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PubMed1999

c-Fos expression in the myenteric plexus, spinal cord and brainstem following injection of formalin in the rat colonic wall.

Fos expression induced by injection of dilute formalin (50 microl, 5% in physiological saline) into the colonic wall was examined in the myenteric plexus, lumbosacral spinal cord and brainstem of the rat. The aims of this study were (i) to determine whether neurons in these regions express Fos in response to the injection of formalin into the colon and (ii) to examine whether administration of an alpha 2 adrenoceptor agonist modulates Fos expression. Tissues were removed 2 h after the injection of saline or formalin. Saline injected in the colon induced Fos in enteric glia in the myenteric plexus. The number of Fos immunoreactive nuclei significantly increased in both myenteric neurons and enteric glia after the injection of formalin. Similarly, Fos immunoreactive neuronal nuclei were significantly increased in the spinal cord, area postrema and nucleus of the solitary tract after the injection of formalin. Pretreatment of rats with the alpha 2 adrenoceptor agonist xylazine (2, 4 and 8 mg/kg) 15 min before the injection of formalin, dose-dependently reduced the number of Fos immunoreactive neuronal and glial nuclei in the myenteric plexus, and neuronal nuclei in the spinal cord and brainstem. Simultaneous administration of xylazine (8 mg/kg) and the alpha 2 adrenoceptor antagonist yohimbine (1 mg/kg) reversed the effects of xylazine in the spinal cord and brainstem, but not in the myenteric plexus. These data show that injection of formalin in the colonic wall results in Fos expression in myenteric neurons and enteric glia, and neurons in the spinal cord and brainstem. This may be due to the direct chemical stimulation of the innervation of the colon and/or the subsequent acute colitis. The observed neuronal Fos expression can be modulated by an alpha 2 adrenoceptor agonist through noradrenergic pathways and/or reduction of the excitability of the enteric neural circuitry.

Journal Article↗
PubMed2001

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation.

Transient or persistent alterations in the L5 lumbar nerve root have been described as a complication after the reduction of spondylolistheses. In a retrospective analysis of our own patients, we observed a higher incidence of transient motor and sensomotor deficits after single-sitting anatomic correction of May-erding grade IV anterolistheses and spondyloptoses. These findings are consistent with those of other authors. The deficits pertained to muscles in the innervation range of the L5 nerve root, without there being any evidence of intradural root damage or nerve compression. In vitro studies have shown distraction and translation of the nerve root to be pathogenetically relevant mechanisms, leading to damage during intraoperative reduction. Additional alteration of neuronal structures may be caused by ventral parts of the iliolumbar ligament complex during the reduction maneuver. In order to reveal extradural constrictions of the L5 nerve root that might predispose towards intra- or perioperative damage, we examined anatomic specimens to determine the course and neighboring relationships of the lumbosacral plexus, especially in relation to pelvivertebragenic ligamentous connections. In addition to the morphologic considerations, we conducted translation tests, which were designed to simulate changes in shape and size of the epineural layer, as well as in vitro measurements of the resulting pressure on the nerve. In addition to a range of variations in the attachment of the iliolumbar ligament complex, which was always located dorsally to the nerve roots, we found a ligamentous connection formed by connective tissue between the sacrum and the fifth lumbar vertebral body on the caudal margin of the ligament apparatus in 14 out of 30 specimens. Its course was constantly ventral to the L5 nerve root, which was also adherent to the periosteum of the sacrum distal to this constriction in one-fifth of the specimens. The average pressure exerted on the nerve root during the distraction and translation process was over 30 mmHg in the area of this lumbosacral ligamentous connection, at a distance of greater than 20 mm. When the translation distance was further increased, perineural fatty tissue was discharged, due to increasing perineural pressure.

Aged↗
PubMed1986

Lumbar synovial or ganglion cysts.

Most reports regarding synovial cysts of the spinal canal have been presentations identifying an unusual pathological entity that is to be included in the differential diagnosis of cauda equina compression syndromes. Most of the 26 cases reported represent isolated examples of this pathological process. We present five cases of lumbar synovial cysts encountered in our practice in the past 8 years. Patients with lumbar synovial cysts do not demonstrate any predictable clinical picture. They may present with a unilateral sciatica or neurogenic claudication. Lumbar extension is usually restricted, whereas flexion is full. Mechanical signs of nerve root entrapment or lumbosacral plexus irritation are unimpressive. Neurological deficits are usually mild, if present. Radiological findings include degenerative spondylosis, spondylolisthesis, and a rounded posterolateral extradural mass of low attenuation value adjacent to a facet shown on computed tomographic scan. The etiology of lumbar synovial cysts is not known. Histological findings of myxoid degeneration, microcystic change, calcification, and hemosiderin deposits suggest that chronic microtrauma with occasional focal hemorrhage may play a major role in the etiology of the cysts. With resection of the cyst, the postoperative course is usually uneventful. Recurrences have not yet been encountered in our patients.

