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1990-01-01
Root lesions in the lumbo-sacral region are rare, compared with injuries of the roots of the brachial plexus. They occur almost exclusively in association with serious injuries of the pelvis. The present case, without pelvic injury, is a rarity. The appearances on myelography and CT are well known, but the findings on MRI are also described and the value of this non-invasive procedure is discussed. (orig.)
Anatomy of the spinal nerves and dermatomes
2009-01-01
There are 31 pairs of spinal nerves: eight cervical, 12 thoracic, five lumbar, five sacral and one coccygeal. They form by fusion of a posterior sensory spinal root (bearing its posterior root ganglion) with an anterior motor root. These join at each intervertebral foramen. Typically, the nerve then divides into a posterior and an anterior primary ramus. The former supplies the vertebral muscles and dorsal skin. The anterior primary ramus in the thoracic region bears a white ramus communicans to the sympathetic ganglion. Each spinal nerve receives a grey ramus from the sympathetic chain. The nerves T2-T12 supply the skin and muscles of the trunk sequentially. The other nerves are arranged into the cervical, brachial, lumbar and sacral plexuses. The cervical plexus supplies the skin and ant...
2009-01-01
Study Objective To report on our technique of sacral laparoscopic implantation of aneuroprosthesis-LION procedure-for recovery of bladder/intestinal/sexual function in paralyzed patients after spinal cord injury. Design Prospective case series report. Setting Academic community teaching hospital. Patients Eight consecutive complete T-paralyzed patients after explantation of a previous dorsal implanted Brindley-Finetech controller with a sacral deafferentation. Interventions Laparoscopic transperitoneal exposure of the sacral plexuse and bilateral implantation of Brindley-Finetech electrodes to the sacral nerve roots S2 to S4. Measurements and Main Results Feasibility, complications, and outcome of the procedures. In 6 patients, recovery of electrically induced micturition and defecation co...
Propylene oxide causes central-peripheral distal axonopathy in rats
1988-09-01
In Wistar rats subjected daily to a 6-hr exposure of propylene oxide (PO) at a concentration of 1,500 ppm (5 times a wk for 7 wk), ataxia developed in the hindlegs. Myelinated fibers in hindleg nerves and in the fasciculus gracilis showed axonal degeneration, sparing the nerve cell body of the first sacral dorsal root ganglion and myelinated fibers of the first sacral dorsal and ventral roots. These pathologic findings are compatible with central-peripheral distal axonopathy. This is apparently the first animal model of PO neuropathy to be verified histologically.
Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots
1991-05-01
Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis. (orig.).
Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots
1991-01-01
Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis. (orig.)
Magnetic resonance imaging of the sacral plexus and piriformis muscles
2008-08-15
The objective was to evaluate the piriformis muscles and their relationship to the sacral nerve roots on T1-weighted MRI in patients with no history or clinical suspicion of piriformis syndrome. Axial oblique and sagittal T1-weighted images of the sacrum were obtained in 100 sequential patients (200 pairs of sacral roots) undergoing routine MRI examinations. The relationship of the sacral nerve roots to the piriformis muscles and piriformis muscle size were evaluated, as were clinical symptoms via a questionnaire. The S1 nerve roots were located above the piriformis muscle in 99.5% of cases (n=199). The S2 nerve roots were located above the piriformis muscle in 25% of cases (n=50), and traversed the muscle in 75% (n=150). The S3 nerve roots were located above the piriformis muscle in 0.5% of cases (n=1), below the muscle in 2.5% (n=5), and traversed the muscle in 97% (n=194). The S4 nerve roots were located below the muscle in 95% (n=190). The piriformis muscles ranged in size from 0.8-3.2 cm, with an average size of 1.9 cm. Nineteen percent of patients had greater than 3 mm of asymmetry in the size of the piriformis muscle, with a maximum asymmetry of 8 mm noted. The S1 nerve roots course above the piriformis muscle in more than 99% of patients. The S2 roots traverse the piriformis muscle in 75% of patients. The S3 nerve roots traverse the piriformis muscle in 97% of patients. Piriformis muscle size asymmetry is common, with muscle asymmetry of up to 8 mm identified. (orig.)
Anatomical variations of lumbosacral plexus
2010-01-01
Basis Deviations detected during spinal operations have motivated us to start research related to variations of lumbosacral plexus formation. Aim of this work was to find out deviations of its formation from ascension of particular roots from foramen invertebrale and foramina sacralia up to formation of terminal branches. Set One hundred lumbosacral plexi have been examined in 50 adult cadavers for apurpose to find out an incidence of neural variations. We have observed participation of Th12 root, L4 and L5 roots in its formation, as well as various deviations from ascension of particular plexiform roots up to their ending branches. For lumbal plexus, we have observed four nerve roots and six lumbal nerves; for sacral one, three sacral roots with a share of S4 and lumbosacral trunk forme...
1995-12-31
Lumbar foramen injection under fluoroscopic guidance is indicated either for a diagnostic purpose to determine which nerve root is painful or for a selective steroid injection. Lumbar foramen approach is based on that of the posterior-lateral extradural discography. Selective puncture of the first sacral foramen under fluoroscopic guidance may be indicated for the treatment of sacral symptomatic meningeal cysts, a very unfrequent lesion. (authors). 4 refs., 3 figs.
Laparoscopic pelvic anatomy of nerve-sparing radical hysterectomy
2010-01-01
Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the po...
