title: Two-stage decompression for combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis of the thoracolumbar spine: a case report.
abstract: BACKGROUND
  A case of combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis of the thoracolumbar spine is reported.
  
  
  METHODS
  A 76-year-old man with multilevel spinal canal stenosis of the thoracolumbar spine (Th11-12, L2-S) who showed symptoms of epiconus syndrome was reported. First, we performed anterior decompression and fusion at the thoracolumbar junction (decompression: Th11-12, fusion: Th10-L2), which ameliorated his symptom partially. However, he presented cauda equina symptoms. Then, he underwent posterior spinal decompression (L3-5) and fusion (Th12-L5).
  
  
  RESULTS
  After anterior decompression, several symptoms disappeared. However, motor and sensory disturbance below L4 and bladder-bowel disturbance remained. We then performed a secondary operation. At three years' follow-up, he was able to walk with the aid of a cane.
  
  
  CONCLUSIONS
  Combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis was treated by combined two-stage anterior and posterior decompression. In this case, multilevel decompression via anterior and posterior approaches was necessary to relieve the symptoms.
authors.affiliation: Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, Gifu, Japan. akira-hi@amber.plala.or.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Hioki
authors.forename: Kei
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Hosoe
authors.forename: Shoji
authors.initials: S
authors.lastname: Fukuta
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011128:Polyradiculopathy / Q000209:etiology / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013130:Spinal Stenosis / Q000150:complications* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery*