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PubMed1993

[Morphometric study of the lumbosacral plexus innervating the muscles of the rat pelvic floor].

Motoneurons of the pelvic muscles in the lumbo-sacral segment of the spinal cord have been extensively studied in different species. However, few informations occur in the literature about the individual morphology of each group of neurons and their connections. Thus, in the Rat we have studied the neuronal mapping of 5 pelvic muscles, bulbospongiosus, ischio-cavernosus, levator ani, sphincter ani, sphincter urethrae, using a retrograde tracer, the horseradish peroxidase (H.R.P.). Most of the muscles injected by H.R.P. receive their innervation from the motoneurons located in the homolateral side of the spinal cord. The motoneurons of sphincter ani (+/- 40) and those of the bulbo-spongiosus (+/- 50) have the same morphology. Their dendrites contact contralateral motoneurons. They are situated in the dorso-medial nucleus of the L5-L6 segments of the spinal cord. The motoneurons of the ischio-cavernosus (+/- 80) and those of sphincter urethrae (+/- 40) are situated in the dorsolateral nucleus of the L5-S1 segments of the spinal cord where they form two distinct groups. On the contrary, in the ventro-medial nucleus, the neurons are mixed. The dendrites in the dorso-lateral nucleus form an important longitudinal network. The motoneurons of the levator ani (+/- 50) are situated in the ventral nucleus of the L5-S1 segments. Our works demonstrate the significance of the dendritic networks: they could play a role in the synchronization and the activity of the pelvic muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1992

Prilocaine in lumbosacral plexus block--general efficacy and comparison of nerve stimulation amplitude.

The significance of the threshold amperage of peripheral nerve stimulation (PNS) for the efficacy and latency of sciatic block is shown in a controlled randomized study of stimulation amplitude. In all cases the block was complete within a short time when the threshold amperage was 0.3 mA or less. Incomplete motor and sensory blocks occurred with higher stimulation amplitudes of 0.5 and 1.0 mA. In view of these results a prospective study of the clinical efficacy of 852 combined sciatic/3-in-1 blocks using prilocaine, and performed by means of peripheral nerve stimulation was carried out. No CNS or cardiovascular complications, no problems resulting from methaemoglobinaemia and, above all, no nervous lesions were observed. The limiting factor for surgery of the lower limb with this method of anaesthesia is the tolerance of the femoral tourniquet which depends mainly on the efficacy of the 3-in-1 block. Ninety-one per cent of the combined blockades were primarily successful when there was no tourniquet at all, and 87% when the tourniquet was placed on the lower leg. In the course of surgery with a femoral pneumatic tourniquet, only 55% of the blocks did not require supplement when 20 ml of 1% prilocaine was used for the 3-in-1 block, while 72% and 74% were efficacious with 30 ml and 35 ml, respectively. The efficacy of the sciatic block proved to be extremely high (> 95%), its success depending on the dosage of the local anaesthetic and correct execution of the peripheral nerve stimulation.

Adult↗

PubMed1998

MR neurography. MR imaging of peripheral nerves.

Recent advances in MR imaging coupled with specially designed phased-array surface coils are revolutionizing imaging of the peripheral nervous system. Direct visualization of normal-sized major peripheral nerves within the body is now possible. This article describes the appearance of normal peripheral nerves together with imaging characteristics of various types of nerve pathology including traumatic injury, compressive syndromes, and neural tumors. Imaging of the brachial plexus, lumbosacral plexus, carpal tunnel, cubital tunnel, and cervical nerves is illustrated and discussed. MR neurography techniques permit imaging detection of peripheral nervous system pathology that in some cases allow earlier and more accurate diagnosis. It is believed that this will ultimately lead to improved understanding of peripheral nerve pathophysiology that will, in turn, lead to improved treatment.

Humans↗

PubMedDate not supplied

Prevalence and distribution of peripheral nerve injuries in victims of Bam earthquake.

