PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “LUMBOSACRAL 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 1,441 records · Page 80Linked to original sources
PubMed2004

[Experimental and clinical studies on selective sacral rhizotomy in treatment of spastic bladder after spinal cord injury].

OBJECTIVE: To observe the effect of selective sacral rhizotomy in treating spastic bladder after spinal cord injury and to explore the mechanism and the best surgical method of different sacral rhizotomies. METHODS: The spastic bladder models were established in 12 male dogs and were divided into 4 groups according to the different rhizotomies of the sacral nerve as the following: rhizotomy of the anterior root of S2 (group A), rhizotomy of the anterior root of S2 and half of the anterior root of S3 (group B), rhizotomy of the anterior roots of S2 and S3 (group C), and total rhizotomy of the nerve roots of S2-4 (group D). By urodynamic examination and electrophysiological observation, the changes of all functional data were recorded and compared between pre-rhizotomy and post-rhizotomy to testify the best surgical method. In clinical trial, according to the results of the above experiments, rhizotomy of the anterior root of S2 or one of the half-anterior root of S3 were conducted on 32 patients with spastic bladder after spinal cord injury. The mean bladder capacity, the mean urine evacuation and the mean urethra pressure were (120 +/- 30), (100 +/- 30)ml and (120 +/- 20) cm H2O, respectively before rhizotomy. RESULTS: After rhizotomy, the bladder capacity in 4 groups amounted to (150 +/- 50), (180 +/- 50), (230 +/- 50), and (400 +/- 50) ml, respectively; and the urine evacuation volume were (130 +/- 30), (180 +/- 50), (100 +/- 50) and (50 +/- 30)ml, respectively. In the treated 32 patients, the mean bladder capacity were raised to 410 ml, and the mean urine evacuation volume were also increased to 350 ml. Incontinence of urine disappeared in all patients. After 22-month follow-up on 13 patients, no recurrence was observed. CONCLUSION: The effect of selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies.

Adult↗
PubMed2004

[Value of magnesium sulfate and/or valium in preventing local anesthetic toxicity of sacral block].

OBJECTIVE: To study the effects of magnesium sulfate and/or valium in preventing local anesthetic toxicity induced by sacral block. METHODS: A total of 240 adult patients scheduled for sacral block were randomized equally into four groups matched for sex, age and body weight. Ten minutes before sacral block, the patients in group B received valium (0.1 mg/kg), group C received magnesium sulfate (50 mg/kg), group D received both valium (0.1 mg/kg) and magnesium sulfate (50 mg/kg). The control (group A) received neither valium nor magnesium sulfate. Local anesthetic toxicity was observed and recorded in all the groups. RESULTS: Local anesthetic toxicity was significantly decreased in group B and group C compared with group A (P<0.05), and the toxicity was even more significantly decreased in group D(P<0.01 vs group A). CONCLUSION: Local anesthetic toxicity of sacral block can be significantly decreased by intravenous injection of valium or magnesium sulfate, and their combination produces stronger effects.

Adolescent↗
PubMed2005

Sacral-neuromodulation CT-guided.

PURPOSE: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four to ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. MATERIALS AND METHODS: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patients showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anomalies of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spinal needle introduced checking correct positioning with a CT control scan. An electrode was then inserted after having checked correct muscular contractile response and the precise position with a further CT scan. RESULTS: Thirty patients were subjected to PNE under CT guidance for a total of 38 centerings. Eight patients underwent the PNE procedure on both the S3 foramina. The sacral foramen was centred at the first attempt in 36 out of 38 cases. Two cases required several attempts to centre correctly the foramen. In 4 patients out of 30 a second electrode was implanted. In one patient who had a nonconsolidated sacral fracture, CT guidance enabled insertion of the electrode inside the only practicable foramen, a manoeuvre that would have been impossible with fluoroscopical guidance. Only once was the electrode placed in a wrong location but promptly repositioned after a CT control. During the whole trial period we had a positive response to the PNE test in 18 out of 30 patients (60%), a partial response in 4 out of 30 patients and a negative response in the remaining 8 patients. None of the patients who underwent the PNE test had infectious complications and the procedure was well tolerated by all. The procedure lasted about 45 minutes.

Adult↗
PubMed2005

Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia.

PURPOSE: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. MATERIALS AND METHODS: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularisation. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. RESULTS: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the months immediately following the procedure. DISCUSSION: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limbs. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of CT-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation.

Aged↗
PubMed2005

Percutaneous lumbar sympathectomy in the treatment of erectile dysfunction secondary to cavernous adrenergic hypertone: initial results of an original technique.