1981-01-01
Lumbar epidurography serves as an important radiographic procedure in the evaluation of patients with equivocal myelography and confusing or non-diagnostic physical findings. It is particularly valuable in patients with a wide ventral epidural space secondary to previous surgery, arachnoiditis or on a congenital basis. Several techniques and various contrast agents have been employed for the procedure. A pure Seldinger technique with a caudal approach through the sacral hiatus and injection of metrizamide gives excellent visualization of the epidural space and nerve root sleeves. The proper concentration of metrizamide is crucial for optimal results. Lateral, AP, and AP oblique radiographs, occasionally combined with lateral, complex motion tomography, clearly demonstrate the root sleeves and ventral epidural space. CT scanning, with present technology, does not provide the necessary detail for evaluating the epidural space.
Anterior sacral meningocele: management in gynecological practice
2007-01-01
We describe the case of a young woman with anterior sacral meningocele (ASM), initially identified during a routine ultrasound examination and subsequently diagnosed using magnetic resonance imaging (MRI). ASM is a rare disorder characterized by uni- or multilocular extensions of the meninges from the sacral spinal canal to the retroperitoneal presacral space. Common symptoms include lower back and pelvic pain, constipation, difficulties in defecation, dysmenorrhea and dyspareunia, and urinary incontinence, retention or urgency. Perineal and lower-extremity paresthesias may present when nerve roots are affected. Despite its more posterior location, ASM can mimic an ovarian cyst or other adnexal cystic mass, and in the obstetric patient can present a mechanical obstacle to delivery with a r...
2003-09-29
ObjectivesTo test the hypothesis that sacral nerve neuromodulation can alleviate lower limb spasm and spasticity in spinal cord injured patients~%~To develop novel implants and to modify existing technology to carry out the above investigationDescriptionspasticity is a common and distressing manifestation of a neurological lesion for example following spinal cord injury. This problem can prevent funtional rehabilitation in spinal cord injured patioents and has severe consequences for quality of life. Spasticity is characterised by abnormal muscle tone and spasms, which can occur in both striated muscle for example in the limbs, and also the smooth muscle of the bladder, bowel and sphincters.~%~This project aims to address this clinical problem [continued...]
Diagnosis of the lumbar disc herniation by computed tomography
1983-02-01
Diagnostic value of plain CT was assessed on 42 patients clinically suspected to have lumbar disc herniation with sacral or lumbar root pains. CT of the lumbar region visualized the site and size of prolapse of the disc and the positional relationship between the prolapsed disc and the compressed nerve root. CT is one of the useful examination methods for lumbar disc herniation, but its large exposure dose calls for selection of indications on the basis of clinical findings. Since it can be conducted on patients with lumbar disc herniation at the outpatient clinic, patients with iodine hypersensitivity or those with difficult postural change because of strong pains can also be studied.
2006-01-01
Objective Colonic high amplitude propagating sequences (HAPS) are important for colonic transit and defaecation. HAPS frequency is reduced in slow transit constipation (STC). Sacral nerve stimulation (SNS) can altered bowel function. The effects of SNS on colonic HAPS's in severe constipation are unknown. We aimed to determine, in patients with STC, whether SNS can: (1) induce colonic HAPS's, (2) improve symptoms. Method Eight patients with scintigraphically confirmed STC had a manometry catheter (16 recording sites at 7.5 cm intervals) positioned colonoscopically to the caecum. Temporary electrodes (Medtronic) were implanted in the S2 and S3 sacral nerve foramina. 14 Hz stimulation was administered and four sets of parameters (pulse width 300 or 400 ms; S2 and S3) were tested in 4 x 2 h e...
Open-configuration MR-guided nerve root infiltration
2003-01-01
Objective: To describe the procedure and evaluate the accuracy of the interventional MR-guided nerve root infiltration. Methods: Thirteen patients with intervertebral disk herniation underwent interventional MR-guided nerve root infiltration. 4 cases of the cervical and 9 cases of lumbar and sacral nerve roots were infiltration. All patients were performed under 0.23 T open MR system (Proview, Marconi medical system) with optical tracking system (iPath 200, Marconi medical system). The needle was MR-compatible (Daum, Germany, 20 G). The outcome was evaluated as effect on radiculalgia 1-2 months (mean 1.2 months) after the procedure by clinical examination. The effect on radiculalgia was graded as follows: (1) Obvious relief: obvious or complete relief of the pain at the time of outcome evaluation. (2) Temporary relief : temporary relief of pain. (3) No relief but no ...
Cauda equina syndrome presentation of sacral insufficiency fractures.
INTRODUCTION: Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality. PATIENTS AND METHOD: Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy. RESULTS: No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed. CONCLUSION: Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies.
Cauda equina syndrome presentation of sacral insufficiency fractures
2007-04-15
Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality. Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy. No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed. Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies. (orig.)
Imaging and treatment of spinal meningeal cysts in the lumbo-sacral region
2003-01-01
This paper presents the analysis of the symptomatic and asymptomatic cases of SMC and a review of the literature in order to evaluate the current position on treatment options for these lesions. Seventeen patients (5 men - 30% and 12 women - 70%, age, 17 to 68 years) diagnosed with SMC were studied. All examinations were performed with 1.5T (Picker Edge) using standard spine coil. Five symptomatic patients underwent surgery for cyst excision. In all of them, cysts were localized in lumbo-sacral region. MR examinations (from the level T12 to S3) allowed us to accurately classify diagnosed SMC. There were 10 cases of extradural SMC without spinal nerve root fibers (Type I) and 7 cases of extradural SMC with spinal nerve root fibers (Type II). Intradural SMC (type III) were not found in our series. In all cases type II SMC, MR examination did not reveal communication with the subarachnoid ...
