26
|
Stevanato G, Vazzana L, Daramaras S, Trincia G, Saggioro GC, Squintani G. Lumbosacral plexus lesions. ACTA NEUROCHIRURGICA. SUPPLEMENT 2007; 100:15-20. [PMID: 17985537 DOI: 10.1007/978-3-211-72958-8_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Aim of the present study was to analyse the main causes of lumbosacral plexus lesions together with the best diagnostic and therapeutic options for better patient outcome. METHODS We report our surgical experience with eight patients in whom lesion mechanisms consisted of high-energy trauma (4 pts), firearm injuries (2 pts), spontaneous retroperitoneal haematoma in anticoagulant therapy (1 pt) and schwannoma (1 pt). The diagnosis was not straightforward and included clinical aspects, electrophysiological studies, magnetic resonance and CT myelography. Surgery was performed by lateral extraperitoneal approach for the lumbar plexus, transperitoneal approach on the midline to reach the sacral plexus, and neuronavigation was used in the schwannoma case. CONCLUSIONS Lumbosacral plexus lesions require a challenging multidisciplinary approach to diagnose and treat; the outcome, even if delayed, was very encouraging. In all our patients pain was controlled, and six patients returned to unaided walking.
Collapse
|
27
|
Kao CL, Yuan CH, Cheng YY, Chan RC. Lumbosacral plexus injury and brachial plexus injury following prolonged compression. J Chin Med Assoc 2006; 69:543-8. [PMID: 17116618 DOI: 10.1016/s1726-4901(09)70326-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization. Due to the initial motor and sensory deficit pattern, brachial plexus injury or C8/T1 radiculopathy was suspected. Subsequent nerve conduction study/electromyography proved the lesion level to be brachial plexus. Painful swelling of the right buttock was suggestive of gluteal compartment syndrome. Elevation of serum creatine phosphokinase and urinary occult blood indicated rhabdomyolysis. The patient received medical treatment and rehabilitation; 2 years after the injury, her right upper and lower limb function had recovered nearly completely. As it is easy to develop complications such as muscle atrophy and joint contracture during the paralytic period of brachial plexopathy and lumbosacral plexopathy, early intervention with rehabilitation is necessary to ensure that the future limb function of the patient can be recovered. Our patient had suspected gluteal compartment syndrome that developed after prolonged compression, with the complication of concomitant lumbosacral plexus injury and brachial plexus injury, which is rarely reported in the literature. A satisfactory outcome was achieved with nonsurgical management.
Collapse
|
28
|
Voermans NC, Koetsveld AC, Zwarts MJ. Segmental overlap: foot drop in S1 radiculopathy. Acta Neurochir (Wien) 2006; 148:809-13; discussion 813. [PMID: 16523224 DOI: 10.1007/s00701-006-0754-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 12/22/2005] [Indexed: 10/24/2022]
Abstract
Knowledge of segmental innervation of skeletal muscles is essential for diagnosing lumbar radiculopathy. Myotomes and dermatomes are traditionally thought to be innervated by a single spinal segment, but experimental studies have shown that this pattern of segmental innervation allows considerable overlap. This implies that muscles (or dermatomes) are innervated not only by axons of one spinal segment, but also partially by axons of adjacent spinal levels. We describe a patient in whom overlap in segmental innervation complicated adequate diagnosis of a recurrent lumbar hernia. Further, we present an outline of electrophysiological and anatomical studies on segmental innervation.
Collapse
|
29
|
Ozcan F, Güray Y, Ozçakar L, Korkmaz S. Inadvertent lumbosacral plexopathy due to temporary pacemaker implantation. J Natl Med Assoc 2006; 98:455-6. [PMID: 16573314 PMCID: PMC2576119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Reported here is a 70-year-old man who suffered from a lumbosacral plexopathy after a temporary pacemaker implantation. Drawing attention to the increased number of femoral catheterizations in cardiovascular practice, we have highlighted some neuromuscular complications pertaining to these type of interventions.