Corporeal smooth muscle tone is regulated by a delicate balance between contraction and erectile smooth muscle. An abnormal balance in basal conditions, due to an augmented contraction of erectile smooth muscle, defined "dysfunctional antagonism", may be responsible of a particular condition of erectile dysfunction (ED), secondary to cavernous adrenergic hypertone (CAY). In order to investigate the possibility to treat CAY with a definitive inhibition of adrenergic innervation to corpora cavernosa, we evaluated the results of an original technique of percutaneous lumbar sympathectomy (PLS) in a group of patients with clinical signs and symptoms of CAY In our study, 14 patients were selected and treated with PLS. Pre-treatment evaluation was designed to identify patients with ED caused by CAY, eligible for surgical treatment, and consisted of medical history, the self administered International Index of Erectile Function and Doppler sonography evaluation of cavernous arteries. Were considered eligible to the surgical treatment the patients with normal PSV values and abnormal EDV values after first injection of alprostadil, but reduced to zero after redosing with alprostadil and phentolamine. All these patients were treated with percutaneous bilateral lumbar ganglionic block with mepivacaine and, at a successive time, phenol 4% and evaluated after I and 4 months. Each evaluation consisted of a self-administered IIEF questionnaire, physical examination and Doppler sonography evaluation. Among the 14 patients selected and treated with temporary block with mepivacaine, 3 reported significant adverse events, consisting of loss of ejaculation (2 patients) and severe lumbar pain (1 patient). In all the other patients treated, only mild to moderate lumbar pain was reported. 10 patients out of the 14 treated with mepivacaine accepted to undergo the successive step of ganglionic block with phenol. Nine patients reported improved erections at both visits, as assessed by the GEQ. Moreover, the analysis of responses to IIEF questions 2-3 showed a highly significant improvement in erectile function compared to scores at baseline. Doppler sonography showed normal flow parameters at both visits in 8 patients. No significant adverse events were recorded after the procedures, except for mild to moderate lumbar pain. Clinical data collected in this study seem to confirm chemical sympathesctomy as a reliable, effective and safe therapeutic option in ED secondary to CAY.

Adult↗
PubMedDate not supplied

Bilateral sacral radiculopathy in a cyclist.

UNLABELLED: OBJECTIVE-PURPOSE: The purpose of this case report is to describe a gait disorder presenting as a bilateral sacral radiculopathy after vigorous cycling. Also, we discuss the pathogenic mechanisms and we revise the bibliography. PATIENT AND METHODS: The patient complained of a rapid painless weakness in legs, after intense and prolonged cycling 4 months ago. The physical and electromyographical examinations revealed important weakness in foot and knee flexors, and signs of acute denervation with mixed reinnervation (active and chronic) in myotomal S1 muscles, respectively. The lumbo-sacral magnetic resonance imaging were normal. The follow-up studies demonstrated gradually improvement in clinical and neurophysiological parameters. DISCUSSION: We established that our patient presented a subacute bilateral S1 radiculopathy and we confirmed the progressive clinical and neurophysiological improvement. The radiculopathy are infrequent in cyclists, and its common origin is the external compressive aggression. In our patient we speculate and discuss that this radicular lesion could present different pathogenic mechanisms: the elongation, the compression and the secondary vasanervorum ischemia. In our knowledge S1 radiculopathy related to compressive lesions in sportsmen has not been previously described.

Adult↗
PubMed2005

[Cystomanometric study of bladder sensation during sacral neuromodulation test].

PURPOSE: Prospective clinical and urodynamic study evaluating modification of bladder sensation during sacral neuromodulation (SNM). MATERIALS AND METHODS: 24 consecutive patients with non-neurological hyperactive bladder underwent an SNM test. Questioned about their symptoms before and during the test by the urinary handicap assessment scale, patients were divided into two groups: A (improved) and B (not improved). Group A consisted of patients obtaining 50% improvement of their symptoms with SNM followed by return of symptoms at the end of the test, while the other patients constituted group B. We then compared the cystomanometric results according to their clinical response. RESULTS: The mean age was 53 years: 10 patients with a good response constituted group A (n=10, i.e. 42%) and 14 patients with a poor response constituted group B (n=14, i.e. 58%). Clinically, in patients with a good response, SNM decreased urge incontinence by 100%, day-time frequency by 89% and protections by 55%. Urodynamic assessment in group A during the test demonstrated a significant increase of +23% of bladder capacity (p<0.01), +57% of the volume of onset of the first unstable contraction (p<0.004), +83% of bladder volume to the first urge to urinate BI (p<0.001) and +46% to urgency B3 (p<0.04). During SNM, cystometry revealed that 1 or 2 bladder filling volumes were increased at B1 and/or B3 in 100% of improved subjects. In contrast, 1 or 2 volumes decreased at B1 and/or B3 in 58% of non-improved subjects. No significant difference of intensity of unstable contractions was observed between the 2 groups during SNM (p=0.31). CONCLUSION: A significant correlation was observed between the two methods of clinical and urodynamic assessment. Our results suggest the use of the cystomanometric increase of bladder volume at B1 and B3 as selection criterion for candidates for SNM with non-neurological hyperactive bladder.

