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Biomedical subjects

R Maigne

Publications and source records attributed to R Maigne.

At least 19 recordsLinked to original sources
PubMed1991

The lumbar mamillo-accessory foramen: a study of 203 lumbosacral spines.

We have examined 203 lumbar and sacral skeletal specimens and have noted the frequent occurrence of a mamillo-accessory foramen, formed by the ossification of the mamillo-accessory ligament. The dorsal ramus of the lumbar nerve passes through this foramen. At the L5 level, this foramen is found frequently: in 26% of the cases on the left side and in 13.5% on the right. In some cases it is seen as a simple, deep notch. It is found much less frequently at L4 and almost never seen above. It is equally rare at the sacral level where it is formed by a narrowing and closure of the groove between the zygapophyseal joint and the sacral lateral mass. The authors propose that these bony foramina are a manifestation of osteoarthritic changes and that they could, in certain cases, irritate or compress the dorsal ramus along its passage.

Humans↗
PubMed1991

Upper thoracic dorsal rami: anatomic study of their medial cutaneous branches.

The authors describe the distribution of the medial branches of the upper thoracic dorsal rami (T1 to T5 levels). At each level, after travelling through the erector spinae, they become superficial, and reach the apex of the spinous process of the corresponding vertebra. They then spread out laterally, innervating the skin. They can occasionally be compressed by paravertebral tendons, and this possibly contributes to certain forms of dorsal pain. Anastomosis of the dorsal cutaneous branch of the second thoracic nerve (T2) with the descending lateral branch of the accessory nerve has been observed. Its presence could explain the occasional clinical situations where there is no resultant paralysis from accidental surgical section of the latter nerve.

Female↗
PubMed1991

Trigger point of the posterior iliac crest: painful iliolumbar ligament insertion or cutaneous dorsal ramus pain? An anatomic study.

A trigger point is frequently found over the iliac crest at 7 to 8 cm from the midline in low-back-pain syndromes. Previously, this was described as either a painful insertion site of the iliolumbar ligament or pain in the distribution of the cutaneous dorsal ramus of the first or second lumbar nerve. The authors performed 37 dissections, and they report their anatomic findings. The iliac insertion of the iliolumbar ligament is inaccessible to palpation, being shielded by the iliac crest. The dorsal rami of L1 or L2 nerve roots, however, cross the crest at 7 cm from the midline, and this distance closely correlates with the dorsal projection of the iliolumbar ligament insertion. These rami are superficial and dorsal to the crest, easily accessible to palpation. In two of the 37 dissections performed, some rami were found to be narrowed as they crossed through an osteofibrous orifice over the crest, thus being susceptible to an entrapment neuropathy. The authors conclude that the trigger point sometimes localized over the iliac crest at 7 cm from the midline likely corresponds to elicited pain from a cutaneous dorsal ramus originating from the thoracolumbar junction rather than from the iliac insertion of the iliolumbar ligament.

Back Pain↗
PubMed1991

[X-ray computed tomographic study of the outcome of lumbar disk hernia after conservative medical treatment (34 cases)].

The subject of this prospective study was to appreciate the natural history of 34 herniated lumbar nucleus pulposus after recovery excluding surgical or intra-discal therapy. First CT scan was performed when radicular pain was worst, second CT between 1 and 32 months after recovery (6 to 40 months after the first CT). After the first 18 months, 18 herniations decreased more than 50% (group I) and 7 less than 25% (group II). Most herniations of group II were large or middle sized and two narrowing of discs were observed between the two CT. Group II was made of small sized herniations and 4 discs out of 7 narrowed. Beyond 18 months, herniations decreased more than 75% excepted one being calcified. Decrease of herniations and of intra-discal pressure were observed in the study. Both could allow recovery.

Adult↗
PubMed1989

The lateral cutaneous branches of the dorsal rami of the thoraco-lumbar junction. An anatomical study on 37 dissections.

Thirty-seven dissections have shown that the skin of the low back is innervated by the lateral branches of the dorsal rami of T12 and LI in 22 cases (60%) or T12 L1 and L2, in 10 cases (27%) or T12 L1 and L2 receiving an anastomosis from L3 in 5 cases (13%). The most medial nerve crossed the iliac crest through a rigid osseo-aponeurotic orifice located 7-8 cm from the midline which was seen compressing the nerve in 2 instances. This pattern of distribution may sometimes explain unilateral low back pain.

Adult↗
PubMed1989

[Pain in the trochanteric region caused by tunnel compression of the lateral cutaneous perforating branch of the ilio-hypogastric nerve. Indications for neurolysis].

After consideration of anatomical and clinical studies, the authors describe a new tunnel syndrome involving the lateral cutaneous branch of the iliohypogastric nerve as it emerges above the iliac crest. Irritation of the strangulated nerve produces pain over the lateral aspect of the hip. In 7 cases where local infiltration failed, neurolysis was carried out and produced excellent results in 5 patients, thus confirming the pathophysiology of this syndrome.

Female↗
PubMed1988

[Anatomical study of the cutaneous innervation of the lumbosacral region. Application to the physiopathology of certain lumbalgias].