Collapse
|
30
|
Gillitzer R, Hampel C, Wiesner C, Pahernik S, Melchior SW, Thüroff JW. Pudendal nerve branch injury during radical perineal prostatectomy. Urology 2006; 67:423.e1-423.e3. [PMID: 16461104 DOI: 10.1016/j.urology.2005.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Revised: 07/13/2005] [Accepted: 08/09/2005] [Indexed: 11/23/2022]
Abstract
We report the first case of direct surgical injury to a pudendal nerve branch during radical perineal prostatectomy. A 65-year-old patient presented with typical symptoms of a pudendal nerve lesion after radical perineal prostatectomy. As the patient did not respond to conservative treatment, surgical exploration and exeresis of the injured sensory branch of the pudendal nerve was necessary, resulting in pain improvement. Urologic surgeons should be aware of the typical symptoms after iatrogenic injury to the pudendal nerve or its branches. Early diagnosis and neurosurgical intervention are important to obtain a more favorable outcome.
Collapse
|
31
|
Tung TH, Martin DZ, Novak CB, Lauryssen C, Mackinnon SE. Nerve reconstruction in lumbosacral plexopathy. Case report and review of the literature. J Neurosurg 2005; 102:86-91. [PMID: 16206740 DOI: 10.3171/ped.2005.102.1.0086] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurological injury to the lumbosacral plexus associated with pelvic and sacral fractures has traditionally been treated conservatively, despite significant and often debilitating functional deficits of the lower extremities. The authors report a case of reconstruction of the lumbosacral plexus, including nerve grafting to restore lower-extremity function caused by severe trauma to the pelvis. A 16-year-old boy sustained pelvic and sacral fractures in a motor vehicle accident. After stabilization of his orthopedic injuries, he suffered from paresis of his right gluteal and hamstring muscles and had no motor or sensory function below his knee. Two months later, he underwent reconstruction of his lumbosacral plexus performed using a nerve graft from his L-5 and S-1 nerve roots proximal to the inferior gluteal nerve and distal to a branch to the hamstring muscles. After another 2 months, his recovering saphenous nerve was transferred to the sensory component of the posterior tibial nerve by using cabled sural nerve grafts to restore sensation to the sole of his foot. After 2.5 years, he experienced reinnervation of his gluteal and hamstring muscles and could perceive vibration on the sole of his foot. With the assistance of a foot-drop splint, the patient ambulates well and is able to ski. Operative details and the relevant literature are reviewed.
Collapse
|
32
|
Abstract
BACKGROUND Internal fixation has become the preferred treatment for type-C pelvic ring injuries, but controversies persist regarding surgical approach and surgical technique. PATIENTS We evaluated 101 consecutive patients with type C1-C3 pelvic ring injuries who had been treated with standardized reduction and internal fixation techniques. RESULTS Our findings suggest a correlation between excellent reduction followed by sufficient fixation of the pelvic ring and functional outcome. Unsatisfactory reduction (displacement > 5 mm), failure of fixation, loss of reduction and a permanent lumbosacral plexus injury were the commonest reasons for an unsatisfactory functional result. All 40 patients with an associated lumbosacral plexus injury showed at least some evidence of neurological recovery. 14 underwent complete neurologic recovery. 8 had only sensory deficits and the remaining 18 also had motor deficits at the final followup. Complications were rare, but some of them were severe: loss of reduction in 8%, malunion in 10%, deep wound infection in 2%, and a lesion of the L5 nerve root in 1%. INTERPRETATION Our results suggest that special attention should be paid to preoperative planning, reduction of the fracture, decompression of the nerve roots, and fixation of the most severe sacral fractures. Our results seem to favor internal fixation of displaced (> 10 mm) and unstable rami fractures and symphyseal disruptions in conjunction with posterior fixation, to achieve better stability of the whole pelvic ring.
Collapse
|
33
|
Bouda J, Bouda JJ. [Neurological complications during gynecological pelvic surgery]. CESKA GYNEKOLOGIE 2005; 70:388-91. [PMID: 16180800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To summarize literary data dealing with neurological complications during gynecological pelvic surgery and present a case report. DESIGN Literary review and a case report. SETTING Department of Obstetrics and Gynecology, Medical Faculty Hospital Plzen. METHODS Literary review of lesions of cerebrospinal nerves during gynecological pelvic surgery, case report. CONCLUSION Neurological complications of pelvic surgery are usually discreet and their diagnosis is often delayed. A close cooperation with neurologists and anestesiologists is necessary.