Adult↗
PubMed1985

[Intrathecal alcohol neurolysis of the lower sacral roots in inoperable rectal cancer].

Intrathecal neurolytic blocks are performed with either 95% alcohol or with 6-8% phenol in glycerin. Alcohol is hypobaric and phenol hyperbaric compared with the cerebrospinal fluid; positioning of the patient must therefore be done accordingly. This is a report about 67 consecutive neurolytic alcohol blocks of the lower sacral roots. Although lumbar puncture is done at the lowest possible level at L5-S1, the block only affects the roots from S3 or S4 downwards. The detailed anatomy of the caudal dural sack reveals why S1 and S2 are not affected. S1 and S2 contribute to the lumbosacral plexus and are important for the innervation of the lower extremities. However in patients with very low CSF pressure, S2 and S1 might become damaged. This is the most important result of this series. To avoid an unexpected extension of the block in patients with very low CSF pressure, we now recommend that synthetic CSF be instilled prior to alcohol. The results were unsatisfactory in patients with perineal pain and pain in the lower extremities as well. In these cases S2 or S2 + S1 are already affected by the tumor. One should employ other therapeutic procedures (e.g., epidural morphine) for these patients. After careful selection of patients, alcohol neurolysis of the lower sacral roots is a useful procedure.

Ethanol↗
PubMed1999

Lumbosacral anterolateral spinal arteries and brief review of "accessory" longitudinal arteries of the spinal cord.

The lumbosacral anterolateral spinal arteries (LALSA) were studied in 14 injected lumbosacral spinal cords. Contrary to many previously published opinions, which claimed that virtually all of the formerly described "accessory" longitudinal arteries of the vasa corona, were too inconstant to be of significance, the LALSA in this series were reliably present bilaterally and averaged a length of 8.4 cm. They ran in the acute angles formed by the emergence of the fascicles of the lumbosacral anterior spinal nerve roots and in this position, served as the origin for most of the proximal radicular arteries that supply the cranial half of the motor roots of the cauda equina. A review of the literature and analysis of other accessory longitudinal spinal arteries revealed that two other pairs of accessory spinal vessels, the lateral cervical spinal arteries (LCSA) and the lateral spinal arterial axes (LSA), have a demonstrable functional role and were sufficiently constant, along with the LALSA, to warrant inclusion in detailed descriptions of human spinal cord vasculature.

Cadaver↗
PubMed1980

Peripheral neuroepithelioma: a light and electron microscopic study.

A primitive neuroectodermal tumor of peripheral nerve origin was examined by light and electron microscopy. The lesion arose in association with the S1 nerve root of the lumbosacral plexus in a 22-year-old female. Following a surgical biopsy, the patient received systemic chemotherapy; however, approximately one-and-a-half years later, she suffered a clinical relapse with locally recurrent tumor. An excisional biopsy was performed, and pathologic examination revealed progressive neuroblastic differentiation. The ultrastructural features of neoplastic Homer-Wright rosettes will be illustrated, and the non-specificity of cytoplasmic glycogen in the evaluation of "small round cell neoplasms" will be emphasized.

Adult↗
PubMed1980

The carcinomatous neuromyopathy of oat cell lung cancer.

A prospective controlled clinical-neurophysiological-pathological study of 71 patients with oat cell carcinoma of the lung revealed no increased incidence of peripheral neuropathy at the initial stages of illness. All patients developed neuropathy by the time they had lost 15% of their body weight, but the neuropathy was less severe than in 20 age-matched alcoholic patients with an equal degree of weight loss. The weight loss and peripheral neuropathy progressed with atrophy of type II (adenosine triphosphatase-positive) muscle fibers out of proportion to the patient's loss of body weight. By 40% body weight loss, all the patients had moderate symmetrical peripheral neuropathy, 6 had proximal brachial or lumbosacral plexus metastases, and 9 had distal pressure palsies. Mononeuritis multiplex developed in only 1 patient, who had diabetes mellitus. Two patients developed Eaton-Lambert syndrome, which resolved in 1 when chemotherapy controlled the systemic tumor, with no protein in the tumor postmortem which could produce the characteristic electromyographic findings of the syndrome.