30 dissections have confirmed that the skin of the gluteal area is innervated by the posterior branches of T12 and L1, 19 times out of 30 (64 p. cent) or T12, L1 and L2, in 8 instances (26 p. cent) or T12, L1 and L2 receiving an anastomosis from L3, in 3 instances. This explains certain lumbo-gluteal pain coming from the dorso-lumbar area ("low lumbalgias of high origin"). In addition, the posterior branch, the most medial (most of the time L1, sometimes L2) goes through an osteo-aponeurotic channel formed by the iliac crest below and the dorso-lumbar fascia above. This channel, located at 7 or 8 cm of the spinal process, may be at the origin of a neuropathy. It projects at the same level in relation to the mid-line as the iliac insertion of the ilio-lumbar ligament. The latter seems impossible to feel as it is too deep and hidden by the superficial aspect of the iliac crest. Lumbalgias, sometimes related to a strain of this ligament, seem to be, most of the time, the result of an irritation of the posterior branch of L1 or L2.

Back Pain↗
PubMed1986

Anatomic study of the lateral cutaneous rami of the subcostal and iliohypogastric nerves.

On the supposition that some "pseudocoxalgias" might be due to a neuralgia of the lateral rami leaving the subcostal and iliohypogastric nerves above the lateral edge of the iliac crest, the authors undertook an anatomic study of their pathways and pattern of distribution. These rami supplying the skin below the iliac crest, which they cross close together, the ramus arising from the subcostal nerve by perforating the internal and external oblique abdominal muscles, that arising from the iliohypogastric nerve a little lower, creating a bony groove palpable in thin subjects and transformed into an osseomembranous tunnel by the aponeurosis of these muscles. This arrangement may give rise to an entrapment syndrome. At this intersection, the course is either vertical or "bayonet-shaped", directly subcutaneous, and hence exposed to possible friction and microtraumata (tight clothes). The two rami are of unequal length. Frequently, the ramus arising from the subcostal nerve is short, not exceeding 10 cm, below the iliac crest, thus corresponding to the usual description. That arising from the iliohypogastric nerve descends further, passing 3 to 5 cm anterior to the great trochanter. It ends either at this level or 8 to 10 cm below. This accounts for the distribution of the pain felt when there is irritation of this ramus.

Female↗
PubMed1986

[Syndrome of perforating lateral branches of the subcostal and ilio-hypogastric nerves. An unrecognized cause of hip pain].

The authors report 10 cases of pain in the outer surface of the hip related to damage of the perforating lateral branch of the subcostal or ilio-hypogastric nerve, which innervate this region. Anatomic investigation showed that there was a possibility of canal neuropathy, the possible mechanisms and signs of which are discussed. In general, treatment consisted of local infiltrations, but one patient underwent surgery with highly successful results.

Arthritis↗
PubMed1980

Low back pain of thoracolumbar origin.

Low back pain arising from the apophyseal joints of the thoracolumbar region is common and is often erroneously attributed to pathologic changes in the low back. The diagnosis is made on pure clinical grounds. Classic signs are: a positive "iliac-crest point" test, a positive skin-rolling test, localized tenderness over a certain spinous process at the thoracolumbar junction and tenderness over the involved apophyseal joint. The diagnosis is confirmed by a periapophyseal joint block using a local anesthetic. Of 350 patients seen in a back pain clinic, 40% were found to have pain of thoracolumbar origin. Treatment included manipulation, infiltration with corticosteroids, electrocoagulation and/or surgical denervation of the involved apophyseal joint.

Adolescent↗
PubMed1979

[First results of a surgical treatment of a persistant low-back pain of dorso-lumbar origin].

Low-back pain may originate in the thoraco-lumbar joints. Due to motion and stress, the latter constitute a high-risk transitional zone. Pain is transmitted by the posterior branches of the D11, D12 or L1 spinal nerves, which innervate the cutaneous and subcutaneous levels of the low-back and upper buttocks region. It is experienced as a deep-seated pain. Clinical examination makes it possible to determine the level responsible. The lumbar pain disappears with anesthesia of the interapophysary articulation. Appropriate medical treatment most often succeeds. If its fails, surgery can provide a solution. It consists of a capsulectomy on the level responsible, and on the upper and lower adjoining regions. This operation also destroys the posterior branch, which is closely joined to the capsule. Out of the 10 cases operated on, there was 1 failure, 6 very good results and 3 good results after follow-up periods of 20 months to 6 months. Without prejudging the future, it seems that there is hope for the treatment of unexplained back pains or those persisting after operations on lumbar disks that are not relieved by appropriate medical treatment of the thoraco-lumbar joints.

Adult↗
PubMed1978

[Low back pain of dorse-lumbar origin: surgical treatment of postérlor articular capsule excision (author's transl)].

Low back pain may be of dorso-lumbar spinal origin. Pain is transmitted via the posterior branches of the D11, D12, and L1 spinal nerves. The existence in the patient with lumbago of an area of localised pain along the iliac crest, of subcutaneous tenderness or pain in the buttock and of pain over the dorso-lumbar joints is indicative of the diagnosis. Local infiltration at the site of dorso-lumbar tenderness often causes the low back pain to disappear, often temporarily. Since the posterior branches of the spinal nerves are struck down to the capsules of the inter-apophyseal joints, it was felt that excision of these capsules would reproduce, in a permanent manner, the effects of these infiltrations. On the basis of initial results these are grounds for hope relief for certain cases of unexplained lumbar pain or of the sequellae of low lumbar surgery.

Back Pain↗