SEARCH · PubMed Health

Results for “SACRAL PLEXUS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources

PubMed1991

[Innervation of the sacroiliac joint. Macroscopical and histological studies].

Macroscopical and histological studies were carried out to clarify nerve innervation of the sacroiliac joint which is believed to have a role in the development of low back pain. Eighteen Japanese adult cadavers were used for gross anatomical examination and six for histological examination of the nerve supply to the joint. The results were as follows: 1) It is suggested by the gross examination that the upper ventral portion of the joint is mainly innervated by the ventral ramus of the 5th lumber nerve. 2) The lower ventral portion of the joint was mainly supplied by the ramus of the 2nd sacral nerve or branches from the sacral plexus. 3) Lateral branches of the dorsal ramus of the 5th lumber nerve were considered to be the main nerves which innervated the upper dorsal portion of the joint. 4) The lower dorsal portion was innervated by nerves arising from a plexus composed of lateral branches of the dorsal rami of the sacral nerves. 5) The nerves which innervate the joint range in diameter from 0.292 mm to 0.997 mm, and no difference was found among those in the four subdivisions of the joint. 6) Histological examination revealed that nerve fibers and the terminals were present in the joint capsule and adjoining ligaments. The nerve fibers varied from 0.2 micron to 2.5 microns in diameter and ended with five morphologically different terminals.

Adult↗

PubMed1991

Blood lymphocytes are sensitized to branchial plexus nerves in patients with neuralgic amyotrophy.

The percentage of lymphocytic subsets in the blood of cases with neuralgic amyotrophy (NA), and the proliferative response of blood lymphocytes cultured with different nerve extracts, obtained from normal subjects at postmortem, were examined in 6 patients with NA and in 18 age-matched controls with shoulder pain not related to NA. Most (5/6) NA patients had decreased CD3 values and increased CD4/CD8 ratios due to a decreased of the CD8 subset. Lymphocytes of NA patients increased their blastogenic activity in cultures with nerve extracts from different brachial plexus nerves and its branches, but not in cultures with extracts of sacral plexus nerves. Cultures did not respond to nerve extracts in any of the control cases, although mitogenic activity was similarly elicited in cultured lymphocytes stimulated with phytohemagglutinin in both control cases and NA patients. These results suggest that NA is probably an immune mediated disease.

Adolescent↗

PubMed1993

Lumbar plexus block: an anatomical study.

The anatomy of the lumbar plexus and the various approaches used to perform lumbar plexus blockade are reviewed. A single needle technique for a posterior approach to the plexus at the L2-3 interspace is described. This technique was used bilaterally in six intact cadavers, and the extent of spread of an injected dye was documented photographically during a subsequent detailed dissection of the region. In all cases, dye was confined to the posterior part of the psoas muscle, and tracked down the nerves of the lumbar plexus. No dye was seen anterior to the psoas, around the sympathetic chain, on the sacral plexus or in the extradural or subarachnoid spaces. Further studies in patients with needle position and drug disposition being confirmed using computerised tomography and X ray scanning were in agreement with the results observed in the cadavers. This technique represents a simple approach to the lumbar plexus which does not require needle localisation by X ray screening.

Humans↗

PubMed1988

Neurophysiologic maps of the cutaneous innervation of the external genitalia of the ewe.

The area of skin supplied by the afferent fibers in a peripheral nerve is called the cutaneous area (CA) of that nerve. The CA responsive to movement of wool or hair in the genital regions were mapped in 17 ewes, with the identifications of the peripheral nerves and of the spinal nerves contributing to the pudendal plexus being checked at necropsy. Differences were found in the origins and extent of CA of the cutaneous branches from the sacral plexus. The CA of the caudal rectal nerves and of a nerve that passed caudally between the caudal vertebrae and the ventral sacrococcygeus muscle lay lateral to the anus and in the adjacent skin of the tail. The CA of the proximal cutaneous branch and of the distal cutaneous branch from the pudendal nerve (or plexus) overlapped craniocaudally (by approx one-half) the CA of the distal cutaneous branch extending ventrally and ending just caudal to the ipsilateral mammary gland. The deep perineal nerve innervated the skin immediately lateral to the anus and vulva. The dorsal nerve of the clitoris innervated hairs on the ipsilateral half of the vulva. Other fibers in the pudendal nerve were presumed to pass into the mammary branch of the nerve. They innervated the skin ventral to the vulva, the ipsilateral mammary gland, and (in some ewes) areas of the skin cranial to the mammary gland. The CA of the genitofemoral nerve included the ipsilateral teat and the inguinal fossa.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

[Lumbosacral plexus block by the paravertebral route].

