The epiconus syndrome presenting with radicular-type neurological features

We report 15 patients with an epiconus syndrome presenting with radicular-type clinical features involving the lower extremities and identify the vertebral level at which the spinal cord terminated. All patients, consisting of 10 men and five women, aged 37 to 71 years, presented with unilateral or bilateral leg muscle atrophy as well as sensory deficit. Unilateral or bilateral reduction or absence of deep tendon reflexes were present in 13 patients, while pathological reflexes were seen in three cases and bladder dysfunction in 10. Prior to presentation, five patients with the epiconus syndrome were mistakingly diagnosed as having different spinal diseases, which were treated surgically. The level of epiconus compromise detected on radiological examination ranged from the lower level of the T10 vertebra to T12-L1 intervertebral disc level, but most frequently at T11-12 disc level. The level of termination of the spinal cord was between T12 and L1-2 disc level, but most frequently at the middle portion of the L1 vertebra, which was on average 1.6 +/- 0.4 (mean +/- standard deviation) vertebrae distal to the epiconus lesions. The presence of different neurological features related to epiconus compromise should be carefully examined with reference to the level of termination of the spinal cord.