Diseases of the Peripheral Nerve and Mononeuropathies
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
The first sensory branch of the lumbar plexus (Figure 25.38): Arises from the L2 and L3 nerve roots.Emerges from the lateral border of the psoas major muscle and courses along the brim of the pelvis to the lateral end of the inguinal ligament.Reaches the upper thigh after passing through a tunnel formed by the lateral attachment of the inguinal ligament and the anterior superior iliac spine.About 12 cm (4.7 in) below the exit from the tunnel, the nerve gives off an anterior branch, which supplies the skin over the lateral and anterior surface of the thigh, and a posterior branch which innervates the lateral and posterior portion of the thigh.
The Thigh (Anterior and Medial Compartments)
Gene L. Colborn, David B. Lause in Musculoskeletal Anatomy, 2009
On one side of the body carefully dissect the psoas major muscle in piecemeal fashion, preserving the lumbar nerves (which pass posterior to, or through, the psoas). Clean and identify the nerves which arise from the lumbar plexus:the ilioinguinal nerve (L1);the genitofemoral nerve (L1, 2);the lateral femoral cutaneous nerve (L2, 3);the femoral nerve (L2, 3, 4);the obturator nerve (L2, 3, 4);and the lumbosacral trunk (L4, 5).
Electrodiagnosis
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
There are several plexi in the human body. The lumbar plexus is clearly important in the clinical settings of diabetes mellitus, surgical trauma, and pelvic tumors. However, the brachial plexus is the touchstone for electrodiagnostic assessment. Disorders of the brachial plexus include those involving birth trauma (Erb’s palsy and Klumpke’s palsy), radiation plexopathy seen in breast cancer, Parsonage-Turner syndrome (idiopathic disease of the brachial plexus), a variety of traumas (e.g., avulsion), and neurogenic thoracic outlet syndrome (NTOS). NTOS is due to an abnormality of the lower plexus trunk, associated with local anatomical variations, such as cervical rib and scalene anticus syndrome (Brazis et al., 1996). Plexus lesions tend to be extraordinarily painful. volume conduction-related error is common with stimulation of Erb’s point, causing one to interpret these results with a grain of salt (Herbison, 1996).
Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Abdominal Surgery: A Systematic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Lin Liheng, Cai Siyuan, Cai Zhen, Wu Changxue
Several complications related to ESPB have been described in previous studies. Hamilton [45] reported one case of pneumothorax following ESPB; Elkoundi [46] described a priapism; O Selvi [47] reported an unexpected case of motor weakness; Karaca [48] described a LAST (local anesthetic systemic toxicity) following high dose lumbar erector spinae plane block. A retrospective review [49] revealed that 4 of the 182 patients experienced side effects. In these four complications, one case was perhaps related to the spread of the LA to the lumbar plexus, and three cases were considered to be associated with the LA toxicity possibly. Although no major LAST complications such as seizures have been observed, the rate of the LA toxicity was a little high. There is, therefore, a significant need to determine the effective and safe volume and concentration of the local anesthetic.
Roadmap for Motor Evoked Potential (MEP) Monitoring for Patients Undergoing Lumbar and Lumbosacral Spinal Fusion Procedures
Published in The Neurodiagnostic Journal, 2021
W. Bryan Wilent, Julie M. Trott, Anthony K. Sestokas
There are certain procedures in which there is an elevated risk of nerve root or plexus injury, and MEPs have been shown to have value in diagnosing and avoiding such injuries (Aleem et al. 2018; Bhalodia et al. 2013; Lieberman et al. 2019; Riley et al. 2018; Wilent et al. 2020b). The lateral approach to the lumbar spine puts the lumbar plexus at increased risk of injury, and many modalities, including MEPs, have been utilized to limit these injuries (Epstein 2019; Riley et al. 2018). Posterior procedures involving the L5 vertebra (L4-L5 or L5-S1 intervertebral junctions) may pose an increased risk of injury to the L5 nerve root, placing the patient at an increased risk of “foot drop” dorsiflexion injury (Wilent et al. 2020b). This risk is further elevated in patients undergoing pedicle subtraction osteotomy, transforaminal lumbar interbody fusion, or in patients with a diagnosis of high-grade spondylolisthesis (de Kunder et al. 2017; Lieberman et al. 2019). The value of IONM is predicated on the degree of risk to the nervous system; when there is an elevated risk of nerve root injury, such as with the aforementioned diagnoses and procedures, MEPs have an increased value, and the rationale for inclusion is stronger.
The experience of auditory implant recipients undergoing magnetic resonance imaging: Factors associated with pain
Published in Cochlear Implants International, 2023
Matthew E. Smith, Daniel J. Moualed, Simon R. Freeman, Emma J. Stapleton, Raji Anup, Jincy Kurian, Nicola Jarvis, Owen M. Thomas, Simon K.W. Lloyd
All imaging was performed on a 1.5 T MRI scanner at a single institution (GE Signa HDxT 1.5 T), operated with Specific Absorption Rate values of 0.4–0.8 W/kg. Images were acquired after the administration of intravenous contrast medium. Head sequences consisted of: axial T2WI, axial T1WI, and coronal T1WI (all 3 mm slice thickness). Whole spine sequences involved two fields of view: sagittal T2WI, sagittal T1WI (and axial T2WI, T1WI as required), plus coronal fat saturated T1WI including (i) the cervical spine/brachial plexus and (ii) the lumbar plexus.
Related Knowledge Centers
- Lumbar Nerves
- Lumbosacral Plexus
- Lumbosacral Trunk
- Sacral Plexus
- Spinal Nerve
- Subcostal Nerve
- Nerve Plexus
- Lumbar
- Ventral Ramus of Spinal Nerve
- Intervertebral Foramen