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Spinal Cord and Reflexes
Published in Nassir H. Sabah, Neuromuscular Fundamentals, 2020
The largest and longest peripheral nerve, that is, a nerve outside the central nervous system, is the sciatic nerve. In humans, it is a flat thick band, about 2 cm wide, formed by the grouping of spinal nerves L4 to S3. It originates in the lower back, runs through the buttock and thigh, and divides, usually at the back of the knee joint, into the tibial nerve and the common fibular (or peroneal) nerve. The sciatic nerve directly controls the muscles of the posterior thigh and the hamstring portion of the adductor magnus muscle. Its branches control the muscles of the leg and foot. These branches also convey signals from the skin of the lateral leg and the foot.
Acute postoperative pain management with percutaneous peripheral nerve stimulation: the SPRINT neuromodulation system
Published in Expert Review of Medical Devices, 2021
Rodney A. Gabriel, Brian M. Ilfeld
Hallux Valgus Osteotomy. Application of PNS to the sciatic nerve is a novel approach to long-term pain management. In one clinical trial, 7 patients were recruited to receive several weeks of postoperative analgesia via ultrasound-guided PNS for hallux valgus osteotomy[15]. Patients were subjected to three stages of treatment in the recovery room: 1) active or sham stimulation for 5 minutes, 2) crossover treatment for another 5 minutes, and 3) 30 minutes of active stimulation. Subsequently, active stimulation was continued for multiple weeks. During stages 1 or 2 when active stimulation was applied, patients experienced improved analgesia. In contrast, when sham stimulation was applied, no pain relief was apparent. At stage 3 (30 additional minutes of active stimulation), pain scores decreased around 50% compared to baseline pain.
Expert review with meta-analysis of randomized and nonrandomized controlled studies of Barricaid annular closure in patients at high risk for lumbar disc reherniation
Published in Expert Review of Medical Devices, 2020
Larry E. Miller, R. Todd Allen, Brad Duhon, Kris E. Radcliff
Sciatica affects 10% of adults in the United States each year [1] and is a leading cause of disability [2]. Affected individuals experience severe radiating pain along the distribution of the sciatic nerve through the buttocks and leg. Herniation of the nucleus pulposus from within the lumbar intervertebral disc space to the extradiscal space is the primary instigating event in sciatica. Extrusion or sequestration of disc contents may cause these radicular symptoms by direct impingement of adjacent nerve roots or induction of local inflammatory processes. The prognosis of individuals with sciatica is generally favorable with approximately two-thirds of patients reporting complete symptom resolution after 1 year [3,4]. However, bothersome symptoms that are refractory to conservative treatments persist in the remaining one-third of patients who are often referred for lumbar disc surgery to remove the offending herniated disc contents. While continued conservative treatment may also be considered, increasing evidence suggests that surgery is more effective than continued conservative care for chronic sciatica symptoms [5].