INTRODUCTION: In the early morning of Friday 25th Dec. 2003, the ancient and historical city of Bam in Southern East of Iran was vibrated by a big and horrible earthquake for 6.4 degree of Richter. About 30,000 people were died and about 30,000 victims and injured persons were the initial results of the earthquake. Almost all of the buildings were destroyed and all the people became houseless. In this study, 156 patients with peripheral nerve lesion (PNL) were assessed for their injuries. MATERIALS AND METHODS: In a cross sectional study since the second week after the quake until 6 months later, we examined 506 patients with the symptoms and signs of motor/sensory and performed the Electrodiagnostic study for all of the patients who had obvious or suspected lesion of peripheral nerves. There were 156 patients (31.2%) afflicted with peripheral nerve lesion. We performed NCS/EMG for upper limb and face at least 2 weeks and for lower limb, at least 3 weeks after injury in 156 of the victims that had PNL. FINDINGS: Of 156 patients, 75 (48%) were female and 81 (52%) were male. The average of age was 29.2 +/- 12.9 years, about 87.2% were between 15 to 50 yrs old. The frequency of injuries was 88 nerves, 53 neural plexuses and 5 cauda equina lesions. The most frequent injured nerve was sciatic nerve (24.8%) and the next was Radial nerve (15.5%) and the less frequent nerve was axillary which observed just in 1 patient. 21.6% of patients had the brachial plexus and/or lumbosacral plexus injuries. There were more involvements in lower limbs comparing upper limbs and face (p < 0.01). CONCLUSION: Peripheral nerve injury is one of the most frequent injuries in earthquake victims. These lesions may cause temporary or lifelong disabilities in patients. In this study, the more frequent involvement of sciatic and radial nerve seems to be related to their anatomic location and also the position of victims when earthquake happened and the involvement of brachial and lumbosacral plexus could be due to inappropriate evacuation of the victims from the loads and also due to incorrect transportation.

Adolescent↗

PubMed1986

Lumbosacral nerve plexus compression by ovarian-fallopian cysts.

A 43 year old woman presented with a 10 month history of pain, progressive weakness and wasting of the left calf. Electromyography demonstrated denervation at the level of the lumbosacral plexus, particularly of its sciatic component. CT and ultrasound examination revealed intrapelvic cysts which were confirmed on surgical exploration to be fallopian and ovarian cysts.

Adult↗

PubMed1996

[Maternal paralysis of obstetrical origin. Two case reports].

We report two cases of maternal obstetrical paralysis by injuries to the sacral plexus (lumbosacral trunk). This nervous lesion is rare and occurs more often in young small primigravidae, carrying a large fetus, during a prolonged labor and a delivery requiring midforceps. The symptoms appear usually a few hours after delivery: paresthesias of the leg and the foot as well as weakness and possible footdrop (the paralysis may be mild or severe). The different mechanisms involved are inspected. The prognosis of this lesion is good, the patients recover usually within a period of three months. The treatment appears to be physiotherapy.

Adult↗

PubMed2005

Nerve reconstruction in lumbosacral plexopathy. Case report and review of the literature.

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.

Accidents, Traffic↗

PubMed1987

Maintenance of specificity by sprouting and regenerating peripheral nerves. I. Normal variability.

Inter-animal variability in the spinal representation of a single hindlimb muscle, tibialis anterior (TA), in the cat, was examined by retrograde transport of intramuscularly injected HRP, dissection of the lumbosacral plexus and reflex testing after acute section of spinal nerves L5, L6, S1 and S2 sparing L7. No variability between the two sides of the same animal was seen. The transverse position of the TA motor nucleus and the number of labeled cells was constant between the two sides in each animal. Inter-animal variability was considerable, however, in that the number of motor neurons and rostrocaudal extent of the motor neuron column supplying TA varied considerably from animal to animal. According to the relationship between the position of the lumbosacral plexus and the distribution of spinal nerves, 3 classes of representation of the plexus were found: prefixed, postfixed and intermediate. In animals in which the lumbosacral plexus was prefixed, more than one half of labeled cells were rostral to the L7 segment; in those with postfixed plexus more than half the cells were caudal to L7. Section of L5, L6, S1 and S2 spinal nerves weakened the tibialis anterior tendon reflex in 'prefixed plexus' animals but abolished that reflex in 'postfixed' plexus animals, in spite of the presence of labeled motor neurons projecting through the spared L7 nerve. This suggests that some of the afferents and efferents comprising the TA tendon reflex may travel in different spinal roots or that a particular distribution of motor axons within a muscle is required for the maintenance of this particular reflex activity.