Collapse
|
34
|
Sand PK. Should women be offered elective cesarean section in the hope of preserving pelvic floor function? Int Urogynecol J 2005; 16:255-6. [PMID: 15931552 DOI: 10.1007/s00192-005-1303-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2005] [Indexed: 11/30/2022]
|
35
|
Alexandre A, Corò L, Azuelos A. Microsurgical treatment of lumbosacral plexus injuries. ACTA NEUROCHIRURGICA. SUPPLEMENT 2005; 92:53-9. [PMID: 15830968 DOI: 10.1007/3-211-27458-8_12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Surgical treatment of lumbar and sacral plexus lesions is very rarely reported in the literature. The incidence of the involvement of these nervous structures in traumatic lesions of different etiology is probably much higher than believed, and surgical treatment should be taken into consideration more often. In this paper the experience derived from the surgical treatment of 15 cases is reported. Different surgical approaches have been employed according to ethiology, to level of nerve lesion and concomitant lesions of other organs. Patients who suffered a lesion in the lumbar or sacral plexus may have a very severe problem with deambulation since the leg may not be stable or may be unable to withstand the weight of the body. Pain syndrome in these patients may be a very severe obstacle to rehabilitation programs and to deambulation and everyday activity. Microsurgical nerve treatment in the retroperitoneal space is demanding both for the surgeon and for the patient but neurolysis and grafting procedures are possible also in this area. The resulting improvement of motor performance and the relief of pain are strong arguments in favor of this choice. Muscles benefitting most from surgery are the gluteal and femural muscles; more distant muscles, and particularly the anterior tibial nerve dependent muscles will gain minimal benefit from surgery. The relief from pain is relevant in all cases.
Collapse
|
36
|
Liberman M, Weissglas IS. Radiology for the surgeon: soft-tissue case 55. Sacral thumbtack sinus following proctocolectomy. Can J Surg 2004; 47:293-4. [PMID: 15362334 PMCID: PMC3211782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
|
37
|
Kaymak B, Ozçakar L, Cetin A, Erol O, Akoğlu H. Bilateral lumbosacral plexopathy after femoral vein dialysis: synopsis of a case. Joint Bone Spine 2004; 71:347-8. [PMID: 15288864 DOI: 10.1016/j.jbspin.2003.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2003] [Accepted: 06/16/2003] [Indexed: 11/30/2022]
Abstract
Femoral vein dialysis is a technique applied in many clinics. Hemorrhagic complications following the procedure either directly due to the femoral catheterization itself in the early period or less with concomitant late neurological impairments may pose serious challenges to the clinician. Likewise in this report, we are presenting a dialysis patient with bilateral retroperitoneal hematomas causing bilateral lumbosacral plexopathies-to our best knowledge the first in the literature. We have also touched upon its prompt diagnosis and treatment.
Collapse
|
38
|
Abstract
Object. The purpose of this study was to analyze therapeutic possibilities and clinical outcomes in patients with lumbosacral plexus injuries to develop surgical concepts of treatment.
Methods. In a retrospective investigation 10 patients with injuries to the lumbosacral plexus were evaluated after surgery. The patients were assessed clinically, electrophysiologically, and based on the results of magnetic resonance imaging and computerized tomography myelography. In most patients a traction injury had occurred due to severe trauma that also caused pelvic fractures. In most cases the roots of the cauda equina of the lumbosacral plexus had ruptured. In cases of spinal root ruptures repair with nerve grafts were performed. In cases in which proximal stumps of the plexus could not be retrieved palliative nerve transfers by using lower intercostals nerves or fascicles from the femoral nerve were performed.
Conclusions. Lesions of the proximal spinal nerves and cauda equina occur in the most serious lumbosacral plexus injuries. Patients with such injuries subjected to reconstruction of spinal nerves, repair of ventral roots in the cauda equina, and nerve transfers recovered basic lower-extremity functions such as unsupported standing and walking.
