According to abbreviationfinder, CS stands for cone syndrome. Conus syndrome is a paraplegic syndrome caused by pressure damage to the lower spinal cord at the level of the conus medullaris and is associated with micturition disorders. The phenomenon occurs most frequently in the context of a herniated disc. The syndrome is a medical emergency and requires immediate surgical decompression to prevent irreversible damage.
What is Konus Syndrome?
In most cases, cone syndrome is the result of a herniated disc. Less frequently, circulatory disorders or even tumors are responsible for the compression of the corresponding spinal cord segments.
The brain and spinal cord make up the central nervous system. All motor functions are controlled via the nerve tissue located here. The spinal cord in particular plays a key role in controlling movement.
The pyramidal tracts are particularly important in this context, from which all voluntary and reflex movement commands are transported to the muscle organs via efferent nerve tracts. Damage to the spinal cord has correspondingly serious consequences. For example, lesions in the area of the entire diameter of the spinal cord are referred to as transverse spinal cord syndrome.
All spinal cord syndromes are accompanied by paralysis. Depending on the type of spinal cord damage, the paralysis is either flaccid or spastic. The so-called conus syndrome is a paraplegic syndrome with damage located at the level of the conus medullaris, which affects the spinal cord segments S3 to S5. The main symptoms of the syndrome are incontinence and disorders of sexual function.
The cause of cone syndrome is compression of the lower spinal cord. Pressure on the conus medullaris at the end of the caudal spinal cord creates the disorders associated with the syndrome. More specifically, the sacral spinal cord segments from S3 to S5 are predominantly affected by the associated compression.
The coccygeal spinal cord at the level of the lumbar vertebrae can also be affected. In most cases, cone syndrome is the result of a medial disc herniation. Less frequently, circulatory disorders or even tumors are responsible for the compression of the corresponding spinal cord segments.
The syndrome has also been reported in cases where the conus medullaris is congenitally attached to its surrounding structures. In such a case, however, one speaks of a tethered cord syndrome rather than a conus syndrome, which damages the conus medullaris during growth. In almost all cases, the conus syndrome is associated with the so-called cauda syndrome and is sometimes referred to as cone-cauda syndrome in this context.
Symptoms, Ailments & Signs
Like all other paraplegic syndromes, cone syndrome is predominantly associated with movement disorders. In the case of cone syndrome, these are mainly movement disorders of the bladder and anus sphincters. Patients are often unable to hold their stool. The same goes for urine.
Urination disorders such as permanently dripping urine are a key symptom of the syndrome. Overflow incontinence, in which the patient’s bladder is constantly full but cannot be emptied voluntarily, also comes into question as a micturition disorder. In most cases, there are no movement disorders in the early stages.
At the beginning, the cone syndrome usually manifests itself in a so-called breeches anesthesia, which is characterized by symmetrical sensory disturbances on the back inside of both thighs. This area of skin is supplied by the nerves of segments S1 to S3. Men in particular often suffer from erection or ejaculation disorders in the later stages of cone syndrome.
As a rule, at least slight pain in the hip area occurs as a result of the compression, since sensory nerves are also damaged by the pressure on the lower spinal cord. Paralysis of the legs usually does not occur.
Diagnosis & course of disease
Doctors diagnose cone syndrome based on history and imaging. The patients’ anus is essentially flaccid because the sphincter muscle is not working properly. As part of the diagnosis, a failed anal or bulbocavernosus reflex can indicate conus syndrome. Patellar and Achilles tendon reflexes are preserved in isolated conus syndrome.
CT or MRI can be used as imaging methods to confirm the diagnosis and clarify the cause. Imaging can show, for example, a causative herniated disc. For patients with cone syndrome, the prognosis depends significantly on the time of diagnosis. If the compression lasts too long, the affected nerves die irreversibly.
Konus syndrome is a very serious and dangerous condition for the body of the affected person. If treatment is not initiated immediately, irreversible sequelae and paralysis of the entire body can usually occur. The person affected suffers from micturition disorders and from paralysis and tingling sensations.
The quality of life is significantly restricted and reduced by the cone syndrome. It is not uncommon for this to lead to movement disorders, so that the patient may also be dependent on a wheelchair. The function of the bladder is also impaired, so that urination can no longer be controlled properly. This often leads to depression and other psychological complaints or upsets.
Sensory disturbances can occur all over the body, which have an extreme impact on everyday life. The genitals are usually affected by erectile dysfunction. The patient’s quality of life is drastically reduced by cone syndrome. It is not uncommon for there to be severe pain in the hip. Treatment for cone syndrome must be immediate.
Complications occur mainly when only delayed treatment is initiated. This can lead to irreversible damage, so that the person affected suffers from the consequences and paralysis for the rest of their lives. No general statement can be made about the reduction in life expectancy.
When should you go to the doctor?