Animals↗

PubMed1990

Neurography using the intramuscular injection of ionic iodine contrast media.

Our report presents a new method of neurography. Sciatic nerve and lumbosacral plexuses in frogs have been visualized after the intramuscular injection of water and lipid soluble ionic iodine contrast media (Telebrix 300, Potassium Iodide 30% and Lipiodol Ultra Fluid). The ascendant flow of the iodine ions (anions) has been achieved by establishing the electrical potential difference between the injection site and the proximal part of the sciatic nerve and lumbosacral plexus. The application of DC current ensued immediately after the injection. Several minutes later the proximal segments of tibial and peroneal common nerves, as well as the sciatic nerve in its full length, have been visualized on X-Ray film. Lumbosacral plexuses became radioopaque after 20 plus minutes.

Animals↗

PubMed1993

[Follow-up and prognosis of neurologic sequelae of pelvic ring fractures with involvement of the sacrum and/or the iliosacral joint].

The extent of neurological lesions following an injury of the pelvic ring is often not initially recognized, as interest is then focused on the treatment of the pelvic ring fracture. Once the fracture has healed, the patient suffers from the sequelae of the neurological injury. Our series of 323 pelvic ring injuries includes 161 sacral fractures and 12 complete disruptions of the sacroiliac joint. Twenty-three patients sustained an injury of the lumbosacral plexus, and 20 patients were examined retrospectively. The different parts of the lumbosacral plexus showed variable recovery potential. An important or complete recovery was noted in 8 of 9 patients suffering from a motor deficit of the lumbar plexus, the obturator nerve, the superior gluteal nerve or the inferior gluteal nerve. Four out of 8 patients with a motor deficit of the sacral plexus had an important or complete improvement. In contrast to these results was the poor recovery of lesions of the lumbosacral trunk. Eight out of 11 patients showed no or only minor recovery, although the pelvic ring was stabilized by operative means in 9 patients. In 2 patients the lumbosacral trunk was directly decompressed by a dorsal approach. In both cases the recovery was complete. In 6 patients the sphincter function was damaged. Recovery was dependent on the localization of the sacral fracture. If the fracture traversed the sacral canal, no neurological improvement was noted.

Adult↗

PubMed2005

Levetiracetam as an adjunctive analgesic in neoplastic plexopathies: case series and commentary.

Certain types of pain associated with cancer may be difficult to treat with standard therapies, often resulting in intractable pain and suffering for the patient. The use of an opioid as analgesic monotherapy can lead to poorly controlled pain as well as multiple side effects. Non-opioid adjunctive analgesics, such as antidepressants and antiepileptic drugs (AEDs) often improve both pain control, and side effect prevalence. Levetiracetam is an AED with unique mechanisms of action that may have analgesic properties in various pain syndromes. Seven patients with neoplasms involving neural structures (four invading the brachial plexus, and three the lumbosacral plexus) had severe pain of 8 to 9 out of 10 on a visual analog scale (VAS), despite the use of parenteral opioids and various adjunctive therapies. These patients were treated with oral levetiracetam titrated over days to two weeks, depending on the location of pain, drug response, and tolerance to tapering of opioid analgesics. Opioid and adjunctive analgesic use and VAS scores were recorded periodically. The maximum levetiracetam dose ranged from 500 mg to 1500 mg BID. All patients experienced pain control improvement after the addition of levetiracetam, with VAS scores decreasing from 8-9 out of 10 to 0-3 out of 10 within two to 14 days of therapy initiation. Overall opioid use decreased by at least an estimated 70%, without drug related adverse events. In this small series of patients, levetiracetam effectively and safely improved pain relief in patients with neoplastic plexopathies previously resistant to standard analgesic approaches.