The authors present a detailed account of a technique of peripheric anesthesia of the lower limb, obtained with a single transcutaneous injection, blocking lumbar and sacral plexus, by a paravertebral way. Encouraging results have been reached in the treatment of both old (no cerebral or cardiorespiratory depressant effects) and young patients, which are frequently under day-hospital treatment. According to their experience, this technique is simple, easy to perform and less dangerous if compared to anesthesia obtained by spinal approach.

Adult↗

PubMed1977

[Post-traumatic and post-operative paresis of the leg plexus (author's transl)].

Post-traumatic and post-operative leg-plexus paresis is often misdiagnosed as sciatic or femoral paresis and thus falsely thought to be rare. In 20 post-traumatic cases the cause was predominantly or exclusively due to sacral plexus damage, with paralysis of the muscles innervated by the sciatic nerve and of the gluteal muscles. The most frequent cause was severe pelvic trauma with ring fracture of the pelvis, separation of the symphysis and iliosacral gap or fracture of the hip joint. Postoperative leg-plexus paresis was noted in eight cases after total hip-joint replacement (predominantly damage to the lumbar plexus) and twice after operatively treated fracture of the acetabulum. Both pressure and tearing lesions can be the basic cause.

Adolescent↗

PubMed1987

Neuroanatomy and clinical significance of the external urethral sphincter.

Although the topographic muscular architecture of the pelvic floor is essentially understood, its nerve supply and functional anatomy remain controversial. We therefore dissected 3 male human cadavers by tracing the entire sacral plexus and the pudendal nerve from the cada equina down to their final destination. Our anatomic dissection demonstrated that the voluntary external urethral sphincter mechanism is augmented by two separate muscular components: the levator ani and the transversus perinei muscle. Urodynamic findings with sacral neurostimulation support our anatomic description.

Adult↗

PubMed2002

Continuous sacral nerve root block in the management of neuropathic cancer pain.

IMPLICATIONS: Neuropathic cancer pain caused by tumor infiltration in the sacral plexus is primarily treated by nonsteroidal antiinflammatory drugs, antidepressants, anticonvulsants, and opioids. In one patient with severe pain despite pharmacotherapy, a catheter for the continuous administration of local anesthetics was inserted along the first sacral root, resulting in markedly improved analgesia.

Adult↗

PubMed2006

Histopathological and immunohistochemical study of the enteric innervations among various types of aganglionoses including isolated and syndromic Hirschsprung disease.

We investigated enteric innervations in 15 isolated and five syndromic cases of Hirschsprung disease (HSCR) with immunohistochemistry for the S100 protein (S100), class III a-tubulin (TUJ1), peripherin, neuronal nitric oxide synthase (nNOS) and CD34. The number of neurites per smooth muscle unit of the circular muscle layer (CML) was counted in the longitudinal sections. TUJ1 was the best marker to detect whole neuritic networks of the enteric nervous system. There were differences in the innervation patterns between isolated rectosigmoid aganglionosis (RS) and long segment aganglionosis (LS) including total colonic aganglionosis and extensive aganglionosis. In the aganglionic bowel (AGB) of LS, no nerve fibers innervated smooth muscle units in the CML in the area from the small bowel to the terminal descending colon. In the rectosigmoid region of every type of isolated HSCR, we observed transmural nerve fibers forming meshworks in the CML with TUJ1 and S100 antibodies. In RS, the neurites running parallel with smooth muscle cells gradually decreased in number in the distal portion. However, in the rectosigmoid AGB in LS, those neurites were absent and most neurites perpendicularly crossed the CML. Hypertrophic nerve trunks (HNT) in the submucous and myenteric plexuses were observed more frequently in the rectosigmoid region than in the rostral portion. Based on these data, it is suggested that the neuritic meshworks in the CML of the rectosigmoid AGB might derive from not only the sacral plexus, via HNT, but also intrinsic neurons in the oligoganglionic bowel. All of the syndromic HSCR were RS. In the AGB of RS with Down syndrome, the distribution of neurite meshworks in the CML is markedly reduced. In the AGB of RS with mental retardation suspected of having Mowat-Wilson syndrome, the density of intramuscular innervation was comparatively higher. In the rostral portion to the AGB of syndromic HSCR, myenteric ganglia were clearly small in size, and more numerous per smooth muscle unit with scarce internodal strands. These dysplastic features fall under neither hyperganglionosis nor hypoganglionosis classifications. We considered that syndromic HSCR might occur on the basis of a dysplastic enteric nervous system caused by genetic alteration.

