Injuries of the conus medullaris

Eighteen patients with traumatic lesions of the conus medullaris were reviewed with particular reference to bowel, bladder and sexual functions. The average follow-up was 4 years. The injury most frequently occurred with a burst fracture of the first lumbar vertebra. All patients could walk on discharge but 4 required some form of external support. Regular bladder habit was regained in all patients but none had normal bladder sensation. Urinary tract infections were quite uncommon and there was good correlation between the incidence of infections and the degree of bladder control. No patient had developed chronic renal failure or chronic urinary tract infection. Bowel control was similarly preserved but at a somewhat lower level of competence. Eleven of 16 males had been able to undertake intercourse though with variable adequacy. Potency was linked with the degree of preservation of genital sensation. The conclusion is that the prognosis for conus lesions is somewhat better than is widely appreciated.