The conus medullaris is the most distal bulbous part of the spinal cord.

It is located at the level of

L2. It comprises the S1-S5 roots, plus the coccygeal one. Facts about conus medullaris syndrome:
·0 Acute onset
·1 Pain usually bilateral and not very prominent
·2 Sexual impotence very prominent
·3 Saddle anesthesia present
·4 Normal patellar and Achilles reflexes
·5 Flaccid paralysis of bladder and rectum
·6 Overflow urinary incontinence
·7 Decreased rectal tone -> fecal incontinence
·8 Spastic paralysis of lower extremities (muscles supplied by S1-5)
·9 Perianal sensory loss present

The cauda equina contains nerve roots from L1-L5 and S1-S5. Cauda equina syndrome is
characterized by compression of 2+ of those nerve roots. Facts about cauda equina syndrome:
·10 Gradual onset
·11 Pain usually unilateral and severe
·12 Radicular pain (back pain radiating to the legs)
·13 Urinary and fecal incontinence present
·14 Saddle anesthesia present
·15 Perianal sensory loss present
·16 Flaccid paralysis of lower extremities
·17 Loss of patellar and Achilles reflexes
·18 Sexual impotence less common