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Anatomy & Embryology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
The autonomic nervous system provides sympathetic and parasympathetic supply to organs, blood vessels, glands and smooth muscle. The somatic system innervates skin, skeletal muscles and joints. Parasympathetic fibres arise from cranial and sacral spinal nerves, whilst sympathetic fibres for the thoracolumbar region originate from spinal nerves T1 to L3. The two sympathetic chains lie anteriorly on either side of the vertebral column to which the preganglionic fibres synapse. These fibres then continue via splanchnic nerves to the coeliac or superior and inferior plexuses associated with the aorta to synapse with postganglionic fibres that supply the target organ. Preganglionic fibres also directly supply the adrenal gland. The coeliac plexus is closely associated with the coeliac trunk and is where a significant proportion of the autonomic supply to the kidneys, adrenals, renal pelvis and ureters pass through. The superior hypogastric plexus lies below this near the aortic bifurcation and connects with the inferior hypogastric plexus below. Any disruption here during retroperitoneal lymph node dissection can result in retrograde ejaculation. The somatic lumbosacral plexus is formed from spinal nerves L1 to S3 and provides innervation to the abdomen and lower extremities. The major nerves of the plexus are described in the following table.
The Spinal Cord and the Spinal Canal
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
Ventral rami of the trunk divide in a manner similar to dorsal rami, providing metameric innervation to the skin (Figure 1.37) and deep structures. In the cervical, lumbar, and sacral regions, the ventral rami of adjacent spinal nerves unite near their origin and form the cervical (C1 to C4 segments), brachial (C5 to T1), lumbar (L1 to L4), and sacral (L4 to S3) plexuses. Lumbar and sacral plexuses are usually termed the lumbosacral plexus. Such a plexal disposition of nerves has considerable implications for regional anesthesia, and these plexuses are described in Part Two of this book.
Flat back deformity revision surgery
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Jefferson Wilson, Matthew S. Galetta, Srinivas Prasad
Injury to the lumbosacral plexus and its branches may occur during lateral approaches to the lumbar spine. Care should be taken in retracting and dilating the psoas muscle to protect these neural structures. In particular, care should be taken to restrict retractor opening to the minimal amount needed for exposure and graft placement. The femoral nerve should be retracted from anterior to posterior, and care should be taken that positioning of the patient does not put the femoral nerve under tension, reducing its ability to withstand intraoperative retraction. Finally, the duration of trans-psoas retraction should be minimized.
Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report
Published in Physiotherapy Theory and Practice, 2019
William R. VanWye, Harvey W. Wallmann, Elizabeth S. Norris, Karen E. Furgal
The onset of the patient’s symptoms coincided with the recent D&C procedure, which was performed in the lithotomy position. Lithotomy positioning can result in stretch injuries to the femoral, lateral femoral cutaneous, obturator, sciatic, or common peroneal nerves (Barnett et al, 2007). It can also result in a lumbosacral plexus stretch injury, which is more consistent with the patient’s presentation (Flanagan, Webster, Brown, and Massey, 1985). Identifying the pattern of weakness and numbness clinically after a lumbosacral plexus injury may be difficult (Flanagan, Webster, Brown, and Massey, 1985; Preston and Shapiro, 2013). The patient exhibited hamstring weakness, which is innervated by the sciatic nerve, as well as weakness of the left ankle plantarflexors (i.e. gastrocnemius and soleus muscles), which are innervated by the tibial branch of the sciatic nerve (Kendall, McCreary, Provance, and Kendall, 1999). Yet, the patient also had left gluteus maximus and medius weakness, which are innervated by the inferior and superior gluteal nerve, respectively. The potential pattern in this case; each of these muscles is partially supplied by the S1 nerve root (Kendall, McCreary, Provance, and Kendall, 1999).
Distal Stimulation Site at the Medial Tibia for Saphenous Nerve Somatosensory Evoked Potentials (DSn-SSEPs) in Lateral Lumbar Spine Procedures
Published in The Neurodiagnostic Journal, 2021
Kathryn Overzet, Derrick Mora, Eloise Faust, Lindsay Krisko, Dyanne Welch, Faisal R. Jahangiri
The root contributions of the lumbosacral plexus and the femoral nerve trunk are often encountered in the surgical field of lateral lumbar procedures. The lumbar plexus is formed by the first four lumbar nerves (L1–4) and the subcostal nerve (T12). The plexus passes through the iliopsoas muscle and runs obliquely down the pelvis. The femoral nerve (L2–4) is the largest branch in the lumbar plexus and innervates the skin of the medial thigh and the muscles that extend the lower leg (Moore et al. 2017).
Contralateral lumbosacral plexopathy following lumbar microdiscectomy
Published in British Journal of Neurosurgery, 2020
Isabel Tulloch, Riaz Ali, Marios C. Papadopoulos
The lumbosacral plexus is formed by an intermingling of the ventral rami of spinal nerves T12 to S4.1 The term plexopathy indicates involvement of not only the plexus, but also its associated peripheral nerves. To make a diagnosis of LSP, several diagnostic criteria must be met.