Adult↗
PubMed1991

The sympathetic role as an antagonist of erection.

The effects of the lumbar and pelvic sympathetic system on penile erection were studied in a canine model. Erection was induced by cavernous nerve stimulation and detumescence by sympathetic trunk stimulation. Erection induced by cavernous nerve stimulation normally subsides slowly. After discontinuation of electrical stimulation the intracavernous pressure drops within a mean of 291 s to 50% and after a mean of 372 s to 10% of the highest level. However, stimulation of the sympathetic trunk at the level of L4-S1 applied directly after discontinuation of cavernous nerve stimulation accelerated this drop of intracavernous pressure significantly: to 50% after a mean of 19 s and to 10% after a mean of 36 s. If stimulation of the sympathetic trunk was initiated 20 s before cavernous nerve stimulation, the pressure rise was aborted completely. Neurostimulation of the hypogastric nerves alone or in combination with cavernous nerve stimulation did not change the intracavernous pressure. These results were not altered after neurotomy of the pudendal or hypogastric nerves. The main pathway of the fibers from the sympathetic trunk to the penis seems to run via the pelvic plexus. The stimulation voltage and frequency to induce erection or detumescence were equivalent. Our results suggest that an elevated central sympathetic tone may be one of the causes of psychogenic impotence.

Animals↗
PubMed1997

A case of a neurological complication after transvaginal oocyte retrieval.

A patient is described who developed neurological signs of the left leg following transvaginal ultrasound-guided puncture. A hypodense lesion of the obturator space above the lumbosacral plexus was seen on ultrasound which could explain her signs, due to compression by a hematoma. She recovered completely.

Adult↗
PubMed1997

[Differential sciatica pain diagnosis from the neurologic viewpoint].

Low back pain and sciatica with or without neurological deficits represent frequent disorders in clinical practice. Both, history and neurological examination are essential for localizing underlying lesions and initiating appropriate investigations. Pain location, sensory symptoms, motor signs and reflexes are extremely reliable in indicating which motor root(s) or peripheral nerve(s) are affected. Sometimes, pain and/or paraesthesia are the only presenting symptoms. Therefore differential diagnosis of low back pain and sciatica is various. This article summarizes the differential diagnosis of low back pain and sciatica according to the site of the lesion as follows: 1. lesions of the spinal cord, 2. lesions of the nerve roots (L4, L5, S1-S3), 3. lesions of the lumbosacral plexus, 4. peripheral nerve lesions (sciatic nerve, peroneal nerve), 5. low back pain and sciatica due to neuropathies, and 6. low back pain and sciatica as a symptom of other neurological disorders. Additionally, the status of neuroradiological procedures in establishing diagnosis is discussed.

Diagnosis, Differential↗
PubMed2000

[Associated injuries in severe pelvic trauma].

