesia: A study at Dr Soetomo General Academic Hospital, Surabaya, Indonesia

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