Conus Medullaris Syndrome Following Traumatic Thoracolumbar Burst Fractures: Clinical Presentation, Surgical Management, and Early Outcomes in Three Cases

Burst fractures of the thoracolumbar spine can carry a neurological deficit, particularly where the conus medullaris is injured. Conus medullaris syndrome (CMS) typically disturbs bladder, bowel, and sexual function while sparing much of the leg power, and its earliest signs are easily missed. We report three patients in whom a traumatic thoracolumbar burst fracture produced features of CMS and describe their operative management. A 57-year-old man with an L1 burst fracture and intact leg power presented with bowel and bladder incontinence and underwent posterior stabilization (D11-L3), regaining continence early. A 25-year-old man with an L1 burst fracture and sacral involvement after a fall from height had impaired voiding and defecation with blunted S3-S5 sensation and was treated with L1 decompression with stabilization (D12-L2). A 62-year-old woman with a 2-month-old D12 nonunion, paraparesis, and multilevel disc protrusion underwent D10-L2 transforaminal lumbar interbody fusion. All three patients demonstrated neurological improvement after surgical decompression and stabilization. Early recovery of bladder function occurred in one patient, while the remaining two experienced symptomatic improvement with ongoing rehabilitation. Thoracolumbar burst fractures involving the T12-L2 region may compress the conus medullaris, resulting in a spectrum of neurological deficits ranging from isolated sphincter dysfunction to mixed upper and lower motor neuron signs. Early recognition requires careful neurological examination, particularly assessment of sacral sensation and sphincter function, and early magnetic resonance imaging and prompt posterior decompression with fixation favor recovery, though return of bladder and sphincter function stays unpredictable.