• Akira Hioki, Kei Miyamoto, Hideo Hosoe, Shoji Fukuta, and Katsuji Shimizu.
• Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, Gifu, Japan. akira-hi@amber.plala.or.jp
• Arch Orthop Trauma Surg. 2008 Sep 1; 128 (9): 955-8.

IntroductionA case of combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis of the thoracolumbar spine is reported.MethodsA 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).ResultsAfter 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.ConclusionsCombined 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.

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