CT-guided sacroplasty for the treatment of zone II sacral insufficiency fractures
2009-01-01
Sacral insufficiency fractures are a relatively common cause of lower back pain in the elderly. These fractures can now be treated effectively with percutaneous sacroplasty. However, concerns exist regarding potential extrusion of cement into the sacral foramina that could lead to injury of the sacral nerves or cement migration into the spinal canal. Therefore, the use of sacroplasty in the treatment of sacral insufficiency fractures has largely been limited to fractures predominantly involving the sacral ala. In this case report, we describe the procedure in a patient who was successfully treated with CT guided sacroplasty for bilateral foraminal (Zone II) sacral insufficiency fractures by injecting Polymethylmethacrylate (PMMA) cement lateral to the actual fracture line.
The lumbar and sacral plexuses
2010-01-01
The lumbar plexus is derived from the anterior primary rami of L1, L2, L3, and part of L4. It may also receive a contribution from T12. Its major derivatives are the femoral and the obturator nerves. The sacral plexus arises from the anterior primary rami of the five sacral nerves and the coccygeal nerve, together with the lumbosacral trunk, an important contribution which comprises the whole of L5 together with a contribution from L4. Its terminal branches are the sciatic and the pudendal nerve. In addition, both plexuses have numerous collateral muscular and cutaneous branches, and the sacral plexus gives rise to the pelvic parasympathetic outflow from S2 and S3.
The lumbar and sacral plexuses
2007-01-01
The lumbar plexus is derived from the anterior primary rami of L1, L2, L3, and part of L4. It may also receive a contribution from T12. Its major derivatives are the femoral and the obturator nerves. The sacral plexus arises from the anterior primary rami of the five sacral nerves and the coccygeal nerve, together with the lumbosacral trunk, an important contribution which comprises the whole of L5 together with a contribution from L4. Its terminal branches are the sciatic and the pudendal nerve. In addition, both plexuses have numerous collateral muscular and cutaneous branches, and the sacral plexus gives rise to the pelvic parasympathetic outflow from S2 and S3.
Distribution and Nerve Pathways of Neurons Supplying the Bulbourethral Gland in the Pig
2010-01-01
Abstract The present study has disclosed for the first time the distribution and peripheral nerve pathways of autonomic and primary afferent neurons projecting to the bulbourethral gland (BG) in a mammalian species, the pig (n = 5), using combined retrograde tracing and cutting the hypogastric (n = 3) or pelvic (n = 3) nerve. Neurons projecting to the right BG were found in pelvic ganglia (PG), sympathetic chain ganglia (SChG; L2-S3), the caudal mesenteric ganglion (CaMG) and dorsal root ganglia (DRG; L1-L3, S1-S3). In general, the majority (about 75%) of them were located in the ipsilateral ganglia. Results of denervation experiments suggest that the neurons located in CaMG, and lumbar SChG and DRG project through the hypogastric nerve while processes of those found in the sacral SChG and...
Morphological changes in neurons of the hind limb reflex arc during long term immobilization
Twelve adult rabbits were immobilized for 9 to 31 days, followed by histological study of the nerve processes of lumbar vertebra 7 and sacral vertebra 1, the sciatic nerve and the motor endings of the thigh muscles. ...
2009-01-01
Typically, the sacrum represents five fused sacral vertebrae. Variations are common: lumbarization of S1, sacralization of L5 and fusion of the coccyx. Frequently, a degree of spina bifida occulta is seen. The sacrum has a central mass, four anterior sacral foramina and a lateral mass. The foramina transmit the anterior primary rami of S1-S4. The wings of the sacrum (the alae) are crossed by the lumbosacral trunk, L4 and L5, which joins the sacral plexus. Posteriorly, a median crest ends below as the sacral hiatus, bearing the cornu on either side. The hiatus is covered posteriorly by the tough posterior sacrococcygeal ligament. The posterior sacral foramina transmit the posterior roots of S1-S4. The auricular surface lies laterally and forms the sacroiliac joint with the corresponding sur...
2006-01-01
Abstract Objectives. The aim of the study was to test the effectiveness of sacral nerve stimulation (SNS) performed by a transforamenal approach in patients with isolated chronic intractable pelvic pain. Materials. Sevenpatients with intractable pelvic pain underwent implantation of self-anchoring leads by way of the dorsal S3 foramen in four cases and of the dorsal S4 foramen in three cases. Patients with pain improvement
1989-11-01
A case of traumatic lumbar meningoceles at four levels in combination with total and partial nerve root avulsion and with preservation of a nerve root is reported. Several diagnostic imaging techniques (myelography, CT, myelo-CT and MRI) are compared and their value in demonstrating the continuity of the nerve roots is discussed. MRI could assess the continuity of a nerve root in a traumatic meningocele, not demonstrable by myelography or myelo-CT. The combination of myelography, myelo-CT and MRI is likely to provide a complete diagnostic evaluation of nerve root lesions. (orig.).
1989-01-01
A case of traumatic lumbar meningoceles at four levels in combination with total and partial nerve root avulsion and with preservation of a nerve root is reported. Several diagnostic imaging techniques (myelography, CT, myelo-CT and MRI) are compared and their value in demonstrating the continuity of the nerve roots is discussed. MRI could assess the continuity of a nerve root in a traumatic meningocele, not demonstrable by myelography or myelo-CT. The combination of myelography, myelo-CT and MRI is likely to provide a complete diagnostic evaluation of nerve root lesions. (orig.)
