Prevention of diagnostic errors in position of conus medullaris in adult patients

Background and aims: Finding the safe location of spinal cord for cerebrospinal fluid (CSF) during surgical procedures is very important due to its various nature for each patient as well as its potential peripheral nervous system hazards. The aim of this study was to find the relationship between the location of conus medullaris (CM) and gender, age and body mass index (BMI) in order to minimize the potential diagnostic errors. Methods: Magnetic resonance imaging (MRI) with T1-weighted sagittal spin echo sequences of the lumbar spine was studied in 350 patients older than 20 years old, whom had been referred for imaging in order to assess the potential causes of low back pain of the lumbar spine, and were referred to Shahid Chamran MRI center in Sanandaj, located in the west of Iran, this study was done in 2014. The results were compared with international standards to reveal the potential errors. Results: In different age groups, the mean position was varied ranging from T12-L1 intervertebral disc to upper part of L1 middle third, not clinically significant. The inter canal position of the spinal cord was toward dorsal. No significant relationship was found between CM and gender, age as well as BMI. Similar relationship was found for the spinal cord position in spinal column. Conclusion: There is a safe region of 2-4 vertebral bodies and intervertebral spaces during spinal block. It means that the variation of CM position and its end level could be a guidance to realize that why neurological symptoms may vary in different patients. 

Prevention of diagnostic errors in position of conus medullaris in adult patients Keywords:

Diagnostic errors , Conus medullaris , Anatomic variations , Imaging modalities