Child, Preschool↗

PubMed1990

Neuroanatomy of the striated muscular anal continence mechanism. Implications for the use of neurostimulation.

The striated pelvic floor musculature and the striated muscle of the external and sphincter contribute to anal continence by effecting, respectively, the rectoanal angulation of the bowel and an anal high pressure zone. The muscular anatomy of the pelvic floor is generally understood, but the neuroanatomy remains controversial. The authors dissected three male cadavers and traced the sacral nerves from their entrance into the pelvis through the sacral foramina throughout their branching to their final destinations. Deriving from a common source, the sacral nerves S2 to S4, the neural supply of the levator ani was distinct from that of the external anal sphincter: the levator is supplied by direct branches splitting from the sacral nerves proximal to the sacral plexus and running on the inner surface; the external anal sphincter is supplied by nerve fibres travelling with the pudendal nerve on the levator's undersurface. To document the functional relevance of these anatomic findings, stimulation of the pudendal and sacral nerves was performed at different levels in five patients with lower urinary tract dysfunction. Stimulation of the pudendal nerve increased the anal pressure, whereas stimulation of S3 increased it only slightly but caused an impressive decrease of the rectoanal angle; when S3 was stimulated after bilateral pudendal block, anal pressure did not change but the decrease in the rectoanal angulation persisted. The changes in anal pressure could be obtained without fatigue at stimulation frequencies of 10 to 20 Hz.

Adult↗

PubMed1985

Acute bilateral brachial plexus neuritis associated with hypersensitivity vasculitis. A case report and review of literature.

The occurrence of brachial plexus neuritis during the acute phase of vasculitis is uncommon. We describe a patient with a long history of rhinitis and a recent onset of asthma, who developed purpuric skin lesions, abdominal pain, eosinophilia and brachial neuritis along with evidence of sacral plexus neuropathy. High dose steroids and cyclophosphamide induced a remission. He stopped all medications after 3 years and after 6 years the patient has some fixed minimal residual neurological deficit. The importance of aggressive therapy in treating extensive polyneuropathy during the acute phase of hypersensitivity vasculitis is raised. A possible cytotoxic role of eosinophils in the pathological process is suggested.

Acute Disease↗

PubMed2004

A review of sacral nerve stimulation for the treatment of faecal incontinence.

Sacral nerve stimulation is an emerging surgical technique that uses chronic low-level electrical stimulation, applied to the nerves of the sacral plexus, to produce a clinically beneficial physiological effect on the lower bowel, pelvic floor and anal canal. Faecal incontinence is common, maximal conservative therapy may improve some patients but many require surgery. Results are variable and often unsatisfactory and further options are limited, the traditional end-point being the formation of a colostomy. Sacral nerve stimulation appears to be an alternative treatment that is successful, has low morbidity, is maintained in the medium term and associated with an improved quality of life. The technique has the advantage of a minimally invasive test procedure with high predictive value and the surgery is minor. The underlying mechanism of action although predominately neurological in nature remains to be determined. Precise patient selection is currently unclear however, results are superior to other techniques.

Electric Stimulation Therapy↗

PubMed2006

Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability.