Konus syndrome always represents a medical emergency. Treatment must be started immediately if symptoms such as paralysis or numbness in the legs are noticed. After the initial treatment by the emergency doctor, the patient must be examined in a specialist clinic. Long-term therapy is planned individually depending on the severity of the paraplegia and is carried out by various specialists. Individuals suffering from Konus Syndrome must consult their doctor closely. The paraplegic syndrome can be treated well, but as the condition progresses, various symptoms can arise that require individual treatment.
Patients who suddenly notice signs of movement disorders of the bladder and anus sphincters should inform the doctor. Unusual sensory disturbances or pain also need to be clarified if they occur suddenly and there is a suspicion of a medical complication. Konus syndrome significantly reduces the quality of life, so those affected often need therapeutic support. If depressive moods or other problems become noticeable, it is best to inform the doctor. They can examine the patient to rule out an organic cause and consult a therapist if necessary.
Treatment & Therapy
Konus syndrome is always a medical emergency that requires immediate intervention. The longer the pressure on the lower spinal cord remains, the more likely permanent nerve damage is. After the diagnosis has been made, surgical decompression is carried out as soon as possible.
Conservative drug measures are not suitable for treatment. The cause of the present disturbances must be eliminated, in this case the pressure condition near the spinal cord. In individual cases, a so-called nucleoplasty is used to relieve the lower spinal cord. This procedure is a minimally invasive treatment for the treatment of herniated discs.
In this case, the intervention takes place under local anesthesia. During the procedure, the surgeon works with a special probe that is inserted into the spinal cord. In certain circumstances, patients may require targeted physical therapy after the procedure. The symptoms caused by the compression usually improve as soon as the spinal cord is relieved.
However, the physiological initial state is usually not fully restored by the relief. Physiotherapeutic measures are particularly important in the case of a cone syndrome that was only recognized and corrected at a late stage.
Outlook & Forecast
The prospect of a cure for cone syndrome depends on the speed of medical treatment. Since the disease is an intensive care emergency, an emergency service must be alerted as soon as possible. In addition, for a good prognosis, the taking of first aid measures by those present is absolutely necessary. If emergency care or medical attention is denied, the chances of recovery are greatly reduced. Normally, it can no longer be reached in the further course of life. The damage suffered by the organism is irreversible and usually triggers consequential damage. The later extensive therapy can be initiated, the more severe the long-term effects of cone syndrome.
Despite all efforts, many patients cannot be free of symptoms because comprehensive care was not provided immediately after the triggering event. Paralysis or restricted mobility often remain for life. In addition, due to the emotional burden of the disease, subsequent psychological disorders are to be expected.
Initiated therapies, the administration of medication and invasive treatments can also trigger complications or side effects. These lead to a need to optimize the treatment plan and can delay the healing process. Months or years after the triggering event, many patients report an impairment in their quality of life due to the persisting symptoms.
Since the herniated disc is the most common cause of cone syndrome, the same preventive measures as for herniated discs apply to the prophylaxis of the syndrome. Back training or regular visits to a back school, for example, have proven to be effective preventive measures in connection with slipped discs.
In the case of cone syndrome, aftercare measures are very limited in most cases. As a rule, the disease cannot be completely treated either. First and foremost, the affected person is dependent on a quick diagnosis so that there is no further paralysis on the body. In many cases, the paralysis itself cannot be reversed, so that in these cases the affected person no longer has any follow-up care available.
Most of those affected are therefore dependent on the help of other people in their lives and need support in their everyday lives. Above all, the help and care provided by family and friends has a very positive effect on the further course of the disease. Depression or other psychological upsets can often be alleviated or even prevented.
Physiotherapy measures are often also necessary for cone syndrome. The person concerned can repeat the exercises at home and thus speed up the healing process. Further follow-up measures are usually not possible. However, the syndrome does not usually reduce the life expectancy of the person affected.
You can do that yourself
Konus syndrome is always a medical emergency. As soon as the first signs of spinal cord syndrome appear, an ambulance must be called. Until this arrives, first aid measures must be taken or the affected person should lie down and try to breathe calmly.
After the operation, the patient must take it easy. Exercise and other physical activities should be avoided in the first few days. After a week, after consultation with the doctor, gentle sport can be resumed. If cone syndrome is only recognized at a late stage, the damage that has already occurred must be corrected. This is primarily achieved through physiotherapeutic measures, which can be supported by those affected with individual training. The doctor will refer the patient to a suitable physiotherapist.
Identifying and eliminating the cause is an important treatment step. Many patients with cone syndrome are overweight or work in a job that puts a lot of strain on their backs. These triggers must be found and rectified as quickly as possible. This can be achieved by changing jobs, changing lifestyle habits or accompanying therapy. Regular back training or attending a back school can also alleviate the symptoms and prevent conus syndrome from recurring.