1994-01-01
Experimental autoimmune encephalomyelitis (EAE) is an inflammatory demyelinating disease of the central nervous system (CNS) and can be induced by inoculation of animals with homogenized CNS tissue or highly purified myelin proteins such as myelin basic protein (MBP) or proteolipid protein (PLP). It is widely studied as a possible animal model of multiple sclerosis. We performed the present neurophysiological study to define the location of nerve conduction abnormalities in EAE induced by immunization with PLP (PLP-EAE) and in EAE induced by immunization with MBP (MBP-EAE) in the Lewis rat. In rats with tail weakness due to acute PLP-EAE, conduction was normal in the spinal nerve roots and peripheral nerves but there was evidence of conduction block in a high proportion of the fibres in the dorsal columns of the lumbosacral spinal cord. In contrast, in acute MBP-EAE, there was conduction block in a high proportion of fibres in the sacral dorsal and ventral roots of the peripheral nervous system (PNS) and in the dorsal columns of the lumbosacral spinal cord. The distribution of nerve conduction abnormalities is consistent with previous histological studies showing that inflammation and primary demyelination are restricted to the CNS in PLP-EAE, but are present in the CNS and in the spinal roots of the PNS in MBP-EAE. The restriction of functional abnormalities to the CNS in PLP-EAE but not in MBP-EAE may have implications for the human inflammatory demyelinating diseases, including multiple sclerosis. Coverage: 1994-01-01T00:00:00Z
A case of neurofibromatosis developing facial paralysis following treatment with a gamma knife
2002-01-01
Neurofibromatosis is generally classified into types I and II: the latter may be life-threatening when the acoustic nerve tumor becomes enlarged. The author reports on a patient with bilateral acoustic nerve tumors, as well as large tumors at the neck and sacral regions, who developed facial nerve paralysis following surgery in which a gamma knife was used. The patient, a 30-year-old woman with no family history of neurofibromatosis, had a prominent neurofibroma at the pharyngeal region surgically removed when she was about 23. The procedure left her with dysfunctions of the vocal cords and lingual movements. At the age of 30 (March 2001), a tumor originating at S1 of the sacral nerve plexus was removed, which caused her leg movements to be restricted. Later, an acoustic nerve tumor was found to have enlarged. And in July 2001, the left acoustic nerve tumor was extirpated by using a ...
Lumbo-sacral radiculopathy induced by radiation
1977-11-01
Two patients had lumbo-sacral radiculopathy following radiation treatment of cancer. Twenty previously reported cases were similar. The clinical picture is one of progressive motor and sensory loss in the legs, usually appearing within a year after radiation, but sometimes delayed up to several years. Experimental studies quoted indicate greater vulnerability of peripheral nerves to ionizing radiation than has been previously recognized. Lumbo-sacral radiculopathy is readily produced in the experimental animal (rat) and affords an experimental model closely resembling the human cases reported.
2010-01-01
Purpose Sacral nerve stimulation (SNS) can improve fecal incontinence, though the exact mechanism is not known. This study examines the following hypotheses: SNS leads to contraction of the pelvic floor, influences rectal perception, and improves continence and quality of life. Methods Fourteen patients with sacral nerve stimulators implanted for fecal incontinence were examined prospectively. Morphological and functional assessment was done by endosonography, manometry, and volumetry with the stimulator turned on and off in direct succession. Questionnaires were used to determine incontinence and quality of life. Results With the stimulator turned on, rectal filling conditions were perceived only at higher volumes; in particular, the defecation urge was sensed only at higher volumes. Ther...
Contrasting the Percutaneous Nerve Evaluation Versus Staged Implantation in Sacral Neuromodulation
2010-09-01
Full Text Available.Sacral neuromodulation is increasingly used for the treatment of voiding dysfunction, pelvic pain syndromes, and gastrointestinal disorders. While increased use of this technology has led to a greater understanding of its potential as well as its limitations, difficulty persists in identifying the patients that will benefit most. Either of two trial stimulation techniques is performed before placement of a permanent neuromodulator: the monopolar percutaneous nerve evaluation and the tined quadripolar staged trial. The preponderance of recent literature asserts the superior sensitivity of the staged trial over percutaneous nerve evaluation. However, the techniques offer disparate advantages, and other issues, such as cost-effectiveness, remain largely unexplored. The role of sacral neuromodulation will continue to expand as physicians and patients become increasingly aware of its therapeutic potential. Widespread adoption of this clinically superior technique will most rapidly help the greatest number of patients.
CT of extraforaminal disc herniation with associated vacuum phenomenon
1988-02-01
Lumbo-sacral extraforaminal disc herniation with spinal nerve compression is a well recognized entity. The diagnosis is difficult, however, and the true incidence therefore unknown. We report a case where CT was diagnostic.
MR imaging features of giant pre-sacral schwannomas: a report of four cases
2002-09-01
Benign giant sacral schwannoma is an uncommon cause of destruction of the sacrum. This report details four cases of a variant of this condition called giant presacral schwannoma (GPSS). On MR imaging the features are of a large, well-defined presacral soft tissue mass, arising just to one side of the midline with minor involvement of the bone. The typical MR features of a benign peripheral nerve sheath tumour are not seen. The tumours appear heterogeneous due to long-standing degeneration. Biopsy is advocated as the appearances of GPSS can be similar to a malignant peripheral nerve sheath tumour (malignant schwannoma). (orig.)