STUDY DESIGN: Retrospective evaluation of 19 consecutive patients with sacral fracture dislocations and cauda equina syndrome. OBJECTIVE: To review the safety and patient impact of early surgical decompression, and rigid segmental stabilization in patients with high-grade sacral fracture dislocations. SUMMARY OF BACKGROUND DATA: The ideal treatment for patients presenting with fracture dislocations of the sacrum resulting from high-energy mechanisms remains unknown. Previous studies consisted of multicenter case reviews that showed satisfactory outcomes with either nonoperative or a variety of surgical methods. However, over the last 20 years, no consistent treatment algorithm for these severe injuries has emerged. The advent of rigid, low-profile segmental fixation of the lumbar spine to the pelvic ring has offered a solution to many of the surgical challenges. This study evaluates the rate of complications of this method. It is intended to serve as a foundation for further evaluation and development of this treatment strategy, and as a basis for future comparison studies. METHODS: Patients were treated with a formally established algorithm, including resuscitation, and clinical assessment with detailed neurologic assessment and radiographic workup with pelvic computerized tomography and reformatted views. Electrophysiologic testing was conducted to confirm the presence of sacral plexus injuries in patients who were unable to be examined. Patients received neural element decompression and open reduction with segmental internal fixation through a midline posterior approach by connecting lower lumbar pedicle screws to long iliac screws when the patient's general medical condition allowed for surgical intervention. A formal sacroiliac arthrodesis was not performed. For the purposes of this study, patients were assessed specifically for the following adverse events: (1) infection, (2) wound healing, (3) neurologic deterioration following surgical treatment, (4) postoperative loss of sacral fracture reduction, (5) instrumentation failure, (6) axial lumbopelvic pain requiring further treatment, and (7) unplanned secondary surgery. RESULTS: There were 19 patients with an average age of 32 years treated according to this algorithm. Fracture reduction was successfully maintained in all patients. During the index surgical intervention, 14/19 patients (74%) had had either a traumatic dural tear or nerve root avulsion. Major complications involved fracture of the connecting rods in 6/19 patients (31%) and wound healing disturbances in 5/19 (26%). There were no lasting complications such as chronic osteomyelitis noted. In patients followed over a 1-year period, the visual analog score, referable to the sacral injury, averaged 5.5 on a scale of 0-10. CONCLUSIONS: Rigid segmental lumbopelvic stabilization allowed for reliable fracture reduction of the lumbosacral spine and posterior pelvic ring, permitting early mobilization without external immobilizaton and neurologic improvement in a large number of patients. Complications were primarily related to infection, wound healing, and asymptomatic rod breakage, and were without long-term sequelae.

Adolescent↗

PubMed1988

Lumbar plexus block in children: a comparison of two procedures in 50 patients.

Two techniques for blocking the lumbar plexus were prospectively evaluated in 50 children undergoing surgery in the hip region and randomly allocated to one of two equal groups. A variant of the "psoas compartment block" and the classic technique were used in groups 1 (n = 25) and 2 (n = 25), respectively. All procedures were carried out under light general anesthesia with the patients in the lateral position using insulated needles and electrical stimulation. Both procedures were effective, allowing completion of surgery without additional treatment in almost all patients. However, the distribution of analgesia differed: 23 (ipsilateral) lumbar and sacral plexus blocks and 2 (ipsilateral) lumbar blocks alone were produced in group 2, compared to 22 areas of anesthesia comparable to those that might be associated with a lumbar epidural block and two ipsilateral lumbar plexus blocks in group 1. The two techniques are not, therefore, mere variants of the same basic approach to the lumbar plexus. The procedure described by Winnie et al. (Anesthesiol Rev 1974;1:11-6) was more suitable for providing unilateral blockade than the "psoas compartment block."

Adolescent↗

PubMed1989

Extent of blockade with various approaches to the lumbar plexus.

The extent of blockade when four different techniques were used for blocking the lumbar plexus was prospectively evaluated in 80 adult patients. The extent of blockade was measured by testing motor function of all nerves except the lateral and posterior femoral cutaneous nerves, which were evaluated by pinprick response. The posterior approaches of Dekrey at L3 (n = 20) and Chayen at L4-5 (n = 20) proved similarly effective in producing blockade of the femoral, obturator, and lateral femoral cutaneous nerves, as well as the nerves to the psoas muscle. The anterior approach of Winnie (femoral sheath or 3-in-1 block) using paresthesia (n = 20) or peripheral nerve stimulation (n = 20) proved effective in producing blockade of the femoral and lateral femoral cutaneous nerves, but ineffective for obturator nerve blockade. None of the four techniques produced blockade of the sacral plexus. Perhaps our means of assessing blockade (motor) is what produced the difference between our findings and those of others.

Humans↗

PubMed1976

Comparative morphological remarks on the origin of the posterior femoral cutaneous nerve.

