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Endometriosis of the Pelvic Nerves
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Shaheen Khazali, Marc Possover
The lumbosacral trunk then runs along the linea terminalis caudally and posteriorly and is joined by S1. Many fibers within the lumbosacral trunk eventually reach the muscles of the lateral compartment of the leg.
Neurologic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Robert Burger, Terry Rolan, David Lardizabal, Upinder Dhand, Aarti Sarwal, Pradeep Sahota
Lumbosacral trunk is unprotected as it crosses the pelvic brim to enter the true pelvis and is prone to compression by the fetal head or forceps. Rarely sciatic nerve itself may be compressed. Injury to lumbosacral plexus or sciatic nerve predominantly affects the peroneal nerve component. Foot drop is noted immediately postpartum. There is weakness of dorsiflexion, inversion and eversion of the foot, and sensory impairment corresponding to L5 dermatome. Ankle reflex is preserved with L4–5 trunk lesion but is absent with sciatic nerve injury. Differential diagnosis is from lumbar radiculopathy and peroneal nerve compression at the fibular neck. Electrophysiologic studies help distinguish by findings of denervation in paraspinal muscles in lumbar radiculopathy and focal nerve conduction abnormality at fibular head in peroneal neuropathy. When difficult to distinguish from lumbar radiculopathy, MRI of lumbar spine is warranted.
Blocks of Nerves of the Sacral Plexus Supplying the Lower Extremities
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The sacral plexus is formed by the union of the ventral rami from L5, S1, S2, S3, and partly from L4 and S4 spinal nerves.11 L4 and L5 ventral rami unite closely at their emergence from intervertebral foramina, thus constituting the lumbosacral trunk which appears at the medial border of the psoas major muscle (Figure 2.28). The lumbosacral trunk runs over the pelvic brim, towards the sacro-iliac joint where it unites with the ventral ramus of the first sacral nerve (Figure 2.1B). The other sacral rami join the plexus just above the greater sciatic notch, thus constituting (1) a lower small band, plexiform in arrangement and prolonged into the pudendal nerve; and (2) an upper large band prolonged by the sciatic nerve, which passes out of the pelvis at this level.
The design and application of an individualized 3D printing assisted guide plates in assisting sacroiliac screws insertion
Published in Computer Assisted Surgery, 2022
Mu-Rong You, Zhi-Qiang Fan, Hai-Min Ye, Zhe Wang, Chun-Hua Zou, Xie-Ping Dong
The application of sacroiliac screws is an effective approach for the treatment of complicated and unstable posterior pelvic ring injuries in clinic, with the advantages of short operation time and rapid functional recovery [15]. However, the proper sacroiliac screws insertion requires the familiarity with the anatomical structure of the sacroiliac joint and depends on the careful preoperative planning to reduce the risk of iatrogenic sacral peripheral nerve and vascular structure [16,17]. Thus, the key lies in the design of screw entry points and the screw channels. In fact, the ideal sacroiliac screw channels are located in the sacral vertebra without damaging the cauda equina nerve, lumbosacral trunk, iliac vessels, presacral vessels and L5/S1 intervertebral disk. In order to prevent the screws from penetrating through the bone and damaging the vital vessels and nerves, reduce the potential exposure of patients and surgeons to X-ray radiation, and improve the accuracy and safety of insertion, the novel auxiliary screws insertion technologies have been generally emerged. For example, the O-ARM navigation system, 3D printing technology, orthopedic robots, and so on [18–20]. The O-ARM navigation system can display high-resolution images in sagittal plane, coronal plane and cross section at the same time. The surgeons can clearly observe the positional relationship between the fracture lines and screws on these three planes, and then insert the screws under the guidance of virtual guide needle, so as to improve the accuracy of insertion to a certain extent. However, the overall operation of O-ARM navigation system is complicated, and the operation and processing of navigation system also cost a lot of time. Moreover, orthopedic robots can conduct the position planning through the preoperative imaging and intraoperative real-time tracking. However, the cost of instruments and equipment is expensive, which is difficult to popularize in primary hospitals [21]. Hence, there is still no ultimate conclusion on which technology is most suitable for the insertion of sacroiliac screws.
Analysis of magnetic resonance signal intensity changes in the sacrococcygeal region of patients with uterine fibroids treated with high intensity focused ultrasound ablation
Published in International Journal of Hyperthermia, 2020
Dandan Li, Chunmei Gong, Jin Bai, Lian Zhang
In this study, we found a relatively high incidence of MR signal intensity changes in the sacrum and the soft tissue adjacent to the sacrum, but only a small number of patients complained of sacral pain or leg pain after HIFU. To evaluate any relationship between the MR signal intensity changes in the pelvis and the sacral or leg pain, we further reviewed the post-HIFU MR images of the 25 cases of sacrococcygeal pain and the 3 cases of leg pain after HIFU treatment. There was no significant difference in the rate of sacral pain among the patients with signal intensity changes in the sacrum, in the soft tissue adjacent to the sacrum, or in both. However, our results showed that the signal intensity change volume in the soft tissue on T2WI in patients with sacral pain was significantly larger than that in patients without sacral pain (Table 7). Sacral pain is only related to local tissue injury or inflammation without involvement of sacral nerve. In this study, leg pain was only seen in patients with MR signal intensity changes in both the sacrum and the soft tissue adjacent to the sacrum, but we did not find any significant difference in signal intensity change volume between the patients with leg pain and those without. We carefully reviewed the MR images of the patients with leg pain and found the signal intensity change area was located in sacral 1 and sacral 2, and the soft tissue adjacent to the lumbosacral trunk (Figure 3). Therefore, sacral pain is only related to local tissue injury or inflammation without the involvement of the sacral nerve, leg pain was generally caused by sacral nerve irritation after HIFU. It seems that sacral pain or leg pain is more likely related to the location of the signal changed area, not the volume. Sacral pain was relieved within 2 weeks after HIFU treatment when the edema subsided. Leg pain persisted for a longer period of time and treatment for symptoms with Celebrex (200 mg oral once a day) and physical therapy was required. The duration of leg pain was related to the area of MR signal intensity changes and pain was generally relieved 2-6 months after HIFU treatment.