2009-01-01
Full Text Available.Overactive bladder is a common and challenging condition for the practicing obstetrician-gynecologist. The prevalence of the condition is increasing with our aging population. Although some patients respond to first-line therapy, a significant number will require sacral nerve stimulation to address the underlying neurologic condition that causes overactive bladder as well as other pelvic floor conditions. This article summarizes the epidemiology and symptomatology, office evaluation, and treatment of overactive bladder with particular emphasis on sacral nerve stimulation (SNS). SNS technique, results, and future applications are also reviewed.
Proximal Sciatic Nerve Intraneural Ganglion Cyst
2009-01-01
Full Text Available.Intraneural ganglion cysts are nonneoplastic, mucinous cysts within the epineurium of peripheral nerves which usually involve the peroneal nerve at the knee. A 37-year-old female presented with progressive left buttock and posterior thigh pain. Magnetic resonance imaging revealed a sciatic nerve mass at the sacral notch which was subsequently revealed to be an intraneural ganglion cyst. An intraneural ganglion cyst confined to the proximal sciatic nerve has only been reported once prior to 2009.
2005-01-01
Pre-sacral or sacral plexus nerve blocks are reported in the anaesthetic literature as effective in controlling pelvic pain, but are rarely performed as they are technically difficult. The pre-sacral space, however, is easily assessable at laparoscopy, and it seemed that infiltration of local anaesthetic solution into this space might offer good pain relief for women undergoing operative laparoscopic procedures for endometriosis when there is destruction of the parietal peritoneum and in whom postoperative pain control, particularly in a day case environment, can prove difficult. Following an initial favorable report of procedure, preliminary clinical studies suggested that the procedure was safe and effective with apparently lower analgesia requirements in the immediate postoperative peri...
2010-01-01
PurposeWe report on the results we obtained with reconstruction for total paralysis of the brachial plexus using long nerve grafts that connect nonavulsed roots to the musculocutaneous and radial nerve. Nerve transfers were performed to restore function of the suprascapular nerve, triceps long head, and pectoralis major muscle. MethodsWe studied 22 young adults with complete brachial plexus palsy who had surgical repair an average of 5 months after trauma. Nerve grafts connected the C5 root to the musculocutaneous nerve. The C6 root was connected by grafts to the radial nerve. When the C6 root was avulsed, the levator scapulae motor branch was connected by grafts to the triceps long head motor branch. In 13 patients, the platysma motor branch was transferred to the medial pectoralis nerve ...
Nerve-preserving sacrocolpopexy: anatomical study and surgical approach
2010-01-01
Objective: The aim of our study is to describe the course of the autonomic nerves in the presacral space and to find the best nerve-preserving approach for sacrocolpopexy. Study design: The autonomic nerves of the presacral space were dissected on six specially preserved female cadavers. Results: The superior hypogastric plexus is located in front of the abdominal aorta and its bifurcation and deviates to the left of the midsagittal plane. At the level of the promontory, or just below, the superior hypogastric plexus branches into two hypogastric nerves that run in front of the sacrum. In the presacral space the parasympathetic pelvic splanchnic nerves from the ventral rami of the sacral spinal nerves (S2-S3) join the hypogastric nerves, forming the inferior hypogastric plexus on both side...
Sacral Nerve Stimulation for Treatment of Intractable Pain Associated with Cauda Equina Syndrome
2010-06-01
Full Text Available.Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.
Hypertrophic nerve roots in a case of Roussy-Levy syndrome
2002-11-01
Hypertrophic radiculopathy is a rare feature of neuropathies. Single cases of enlarged nerve roots have been described in hereditary motor sensory neuropathies (HMSN) and chronic inflammatory demyelinating diseases (CIDP). This is the first description of hypertrophied nerve roots in a patient with Roussy-Levy syndrome. MRI did not show contrast enhancement of the enlarged nerve roots or nodular lesions. (orig.)
Hypertrophic nerve roots in a case of Roussy-Levy syndrome
2002-01-01
Hypertrophic radiculopathy is a rare feature of neuropathies. Single cases of enlarged nerve roots have been described in hereditary motor sensory neuropathies (HMSN) and chronic inflammatory demyelinating diseases (CIDP). This is the first description of hypertrophied nerve roots in a patient with Roussy-Levy syndrome. MRI did not show contrast enhancement of the enlarged nerve roots or nodular lesions. (orig.)
Characteristics of L3 nerve root radiculopathy
2009-01-01
Background In degenerative lumbar spinal disease with nerve root compression, the L5 and S1 nerve roots are the most often affected and the L3 nerve root is involved infrequently. The purpose of this study was to investigate the characteristics of L3 nerve root radiculopathy. Methods Seventeen consecutive patients with L3 radiculopathy were treated. The symptomatic nerve roots were determined by the pain distribution, the neurologic findings, and selective nerve root injection. The clinical characteristics and outcomes of these patients were assessed retrospectively. Results The average age was 76 years. The spinal diseases that were associated with L3 radiculopathy were lumbar canal stenosis in 6 patients, lumbar extraforaminal stenosis and lumbar disk herniation in 5 each, and lumbar can...
Anatomic investigation of the lumbosacral nerve roots and dorsal root ganglia by MRI
1995-05-01
The morphology of the lumbosacral nerve roots and dorsal root ganglia (DRG) was examined by using magnetic resonance imaging (MRI) in 11 healthy male volunteers aged 20-40 years. One hundred and twenty-three nerve roots (15 at the L1 level, 22 each at the L2-L5 levels, and 20 at the S1 level) were examined in terms of the position and angle of the bifurcation of the nerve roots, length of the nerve root, and the position and width of DRG. The nerve roots at the lower levels showed more cephalad position and smaller angle of bifurcation on MRI. The distance from the bifurcation of nerve roots to the cephalad edge of DRG was significantly longer in the upper root levels and was significantly shorter in the L5 roots than the S1 roots. The positions of DRG at the S1 level tended to become cephalad. DRG that was positioned toward more caudal direction was larger and more elliptic. MRI provided useful information concerning morphology and anatomical position of nerve roots and DRG, thereby allowing accurate diagnosis and the determination of surgical indications. (N.K.).