There has been a marked increase in the incidence of pelvic fractures over the last few years. Associated injuries to the urogenital and vascular system as well as nerve injuries worsen the prognosis. Over a five year period 126 patients with severe pelvic trauma were treated. Out of these 39 (30.9%) sustained additional peripelvic injuries and represent the study sample. Type B injuries according to the AO classification occurred in 16 (41%) patients, type C fractures in 23 (59%) patients. The spleen, liver and kidney were the most frequently injured organs (58.9%), followed by urogenital lesions (46.6%), nerve injuries (25.6%) and vascular lesions (15.3%). The most common extrapelvic lesions were thoracic injuries in 56.4% and severe head injuries (GCS < 8) in 33.3%. The mean Hannover Polytrauma score was 35.6 points, the mean Injury Severity Score 27.6 points. Osteosynthesis was performed in 21 pelvic ring fractures (53%), eight procedures (50%) in type B fractures and 13 (56%) in type C fractures. In type B injuries the anterior pelvic ring was stabilized with a tension band wiring in four cases, in two patients with an external fixator and with plate osteosynthesis in one case. In type C injuries the external fixator was applied as the only stabilizing procedure in six patients. In four cases the anterior ring was fixed with tension band wiring or plates and the dorsal aspect of the pelvic ring with sacral bars. Three patients had their additional acetabular fracture plated through a anterior approach. All surviving 28 patients were followed up for an average of 18 months (range 7-59 months) after the trauma. The patients were classified using the pelvic outcome score proposed by the German Society of Trauma Surgery. 53.4% of the type B fractures showed a good clinical outcome, 47.6% a poor outcome. 15.4% with type C fractures presented with a good outcome, 84.6% with a poor outcome. 80% of the type B and 23% of the type C fractures had a good radiological outcome. 20% of type B and 77% of type C injuries had a poor radiological outcome. Five patients (12.8%) sustained persistent urological symptoms. Three of these had urinary dysfunction, two used permanent cystotomies due to their severe neurological deficit after a head injury. Ten patients with nerve injuries at the time of trauma suffered long term neurological dysfunction of the lumbosacral plexus. The mortality rate was 28%. Seven patients died in the emergency room due to uncontrollable bleeding, four in the intensive care unit from multi-organ failure. The management of complex pelvic trauma consists of fracture treatment and interdisciplinary treatment of the associated injury. Lesions of the abdominal organs or of major vessels must be addressed first if hemodynamic instability is present. Injuries to smaller vessels can be embolized percutaneously. Urinary bladder ruptures are treated as an emergency, urethral lesions electively after four to six weeks. We recommend external fixation of the pelvis in the acute phase for control of both the osseous instability and control of haemorrhage through external compression. The treatment of choice for the anterior pelvic ring is tension band wiring or plating. If this is contraindicated due to an open fracture external fixation is the treatment of choice. Type C fractures require posterior ring stabilization which should be postponed until four days post admission.

Abdominal Injuries↗
PubMed1987

The critical hypogastric circulation.

Eleven patients had ischemic complications secondary to ligation, hypoperfusion, exclusion, or thrombosis of the hypogastric arteries after aortoiliac reconstruction or spontaneous aortoiliac thrombosis. Ligation of one hypogastric artery resulted in persistent ipsilateral buttock claudication in three patients. Bilateral acute hypogastric artery ischemia occurred in eight patients and resulted in paralysis in all eight patients, buttock necrosis in four patients, anal and bladder sphincteric dysfunction in two patients, and colorectal ischemia in three patients. Five of these patients (63 percent) died. The mortality rate was 100 percent when buttock necrosis developed. In most of these patients, the neurologic deficit suggested ischemic injury of the lumbosacral plexus rather than spinal cord ischemia. These complications occurred despite patent bypass grafts to the iliac or femoral vessels. These observations suggest that it is essential to maintain patency of the hypogastric vessels in all aortoiliac reconstructions.

Aged↗
PubMed1989

Perineurial permeability and endoneurial edema during Wallerian degeneration of the frog peripheral nerve.

Perineurial permeabilities to [3H]sucrose and [14C]dextran (MW = 70,000), and water content, conduction velocity (CV) and maximum amplitude (MAP) of the compound action potential, were determined in Wallerian degenerated nerves (sciatic or tibial) of the frog and compared with values in the contralateral uncut nerves. Three days after transection of the lumbosacral plexuses, about 2 cm proximal to the sciatic nerve, mean water content of the sciatic nerve was significantly higher than in the contralateral uncut nerve. After 10 days, the degenerating sciatic nerve showed significant increases in the mean perineurial permeabilities to [3H]sucrose and [14C]dextran when compared to values in the contralateral nerve. Means MAP's and CV's were significantly decreased. At 21 days and after, no compound action potential was detected and perineurial permeability and nerve water content had increased further. Decreases in mean MAP's and CV's and permeability increases of the perineurium were less in degenerating tibial nerves than in degenerating sciatic nerves. It is concluded that following transection, (1) Wallerian degeneration produces an irreversible increase in perineurial permeability, (2) the increase of perineurial permeability follows a proximodistal gradient, and (3) the frog peripheral nerve develops endoneurial edema during Wallerian degeneration as do degenerated nerves of mammals.

Action Potentials↗
PubMed1982

Urinary striated sphincter: what is its nerve supply?

Innervation of the voluntary urinary sphincter continues to be a controversial subject. Using retrograde axonal transport techniques to determine the exact nerve supply to the external sphincter has been successful in clarifying this controversy. 1-5 Tracing the transport of horseradish peroxidase (HRP) injected in the voluntary external sphincter and that injected directly in the cut end of the pudendal nerve was done. Transport from both sides ended in the same neurons in the dorsolateral column, thus labelling and identifying the pudendal nucleus which is the motor center for the voluntary urinary sphincter.

Animals↗