The Correlation Between Thoracolumbar Disc Herniation Clinical Manifestation And The Position Of The Conus Medullaris

Objective:In the TLDH（thoracolumbar disc herniation） patients，to record the clinical manifestations and the position of their conusmedullaris，try to find the relationship between them and provide areasonable explanation for the atypical cases, guide the locatingdiagnosis of TLDH.Method:From January2012to January2015，we select24TLDHinpatients of China-Japan Union hospital,record their clinicalmanifestations and the position of their conus medullaris. Theclinical manifestations include the following aspects:1.sensorydisturbance2.pain in the chest and back3.pain in the legs4.gaitdisorder5.muscle force6.sphincter dysfunction7.muscular tension8.knee phenomenon9.Babinski sign10.ankle clonus.Upper motorneuron injury manifest as: sensory disturbance, muscular tensionof the legs increases, Tendon hyperreflexia or pathologic reflex andankle clonus.Lower motor neuron injury performances involve: lateral thigh pain and paresthesia, knee phenomenon weakens,femoral nerve stretching test positive etc.The way we use to locatethe conus medullaris accords to Reimann’s report.On the mediumsagittal image,we find the farthest point of the conusmedullaris,then draw a line perpendicular to the longitudinal axis ofthe cord.We use the level of this line as the position of the conusmedullaris.But in practice,we also use cross sectional images assupplement.Result:8cases of TLDH in T10/11,6cases show simple uppermotor neuron injury symptoms,1cases show simple lower motorneuron injury,1cases show mixed nerve injury.4cases of TLDH inT11/12,3cases show simple upper motor neuron injury symptoms,1cases show mixed nerve injury.4cases of TLDH inT12/L1,3cases show mixed nerve injury,1cases show simple lower motorneuron injury symptoms.3cases of TLDH in L1/2and1case ofTLDH in L2/3,3cases show simple lower motor neuron injury,1cases show mixed nerve injury.4patients with multi segmentalTLDH all show mixed nerve injury.20cases show that the positionof their conus medullaris is from the lower2/3of the L1to the upper1/3of the L2,and their clinical manifestation is typical.The rest4cases do not show the typical clinical manifestation,while theirconus medullaris’s position are not in the common range. Conclusion: TLDH in different segment has different typicalclinical manifestation. When the position of the conus medullaris islocated in the lower2/3of the L1to the upper1/3of the L2, thesymptoms can conform well with typical clinical manifestations; ifnot, the clinical manifestation will be not such typical. To thoseatypical cases,measure the position of their conus medullaris,analyze the compression parts of the cord, then these atypicalclinical presentation can be well explained. This conclusion can beapplied in clinic, there will be helpful to the diagnosis of TLDH.