Adult↗

PubMed2005

[Monitoring retrograde adenoviral transgene expression in spinal cord and anterograde labeling of the peripheral nerves].

OBJECTIVE: Targeted adenoviral gene delivery from peripheral nerves was used to integrally analyse the characterization and time course of LacZ gene (AdLacZ) retrograde transfer to spinal cord and transgene product anterograde labeling of peripheral nerve. METHODS: Recombinant replication-defective adenovirus containing AdLacZ was administrated to the cut proximal stumps of median and tibial nerves in Wistar rats. Then the transected nerve was repaired with 10-0 nylon sutures. At different time point post-infection the spinal cords of C5 to T1 attached with DRGs and brachial plexuses, or L2 to L6 attached with DRGs and lumbosacral plexuses were removed. The removed spinal cord and DRCs were cut into 50 microm serial coronal sections and processed for X-gal staining and immunohistochemical staining. The whole specimens of brachial or lumbosacral plexuses attaching with their peripheral nerves were processed for X-gal staining. The number of X-gal stained neurons was counted and the initial detected time of retrograde labeling, peak time and persisting period of gene expression in DRG sensory neurons, spinal cord motor neurons and peripheral nerves were studied. RESULTS: The gene transfer was specifically targeted to the particular segments of spinal cord and DRGs, and transgene expression was strictly unilaterally corresponding to the infected nerves. Within the same nerve models, the initial detected time of gene expression was earliest in DRG neurons, then in the motor neurons and latest in peripheral nerves. The persisting duration of beta-gal staining was shortest in motor neurons, then in sensory neurons and longest in peripheral nerves. The initial detected time of beta-gal staining in median nerve models was earlier in median nerve models compared with that in the tibial nerve models. Although the initial detected time and the beginning of peak duration of beta-gal staining were not same, the decreasing time of beta-gal staining in motor and sensory neurons of the two nerve models were started at about the same day 8 post-infection. The labeled neurons were more in tibial nerve models than that in median nerve models. Within the same models, the labeled sensory neurons of DRGs were more than labeled motor neurons of ventral horn. The beta-gal staining was tender in median nerves than that in tibial nerves. However the persisting time of beta-gal staining was longer in tibial nerve models. CONCLUSION: The strong gene expression in neurons and PNS renders this system particularly attractive for neuroanatomical tracing studies. Furthermore this gene delivery method allowing specific targeting of motor and sensory neurons without damaging the spinal cord might offer potentialities for the gene therapy of peripheral nerve injury.

Adenoviridae↗

PubMed2005

Outcome of operatively treated type-C injuries of the pelvic ring.

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.

Adolescent↗

PubMedDate not supplied

A retrospective evaluation of 51 cases of peripheral nerve sheath tumors in the dog.

Fifty-one cases of canine peripheral nerve sheath tumors were reviewed. Signalment, presenting clinical signs, duration of clinical signs, physical and neurological examination findings, results of diagnostic procedures, type of surgery performed, tumor location, relapse-free intervals and survival times, and causes of death were evaluated. Tumors were divided into three anatomical groups: tumors involving nerves distal to the brachial or lumbosacral plexus (Peripheral Group), tumors involving nerves of the brachial or lumbosacral plexus (Plexus Group), and tumors involving the vertebral canal (Root Group). The most common clinical findings were unilateral forelimb lameness and muscle atrophy. The most useful diagnostic tests were myelography and electromyography. Although there was no significant difference, dogs in the Root Group tended to have shorter relapse-free intervals and survival times than dogs in the Plexus Group. The overall prognosis for surgical management of peripheral nerve sheath tumors is guarded to poor.