1984-05-01
Myelographic flexion-extension studies were performed in four groups of 10 patients each, with (A) normal myelogram; (B) bilateral nerve root compression at L4-L5; (C) unilateral nerve root compression at L4-L5 and (D) nerve root compression at L5-S1. The aim of the investigation was to assess the role of spinal stenosis in contributing to nerve root compression. The results indicate that a form of stenosis of the spinal canal plays an important role in bilateral nerve root compression at L4-L5, and to a lesser extent in unilateral nerve root compression at L4-L5. It does not appear to play a role in L5-S1 nerve root compression (stenosis of the lateral recess left aside). It is advocated that in myelographic L4-L5 nerve root compression additional flexion-extension studies should be performed in order to evaluate the possible role of stenosis of the spinal canal contributing to this compression. Even in nerve root compression by disc extrusion, concomitant spinal stenosis may necessitate additional decompressive laminectomy.
Cervical neural foramina: Correlation of microtomy and CT anatomy
The CT appearance of the cervical neural foramina and contents is described in detail. Nineteen cervical spine specimens were studied with CT and corresponding cryomicrotomy in direct axial, sagittal, coronal, and oblique planes. Both ventra and dorsal nerve roots can be identified in the foramen's lower portion at or below the disk level. The dorsal nerve roots and ganglion contact the superior facet. The ventral nerve roots contact the uncinate process and bottom of the neural foramen. The ventral nerve roots, dorsal nerve roots and ganglion, and vertebral artery are resolved with current high-resolution CT.
Cervical neural foramina: Correlation of microtomy and CT anatomy
1985-04-01
The CT appearance of the cervical neural foramina and contents is described in detail. Nineteen cervical spine specimens were studied with CT and corresponding cryomicrotomy in direct axial, sagittal, coronal, and oblique planes. Both ventra and dorsal nerve roots can be identified in the foramen's lower portion at or below the disk level. The dorsal nerve roots and ganglion contact the superior facet. The ventral nerve roots contact the uncinate process and bottom of the neural foramen. The ventral nerve roots, dorsal nerve roots and ganglion, and vertebral artery are resolved with current high-resolution CT.
Direct sacral root stimulation: Another possibility in chronic pelvic pain management
2010-01-01
Objective The objective of this study was to explore the direct bilateral sacral root stimulation as another possibility in chronic pelvic pain management. Material and methods We implanted directly two Tined lead (Medtronic, Minneapolis, MN) electrodes in the sacral foramina at the S3 level, used for the treatment of chronic pelvic pain. Based on a sample of 20 patients with a mean of age of 57, this study comprised 3 groups: general surgery service patients—from the proctology section, which included patients with anal incontinence and a patient suffering from constipation; patients with diverse origins of chronic pelvic pain; and patients with lumbago in which the implant of this type of electrode was realized at subcutaneous level. Results After the test, the mean pain relief wa...
Myelography for nerve root avulsion in birth palsy
1990-04-01
Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs); 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM; 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to myelography in delineating a meningocele because CTM is sensitive to a poorly enhanced meningocele. CTM, however, could not diagnose nerve root avulsions so accurately as myelography, since myelography detected 12 (7 completely and 5 incompletely) avulsed roots without meningocele, whereas CTM could not delineate the nerve roots clearly. Thus, myelography is indispensable to evaluate nerve root avulsions without meningocele. Root-SEP was examined in 9 patients who underwent branchial plexus exploration. SEP was negative at 22/25 roots with complete avulsion and was positive at 7/7 roots with myelographically incomplete avulsion, regardless of presence or absence of any traumatic meningocele. Myelography and root-SEP correlated well at 29 (92%) out of 32 roots in evaluating complete and incomplete avulsion injuries. Myelography and root-SEP were not considered in 3 roots. Though myelography demonstrated complete avulsions with traumatic meningocele, SEP was positive in these three roots, which were interpreted as partially avulsed roots. (J.P.N.).
1987-05-01
MT tomography offers an excellent opportunity of indirectly proving that traumatic exairesis of a nerve root has occurred. If a nerve root pocket is 'empty' as a result of the exairesis, it is filled completely with central nerve fluid CNF and is then easily visualised.
1991-04-01
Radiation injury to peripheral nerve is a dose-limiting toxicity in the clinical application of intraoperative radiotherapy, particularly for pelvic and retroperitoneal tumors. Intraoperative radiotherapy-related peripheral neuropathy in humans receiving doses of 20-25 Gy is manifested as a mixed motor-sensory deficit beginning 6-9 months following treatment. In a previous experimental study of intraoperative radiotherapy-related neuropathy of the lumbro-sacral plexus, an approximate inverse linear relationship was reported between the intraoperative dose (20-75 Gy range) and the time to onset of hind limb paresis (1-12 mos following intraoperative radiotherapy). The principal histological lesion in irradiated nerve was loss of large nerve fibers and perineural fibrosis without significant vascular injury. Similar histological changes in irradiated nerves were found in humans. To assess peripheral nerve injury to lower doses of intraoperative radiotherapy in this same large animal model, groups of four adult American Foxhounds received doses of 10, 15, or 20 Gy to the right lumbro-sacral plexus and sciatic nerve using 9 MeV electrons. The left lumbro-sacral plexus and sciatic nerve were excluded from the intraoperative field to allow each animal to serve as its own control. Following treatment, a complete neurological exam, electromyogram, and nerve conduction studies were performed monthly for 1 year. Monthly neurological exams were performed in years 2 and 3 whereas electromyogram and nerve conduction studies were performed every 3 months during this follow-up period. With follow-up of greater than or equal to 42 months, no dog receiving 10 or 15 Gy IORT shows any clinical or laboratory evidence of peripheral nerve injury. However, all four dogs receiving 20 Gy developed right hind limb paresis at 8, 9, 9, and 12 mos following intraoperative radiotherapy.