Collapse
|
39
|
Tonetti J, Cazal C, Eid A, Badulescu A, Martinez T, Vouaillat H, Merloz P. [Neurological damage in pelvic injuries: a continuous prospective series of 50 pelvic injuries treated with an iliosacral lag screw]. ACTA ACUST UNITED AC 2004; 90:122-31. [PMID: 15107699 DOI: 10.1016/s0035-1040(04)70033-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF THE STUDY The purpose of this study was to analyze lesions to the lumbosacral plexus related to pelvic injury and its treatment. MATERIAL AND METHODS Forty-four patients presented 50 posterior osteoligamentary lesions of the pelvic girdle. All patients except eight had other injuries. Mean ISS was 27/75. Posterior lesions were: iliosacral disjunction (n=23), extra-foraminal fracture of the sacrum (n=4), transforaminal fracture (n=22), intra-foraminal fracture (n=1). Vertical posterior displacement was > 1 cm for 24 posterior lesions. Orthopedic reduction was performed at admission for all patients. Fluoroscopy-guided percutaneous lag screw fixation was performed in all cases, on the average eight days after the accident. Neurological involvement was evaluated at admission, after surgery, and at last follow-up. Data were recorded for skeletal muscles, lower limb dermatomes, tendon reflexes, and anal tone. Screw emplacement was checked on the CT-scan. Outcome was assessed subjectively with the Majeed score, a self-administered visual analog scale, and use of antalgesic drugs according to the WHO classification. RESULTS The neurological examination could not be performed for ten patients at admission. Postoperatively, there was a neurological deficit associated with 26 osteoligamentary lesions (23 lesions of the lumbosacral trunk, 14 lesions of the S1 spinal nerve, 3 lesions of the pudendal nerve, 12 lesions of the superior gluteal nerve, and 10 lesions of the femoral nerve). Patients with neurological involvement had experienced more severe trauma. The iliosacral screw was partially extra-osseous in thirteen cases, with an associated iatrogenic neurological deficit in seven. At mean follow-up of 20 Months (range 4-50) there persisted ten major sequelae including eight cases of hallux extensor deficit. DISCUSSION Neurological involvement is underestimated during the acute phase of trauma. After recovery, only the manifestations of major injuries persist. The prognosis is poor in the event of a stretched lumbosacral trunk or gluteal nerve due to iliosacral disjunction. Prognosis is good for nerve contusion due to sacral fracture because of early reduction. The femoral nerve is generally injured by compression due to a peri-fracture hematoma; recovery is the rule. Iliosacral screwing requires rigorous technique by a skilled and experienced surgeon. CONCLUSION About 52% of posterior osteoligamentary injuries are associated with neurological symptoms. After recovery, permanent deficit persists in 21.7%. The most common sequelae are hallux extensor and gluteus medius palsy due to stretching of the lumbosacral trunk.
Collapse
|
40
|
Nordlinger B, Benoist S. Les cancers colorectaux : chirurgie des formes localisées du côlon et du rectum. PATHOLOGIE BIOLOGIE 2004; 52:117-8. [PMID: 15063928 DOI: 10.1016/j.patbio.2003.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2003] [Accepted: 12/15/2003] [Indexed: 11/28/2022]
|
41
|
Abstract
OBJECTIVE The association of intraoperative neurologic injuries with gynecologic surgical procedures is well established. The sequelae of such injuries are usually transient and resolve with minimal intervention, although long-term disability can and does occasionally occur. The purpose of this study was to examine the mechanisms by which these injuries occur in order to reduce the risk of their occurrence. DATA SOURCES A MEDLINE search was performed cross-referencing the index terms "neurological injury" and "gynecological surgery," from January 1, 1960 to December 31, 2002. METHODS OF STUDY SELECTION This article, based on the data and results (Level I-III) obtained from the MEDLINE search, examined the most common neurologic injuries that occur in association with abdominal and vaginal surgical procedures routinely performed by gynecologists. TABULATION, INTEGRATION, AND RESULTS Neurologic injuries after pelvic surgery all generally share a common etiology, specifically injury to one or more components of the lumbosacral nerve plexus. Three major factors that predispose to neurologic injury at the time of gynecological surgery are 1) the improper placement or positioning of self-retaining or fixed retractors, particularly those with deep lateral retractor blades; 2) improper positioning of patients in lithotomy position preoperatively; and 3) radical surgical dissection resulting in autonomic nerve disruption. Level I data strongly implicate the improper placement of self-retaining or fixed retractors as the most common cause of femoral nerve injury arising in association with abdominal surgical procedures. CONCLUSION A thorough understanding of the anatomy of the lumbosacral nerve plexus and the mechanisms by which operative injuries to this plexus occur will enable the gynecologic surgeon to reduce the subsequent risk of their occurrence in his or her own surgical practice.