Animals↗

PubMed1990

[A case of delayed radiation lumbo-sacral plexopathy].

We report a 47-year-old woman who developed a slowly progressive lumbosacral plexopathy with mixed sensorimotor losses in the lower extremities. The symptoms were apparent 8 years after x-ray irradiation for an ovarian carcinoma. Neurological examination showed mild weakness and absent deep tendon reflexes of bilateral lower extremities, and hypesthesia to all modalities in anterior aspects of bilateral lower thighs, in dorsum pedis and soles. Extensive investigations regarding the possibility of tumor recurrence were negative. Computed tomography of pelvis showed abnormal soft tissue densities around the lumbosacral plexus. Intravenous pyelography showed bilateral hydronephrosis and narrowed ureters at the first sacral vertebra level. These findings are consistent with radiation-induced fibrosis rather than tumor infiltration. The results suggest the entrapment lumbosacral plexopathy due to surrounding fibrosis after irradiation. We speculated the sensorimotor losses caused by entrapment of the lumbosacral plexus.

Female↗

PubMed1977

[Functional anatomy of low back pain and ischialgia (author's transl)].

The neuronal systems involved in low back pain are first described in a functional anatomical review and then an attempt is made to work out the special functional structure data which seem to be decisive for the origin and localization of low back pain and ischialgia. Low back pain may arise as a deep pain through stimulation of the nociceptive afferents in the musculature and supporting tissues and as a neural pain through irritation of nociceptive nerve fibers within the innervation area of the lumbosacral plexus. The nociceptive influx from the viscera only elicits pain in the rarest cases, however, it often has a conductive influence. Skeletal muscle plays a special role here, along with the sensory supply to the vertebral motor segment through the spinal nerve and the particular innervation scheme of the lumbosacral plexus caused by the limb budding.

Back Pain↗

PubMed2001

Primary pelvic hydatid cyst: an unusual cause of sciatica and foot drop.

STUDY DESIGN: A case report of primary pelvic hydatid cyst causing sciatica and foot drop. OBJECTIVE: To document the occurrence of primary pelvic hydatid cyst as one of the hidden causes of lower limb weakness and foot drop, and to recommend inclusion of the pelvic cavity when assessing sciatica and foot drop. SUMMARY OF BACKGROUND DATA: It is common to see foot drop caused by peripheral lesions around the knee or disc herniation in the lumbar spine, but if these sites were excluded, the pelvic cavity must be examined for hidden disease that may explain the cause of foot drop and sciatica. METHODS: The authors involved in the care and management of this patient were interviewed and all medical records, radiologic investigations, and related literature were reviewed. RESULTS: After exclusion of spinal and peripheral causes of foot drop, computed tomography of the pelvis showed a well-localized cystic swelling in the right side of the pelvis over the lumbosacral plexus roots. Surgical excision of the cyst resulted in partial recovery of the foot drop at 3 years of follow-up. CONCLUSION: Primary pelvic hydatid cyst rarely causes pressure on the lumbosacral plexus. This was a case of hydatid cyst in the pelvis causing sciatica and foot drop, and it indicates the pelvis as a hidden source of sciatica and foot drop. After surgical excision followed by 4 months' mebendazole therapy, there was no evidence of recurrence on long-term follow-up.

Adult↗

PubMed2006

Causes of lumbosacral plexopathy.

The lumbosacral plexus represents the nerve supply to the lower back, pelvis and legs. This review will focus on diseases and disorders affecting the pathway as demonstrated by magnetic resonance imaging (MRI) and computed tomography (CT). We stress the need to review the lumbosacral plexus in patients with non-specific symptoms such as back, hip, pelvic pain, and in those who present with sciatica unaccompanied by demonstrable intervertebral disc prolapse. We illustrate that the imaging appearances may be non-specific and re-inforce the importance of the clinical history and the use of tissue sampling to achieve an accurate diagnosis.

Abscess↗