Aged↗
PubMed2005

[Neurological complications during gynecological pelvic surgery].

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.

Female↗
PubMed2005

Ilioinguinal/iliohypogastric neurectomy for management of intractable right lower quadrant pain after cesarean section: a case report.

BACKGROUND: Ilioinguinal nerve entrapment is one of the most common nerve injuries following pelvic surgery. We present a case of intractable right lower quadrant pain successfully treated with neurectomy. CASE: A 31-year-old woman, following her third elective cesarean section, noted intense, right inguinal pain immediately upon awaking from anesthesia. The pain was burning and constant and exacerbated by standing and movement. After a period of failed conservative management, a workup concluded probable nerve entrapment. Trigger point injections, amitriptyline and gabapentin therapy resulted in minimal improvement. At 10 months the patient underwent a right ilioinguinal neurectomy with excellent sustained pain relief. CONCLUSION: Low transverse fascial incisions risk injury to the iliohypogastric and ilioinguinal nerves. While pain from entrapment of these nerves often resolves spontaneously, neurectomy may offer resolution in recalcitrant cases.

Adult↗
PubMed2006

[A case of far-out syndrome: case report and review of the literature].

Far-out syndrome (FOS) is a rare disease in which the L5 nerve root is compressed by a transverse process, the sacral ala, and a bony spur at the extraforaminal zone. We report the case of patient with FOS due to a bulging disc and review the literature. This 34-year-old male experienced severe left leg pain and slight motor weakness of the left extensor digitorum. Radiographic studies revealed no abnormality in the spinal canal. The intervertebral disk bulged to the left. Because of fat it was difficult to discern the left L5 nerve root from the sacral ala in the extraforaminal zone. His symptoms failed to respond to conservative treatment and he underwent decompression of the L5 nerve root without fusion. During the operation, the left L5 nerve root was exposed by drilling the sacral ala via the left paraspinal approach. The sacral ala was removed along with the left L5 nerve root to obtain sufficient pulsation and movement of the left L5 nerve root. Neither the intervertebral joint nor the intervertebral disk was removed. The patient's symptoms disappeared immediately after surgery. Due to anatomical factors, the L5 nerve root is easily compressed and the presence of this syndrome should be considered in a differential diagnosis. Careful and appropriate decompression without fusion yielded an excellent outcome.

Adult↗
PubMed2006

Inadvertent lumbosacral plexopathy due to temporary pacemaker implantation.

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.

Aged↗
PubMed2006

Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy.

BACKGROUND AND PURPOSE: Steroid periradicular infiltration is a common nonsurgical sciatic pain treatment of inconsistent efficacy. The purpose of this study was to identify factors for predicting the efficacy or failure of this procedure. METHODS: Two hundred twenty-nine patients with lumbar radiculopathy were prospectively followed up at 2 weeks and 1 year after percutaneous periradicular steroid infiltration. The intensity of radicular pain was scored on the visual analog scale (VAS). Pain relief was classified as "excellent" when the pain was completely resolved or had diminished by 75% or more, "good" for a diminution of 50% to 74%, "fair" for a diminution of 25% to 49%, or "poor" for a diminution of less than 25% or an increase in pain. RESULTS: The mean VAS scores were 6.5 (range, 3.1-9.5) before and 4.2 (range, 0-9.5) 2 weeks after the procedure. Pain relief was graded as excellent in 45 patients (19.7%), good in 48 patients (21%), fair in 45 patients (19.7%), and poor in 91 patients (39.7%). Cause of pain, conflict location, and pain intensity were not predictive factors of radicular pain relief, whereas the symptom duration before the procedure was highly correlated with the pain relief outcome. Patients with excellent results 2 weeks after the procedure had a mean duration of symptoms of 3.04 months (SD 3.28) versus 7.96 months (DS 9.04) in the group with poor pain relief. CONCLUSIONS: Periradicular infiltration is a simple, safe, and effective nonsurgical procedure that should be performed quite early in the course of the illness to provide radicular pain relief, because corticosteroid infiltration is less beneficial for patients with more chronic radicular pain.

Adrenal Cortex Hormones↗