The origin and course of the posterior femoral cutaneous nerve were observed macroscopically in 38 Japanese adult cadavers which were dissected in the University of Hokkaido, Faculty of Medicine during the years 1971/72 and the results obtained were compared with those from some other mammals (rat, rabbit, dog and cat) and a number of bibliographical findings on the other animals. On the basis of the archetype of the pudendal plexus, the site of origin of the posterior femoral cutaneous nerve was divided into seven portions as follows: the sciatic nerve or inferior gluteal nerve (I) and its originating roots (RI), the bigeminal nerve (B) and its originating roots (RB), the part of junction of I and B (CIB), the pudendal nerve (P) and its originating roots (RP). According to the arising mode, the posterior femoral cutaneous nerve was calssified into seven types: Type A (the sciatic nerve type); the nerve arises from I and RI (horse, rat, bird, frog and salamander). Type B (the sciatic transitional type); the nerve arises from I, RI, CIB, RB and B (MAN AND MONKEY). Type C (the bigeminal nerve type); the nerve arises from CIB, RB and B (gorilla, chimpanzee, orangutan, cat and sphenodon). Type D (the pudendal transitional type); the nerve arises from CIB, RB, B, RP and P (dog). Type E (the pudendal nerve type); the nerve arises from RP and P (pig, cattle and rabbit). Type F (the mixed type); a mixture of A to E types. These various patterns in the posterior femoral cutaneous nerve may be explained by the comparative anatomical explanation on the limb medial rotation given in Braus' text-book of Anatomy (Bd. I, S. 273). From these descriptions it is reasonable to presume that the main trunk of the posterior femoral cutaneous nerve of the tetrapod below the Aves arises from the sciatic nerve and is analogous to the gluteal branches of mammals, with its main stem still retained in the pudendal nerve. If the cutaneous area supplied by the posterior femoral cutaneous nerve expands to the lateral border of the buttock in company with the lower limb medial rotation, the part between this area and that supplied by the pudendal nerve is enlarged. At first, these expanded areas are probably supplied by the branches of the pudendal nerve, which gradually become independent to become the main stem of the posterior femoral cutaneous nerve in mammals. This nerve seems, therefore, to be primarily a division of the pedendal nerve, and so in man has various types of arising patterns, A to E, in accordance with the scheme in the phylogeny. Those hypothetical changes are observed in the human sacral plexus, from which the cutaneous nerve arises with a fan-shaped overlapping.

Animals↗

PubMed1998

L5 radiculopathy with reduced superficial peroneal sensory responses: intraspinal and extraspinal causes.

Thirteen patients were retrospectively identified with the electrodiagnostic pattern of combined L5 radiculopathy by needle electrode examination, and abnormality of the superficial peroneal nerve (SPN) sensory nerve action potential (SNAP) amplitude. To have combined L5-derived sensory and motor axon loss, lesions must be localized at or distal to the L5 dorsal root ganglion (DRG), but also proximal to the sacral plexus. Six patients had evidence of an active intraspinal canal (ISC) lesion, 3 had diabetes, and 4 had nonspecific causes. The ISC localization in at least 6 of our cases is counter to the commonly held electrodiagnostic dogma that L5 radiculopathy spares the SPN SNAP, but recent anatomic studies confirm the ISC location of up to 40% of L5 DRG. Thus loss of the SPN SNAP does not exclude ISC lesions.

Action Potentials↗

PubMed1989

Palliative laser therapy for inoperable rectal cancer--does it work? A prospective study of quality of life.

Endoscopic neodymium yttrium aluminium garnet (Nd YAG) laser therapy, is a new and simple method for the palliative treatment of inoperable colorectal cancer. To date the authors have treated 70 patients and the value of this method was assessed prospectively in 14 patients. Quality of life was measured before, during, and after treatment. The quality of life (QL) index, a physician's assessment and a linear analogue self-assessment (LASA) were used. A close correlation was found between the two assessment methods (r = 0.79). Overall there was a significant improvement from the mean pretreatment score and the best score achieved posttreatment (QL: P = 0.002; LASA: P = 0.002). Patients with diarrhea, rectal bleeding, mucus discharge, or pain secondary to tumor bulk, will benefit most from this treatment. Malignant cachexia, pain secondary to sacral plexus involvement, tumor encroachment on the anal canal and/or sphincter dysfunction resulting from tumor invasion should be viewed as relative contraindications to laser therapy. The authors conclude that in selected patients endoscopic laser therapy can provide effective palliation in patients with malignant tumors of the rectum and descending colon.

Aged↗