Abstract:
In performing neuraxial procedures, knowledge of the
location of the conus medullaris in patients of all ages is important. The aim of
this study was to determine the location of conus medullaris in a sample of newborn/infant cadavers and sagittal MRIs of children, adolescents and young
adults. MATERIALS AND METHODS: The subjects of both the samples were
subdivided into four developmental stages. No statistical difference was seen
between the three older age groups (p>0.05). A significant difference was
evident when the newborn/infant stage was compared with the other, older
stages (p<0.001 for all comparisons). RESULTS: In the newborn/infant group
the spinal cord terminated most frequently at the level of L2/L3 (16%). In the
childhood stage, the spinal cord terminated at the levels of T12/L1 and the
lower third of L1 (21%). In the adolescent population, it was most often found
at the level of the middle third of L1 and L1/L2 (19%). Finally, in the young
adult group, the spinal cord terminated at the level of L1/L2 (25%). This study
confirmed the different level of spinal cord termination between
newborns/infants less than one year old and subjects older than one year. In
this sample the conus medullaris was not found caudal to the L3 vertebral
body, which is more cranial than the prescribed level of needle insertion
recommended for lumbar neuraxial procedures. CONCLUSION: It is
recommended that the exact level of spinal cord termination should be
determined prior to attempting lumbar neuraxial procedures in newborns or
infants.