Collapse
|
42
|
Hans FJ, Reinges MH, Krings T. Lumbar nerve root avulsion following trauma: balanced fast field-echo MRI. Neuroradiology 2004; 46:144-7. [PMID: 14685798 DOI: 10.1007/s00234-003-1139-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2003] [Accepted: 10/23/2003] [Indexed: 10/26/2022]
Abstract
Lumbosacral nerve root avulsion uncommonly complicates major trauma. Most patients also have pelvic or lumbar fractures. We present a patient who had a high-velocity vehicle accident with traumatic hip dislocation without fractures of the spine or pelvis. MRI demonstrated lumbosacral traumatic pseudomeningoceles. We used balanced fast field echo and MR myelography to make the diagnosis and show the extent of the pseudomeningocele.
Collapse
|
43
|
Arcocha Aguirrezábal J, Irimia Sieira P, Soto O. [Ilioinguinal neuropathy: usefulness of conduction studies]. Neurologia 2004; 19:24-6. [PMID: 14762731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Ilioinguinal neuropathy is an under-recognized etiology of pelvic pain, that is frequently misdiagnosed with alternative etiologies of pelvic pain. This is partially due to the limited usefulness of neurophysiological studies. Indeed, electromyography of the lower abdominal musculature identifies slightly more than half of the cases. In spite of an available conduction technique described in normal subjects, the usefulness of nerve conduction studies in ilioinguinal neuropathy is uncertain because their use has not been validated with patients. We describe the case of a patient with left inguinal pain following left inguinal herniorraphy. He underwent repeated surgeries and several analgesic treatments, without amelioration of pain. Conduction studies were consistent with ilioinguinal neuropathy. Anesthetic block relieved symptoms temporarily, and the symptoms disappeared upon section of the ilioinguinal nerve. This case describes the usefulness of conduction studies in the diagnosis of ilioinguinal neuropathy.
Collapse
|
44
|
Musaev AV, Guseĭnova SG. [Gunshot injuries of peripheral nervous system: the questions of classification and diagnostics]. Zh Nevrol Psikhiatr Im S S Korsakova 2004; 104:10-7. [PMID: 15554136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Two hundreds and sixty-seven patients with gunshot injuries of 394 nerves and plexus underwent clinical and electromyographic investigation and H-reflex evaluation as well. Based on the results of the data obtained, 3 types of nerves trunk injuries: neuroapraxia, axonothmesis and neurothmesis, were identified. The reduction of biopotential amplitude and synergic muscular activity, decrease of impulse conduction velocities (ICVeff--up to 30%), M-response amplitude (up to 50% and more) and motor units functioning were characteristic of neuroapraxia of nerve trunks. Axonothmesis of nerve trunks featured by the reduction of the amplitude and frequency of muscular biopotentials, decrease of its synergic activity, marked reduction of ICVeff (30--60%), rough fall of M-response amplitude and motor units functioning. In neurothmesis of nerve trunks, "bioelectrical silence" and disappearance of synergic muscular activity as well as an absence of M-response of denervated muscles were observed. An evaluation of monosynaptic reflex has a substantial significance for the determination of the level of low extremities injuries.
