title: Spinal cord tumors of the thoracolumbar junction requiring surgery: a retrospective review of clinical features and surgical outcome.
abstract: OBJECTIVE
  A retrospective review of medical records and imaging studies. To investigate characteristic clinical features and surgical outcomes of spinal cord tumors (SCTs) of the thoracolumbar junction (TLJ). The spinal cord transitions to the cauda equina in the TLJ. The TLJ contains the upper and lower motor neurons of the spinal cord and cauda equina. As a result, the clinical features of lesions in the TLJ vary, and these anatomical characteristics may affect surgical outcome.
  
  
  METHODS
  Pathological diagnosis, clinical features, neurological signs, and surgical outcomes were investigated in 76 patients surgically treated at our institute for SCTs arising from T11 to L2. The patients were divided into epiconus (T11-12, n=18) and conus groups (L1-2, n=58).
  
  
  RESULTS
  Patients in the epiconus group had hyperactive deep tendon reflexes (DTRs), while those in the conus group had hypoactive DTRs (p < 0.05). Nine patients were misdiagnosed with intervertebral disc diseases (IVDs) before correct diagnoses were made. It was impossible to definitively determine the exact cause of symptoms in four patients who had both SCTs and IVDs.
  
  
  CONCLUSIONS
  Among SCTs of the TLJ, the epiconus group displayed upper motor neuron syndrome and the conus group displayed lower motor neuron syndrome. SCTs of the TLJ were frequently misdiagnosed as IVDs due to symptomatic similarities. SCTs of the TLJ should be included in differential diagnosis of back and leg pain, and it is highly recommended that routine lumbar magnetic resonance imaging include the TLJ.
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Dong Ah
authors.initials: DA
authors.lastname: Shin
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Keung Nyun
authors.initials: KN
authors.lastname: Kim
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Shin
authors.forename: Do Heum
authors.initials: DH
authors.lastname: Yoon
mesh_terms: D002420:Cauda Equina / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011859:Radiography; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000473:pathology; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D016896:Treatment Outcome