Collapse
|
45
|
Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol 2003; 189:1574-8; discussion 1578. [PMID: 14710069 DOI: 10.1016/s0002-9378(03)00934-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to map the course of the ilioinguinal and iliohypogastric nerves. STUDY DESIGN The courses of iliohypogastric and ilioinguinal nerves from 11 fresh frozen cadavers were mapped from their lateral emergence on the anterior abdominal wall to their midline termination in reference to fixed bony landmarks. Bivariate fit ellipses were generated for each nerve and compared with sites of standard abdominal surgical incisions. RESULTS Thirteen iliohypogastric and 16 ilioinguinal nerves were identified and mapped. On average, the proximal end of the ilioinguinal nerve entered the abdominal wall 3.1 cm medial and 3.7 cm inferior to the anterior superior iliac spine, then followed a linear course to terminate 2.7 cm lateral to the midline and 1.7 cm superior to pubic symphysis. The iliohypogastric nerve entered the abdominal wall on average 2.1 cm medial and 0.9 cm inferior to the anterior superior iliac spine, which followed a linear course to terminate 3.7 cm lateral to the midline and 5.2 cm superior to pubic symphysis. CONCLUSION Abdominal wall surgical sites below the level of the anterior superior iliac spine have the potential for ilioinguinal or iliohypogastric injury.
Collapse
|
46
|
Jacobs CJ, Steyn WH, Boon JM. Segmental nerve damage during a McBurney's incision: a cadaveric study. Surg Radiol Anat 2003; 26:66-9. [PMID: 14625791 DOI: 10.1007/s00276-003-0189-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2002] [Accepted: 07/04/2003] [Indexed: 11/26/2022]
Abstract
Injury to the ilioinguinal and iliohypogastric nerves after a McBurney's incision have been reported to cause paralysis of the conjoint tendon that may lead to the development of an indirect inguinal hernia. This study reports on the incidence of ilioinguinal and iliohypogastric nerve sectioning after the performance of a classic McBurney's incision as well as the distance and relationship of the ilioinguinal and iliohypogastric nerves to the anterior superior iliac spine and a classic McBurney's incision. The right iliac fossa and lumbar region of 33 cadavers were dissected for the uncovering of the ilioinguinal and iliohypogastric nerves after a correct McBurney's incision was made. Injury to the ilioinguinal and iliohypogastric nerves was recorded. The mean distance between the ilioinguinal nerve and the incision line was 41.89 mm and 34.63 mm between the iliohypogastric nerve and the incision line. The ilioinguinal and iliohypogastric nerves were found to be 6.69 mm and 12.08 mm from the anterior superior iliac spine, respectively. No ilioinguinal or iliohypogastric nerve was injured during all 33 McBurney's incisions.
Collapse
|
47
|
Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, McCarthy RJ. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003; 101:279-88. [PMID: 12576251 DOI: 10.1016/s0029-7844(02)02727-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Neurological injury associated with present day labor and delivery is thought to be unusual. The purpose of this study was to estimate the incidence, severity, and duration of postpartum lumbosacral spine and lower extremity nerve injury and identify factors related to nerve injury. METHODS All women who delivered a live-born infant from July 1997 through June 1998 were asked about symptoms of lumbosacral spine and lower extremity nerve injury the day after delivery. Women with symptoms were examined by a physiatrist to confirm injury, and their cases were then followed by telephone until the symptoms resolved. Maternal variables (including prospective documentation of time spent pushing in various positions) and fetal variables that might be associated with risk of nerve injury were compared between women with injury and those without. RESULTS Six thousand fifty-seven women delivered live-born infants; 6,048 were interviewed and 56 had a confirmed new nerve injury, an incidence of 0.92%. Factors found by logistic regression analysis to be associated with nerve injury were nulliparity and prolonged second stage of labor. Women with nerve injury spent more time pushing in the semi-Fowler-lithotomy position than women without injury. The median duration of symptoms was 2 months. CONCLUSION The estimated incidence of postpartum nerve injury was greater than reported from previous studies and is associated with nulliparity and prolonged second stage of labor.
Collapse
|
48
|
Della Valle CJ, Di Cesare PE. Complications of total hip arthroplasty: neurovascular injury, leg-length discrepancy, and instability. BULLETIN (HOSPITAL FOR JOINT DISEASES (NEW YORK, N.Y.)) 2003; 60:134-42. [PMID: 12102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
|
49
|
Ozçakar L, Sivri A, Aydinli M, Tavil Y. Lumbosacral plexopathy as the harbinger of a silent retroperitoneal hematoma. South Med J 2003; 96:109-10. [PMID: 12602743 DOI: 10.1097/01.smj.0000049854.82132.56] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
|