Obturator nerve schwannoma presenting as an adnexal mass: case report
1999-02-01
Schwannomas are relatively common, benign nerve-sheath tumours. They arise most commonly from either cranial nerves or the dorsal root of spinal nerves. Schwannomas have also been reported to occur in peripheral nerve-root trunks, although this location is much less common. We report a case of a 45-year-old woman with a large pelvic mass originally believed to be an ovarian tumour. Following surgical excision, the tumour was found to be a schwannoma of the obturator nerve. To our knowledge, there are no reported cases of an obturator nerve schwannoma. The imaging features of schwannomas are reviewed. (author)
Obturator nerve schwannoma presenting as an adnexal mass: case report
1999-01-01
Schwannomas are relatively common, benign nerve-sheath tumours. They arise most commonly from either cranial nerves or the dorsal root of spinal nerves. Schwannomas have also been reported to occur in peripheral nerve-root trunks, although this location is much less common. We report a case of a 45-year-old woman with a large pelvic mass originally believed to be an ovarian tumour. Following surgical excision, the tumour was found to be a schwannoma of the obturator nerve. To our knowledge, there are no reported cases of an obturator nerve schwannoma. The imaging features of schwannomas are reviewed. (author)
Ultrastructural changes of compressed lumbar ventral nerve roots following decompression
2006-01-01
To study whether there will be permanent lumbar nerve rot scanning or degeneration secondary to continuous compression followed by decompression on the nerve roots, which can account for postlaminectomy leg weakness or back pain. The study was performed at the Department of Anatomy, Faulty of Medicine, king Abdulaziz University, Jeddah, Kingdom of Saudi Arabia during 2003-2005. Twenty-six adult male New Zealand rabbits were used in the present study. The ventral roots of the left fourth lumbar nerve were clamped for 2 weeks then decompression was allowed by removal of the clips. The left ventral roots of the fourth lumbar nerve were excised for electron microscopic study. One week after nerve root decompression, the ventral root peripheral to the site of compression showed signs of Wallerian degeneration together with signs of regeneration. Schwann cells and myelinated ...
Evaluation of brachial plexus injury by CT myelography
2005-01-01
Objective: To evaluate the diagnostic value of CT myelography (CTM) in brachial plexus injury. Methods: Twenty-seven patients with brachial plexus injury were examined by using cervical CTM with spiral scan and bone reconstruction algorithm. CT images were reviewed by the senior radiologists, who determined if the nerve root avulsion was presented. The criteria of diagnosing nerve root avulsion were loss of normal nerve root appearance in the Isovist filled thecal sac in consecutive CTM slices plus companion signs. The sensitivity, specificity, and accuracy of CTM in diagnosing nerve root injuries were calculated with operation findings and follow-up results as gold standard. Results: Direct sign of nerve root avulsion was the loss of normal nerve root defect seen in the Isovist filled thecal sac in consecutive CTM slices. Indirect signs included: (1) Pseudomeningocele ...
The autonomic nervous system, sympathetic chain and stellate ganglion
2005-01-01
The complementary sympathetic and parasympathetic systems arise and leave the CNS at different sites. In the sympathetic system, fibres arise from the lateral columns of segments T1-L2 to join paired trunks that extend from the base of the skull to the coccyx and form 3 cervical, 11 thoracic, 4 lumbar and 4 sacral ganglia. Somatic fibres pass via 31 spinal nerves to provide vasoconstrictor fibres, secretory fibres to salivary glands, and pilomotor fibres to skin; visceral fibres pass to thoracic and abdominal viscera, the adrenal medulla, cranial and facial structures. From the thoracic sympathetic trunk, splanchnic nerves pass to end in coeliac, aortic and hypogastric plexuses. The parasympathetic system has a cranial and sacral component and has effects on viscera and vascular systems th...
Innervation of the Pelvic Limb of the Adult Ostrich (Struthio camelus)
2010-01-01
With 24 figures Summary The pelvic limb of the ostrich is innervated by the lumbar and sacral plexuses. The lumbar plexus gave rise to several nerves (N.s) including, N. coxalis cranialis, lateral and cranial femoral cutaneous N.s, N. femoralis, cranial, caudal and medial crural cutaneous N.s, and N. obturatorius. The remaining nerves emanated from the sacral plexus. The N. iliotibial, N. ischiofemoralis, N. iliofibularis, and N. coxae caudalis were distributed in the thigh, while the N. ischiadica, which terminated as the tibial and fibular N.s that innervated the leg and foot. The tibial N. gave rise to the parafibular N. then divided to form the Nn. suralis medialis and lateralis. The N. suralis medialis continued as the N. metatarsalis plantaris medialis. The parafibular N. continued a...
Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury
2010-01-01
Background The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder-areflexia phase. Methods Ten patients with neurologically-confirmed complete spinal cord lesions (SCLs) were provided with bilateral SNMs during the phase of atonic-detrusor muscle. Modulation was achieved by two electrodes implanted into each S3-foramen. Six patients declined and served as controls. The mean follow-up was 26.2 months. Results Videourodynamics (VU) confirmed detrusor acontractility, resulting in urinary continence as well as significant reductions in urinary tract infections (UTIs). Bowel movements did not require oral laxatives; additi...
2010-01-01
Abstract Objective In patients undergoing sacral nerve stimulation (SNS), a temporary percutaneous stimulation wire is often used to assess the clinical response to therapy prior to chronic stimulation. The aim of this study was to evaluate the incidence of bacterial colonization of screening wires and risk of clinical infection in patients undergoing prolonged temporary SNS screening. Method Data were collected prospectively on a consecutive series of patients undergoing temporary SNS for bowel dysfunction. Procedures were performed using a standardized percutaneous technique with a single shot of either co-amoxyclav 1.2 g or cefuroxime 1.5 g given intravenously on induction. Adherent polyurethane dressings were applied to secure the wire. At the end of the screening period the wire and d...
Lumbar extraforaminal ligaments act as a traction relief and prevent spinal nerve compression
2010-01-01
Background In a previous study, ligaments that connect the extraforaminal lumbar spinal nerves with the fibrous capsule of the facet joints and the dorsolateral side of the intervertebral disc were described. This anatomical configuration suggests a mechanical role in transferring extraforaminal spinal nerve traction. Methods One embalmed human lumbar spine was dissected from the twelfth thoracic vertebra to the first sacral vertebra to isolate the twelfth thoracic to the fourth lumbar spinal nerves. The spinal nerves from L1 to L4 were pulled at different angles with respect to the axis of the spine. Forces of 1-6N were applied. The displacements of reflective markers glued to the proximal and distal ends of the adjoining ligaments were recorded with a video system. Findings The spinal ne...
Myelography for nerve root avulsion in birth palsy
1990-01-01
Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs). 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM. 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to ...
2006-07-15
Purpose: To report a technique developed for visualizing cervical nerve roots and distal nerve fibers using diffusion-weighted magnetic resonance imaging employing parallel imaging. Material and Methods: We performed maximum intensity projection for a stack of isotropic axial diffusion-weighted images obtained with parallel imaging applying a motion-probing gradient in six directions with a b-value of 500 s/mm{sup 2} in a preliminary series of 13 subjects. Results: This method worked well for visualizing the spinal cord and most of the nerve roots, the dorsal root ganglia, and proximal peripheral nerves. Conclusion: Although the technique remains limited in depicting the brachial plexus and distal nerves, the ability to visualize the proximal peripheral nervous system at the cervical level is promising.
2006-01-01
Purpose: To report a technique developed for visualizing cervical nerve roots and distal nerve fibers using diffusion-weighted magnetic resonance imaging employing parallel imaging. Material and Methods: We performed maximum intensity projection for a stack of isotropic axial diffusion-weighted images obtained with parallel imaging applying a motion-probing gradient in six directions with a b-value of 500 s/mm2 in a preliminary series of 13 subjects. Results: This method worked well for visualizing the spinal cord and most of the nerve roots, the dorsal root ganglia, and proximal peripheral nerves. Conclusion: Although the technique remains limited in depicting the brachial plexus and distal nerves, the ability to visualize the proximal peripheral nervous system at the cervical level is promising
Brachial Plexopathy/Nerve Root Avulsion in a Football Player: The Role of Electrodiagnostics
2008-01-01
Electromyography (EMG) studies are a useful tool in anatomical localization of peripheral nerve and brachial plexus injuries. They are especially helpful in distinguishing between brachial plexopathy and nerve root injuries where surgical intervention may be indicated. EMG can also assist in providing prognostic information after nerve injury as well as after nerve repair. In this case report, a football player presented with weakness in his right upper limb after a traction/traumatic injury to the right brachial plexus. EMG studies revealed evidence of both pre- and postganglionic injury to multiple cervical roots. The injury was substantial enough to cause nerve root avulsions involving the C6 and C7 levels. Surgical referral led to nerve grafts targeted at regaining function in shoulder...
2003-09-01
Normal adult uninjured nerve is unable to support axonal regeneration. We have studied the mechanisms underlying the regeneration of peripheral nerve by culturing adult mouse dorsal root ganglia...Full Text Available
Intraoperative spinal cord and nerve root monitoring: a survey of Canadian spine surgeons
2010-10-01
BackgroundIntraoperative spinal cord and nerve root monitoring is used to identify an insult to the neural elements with the goal of preventing injury. There are 2 major categories...Full Text Available
Carbonic anhydrase (CA) and cholinesterase (CE) histochemical staining of rabbit spinal nerve roots and dorsal root ganglia demonstrated that among the reactive myeliated axons, with minor exceptions, sensory axons were CA ...
Optimising the image of the intradural nerve root: the value of MR radiculography
1996-10-01
We evaluated the additional value of MR radiculography for increasing the sensitivity and specificity of MRI with regard to nerve root compression in patients with sciatica. The single slices of a heavily T 2-weighted oblique coronal image set were reformatted with a maximum intensity projection protocol. This image resembles a classical contrast radiculogram and shows the intradural nerve root and its sleeve. In 43 patients studied with a standard MRI examination there was a need for further assessment of nerve root compression in 19 (44 %). In 13 (68 %) of these, MR radiculography made a definite verdict possible. (orig.). With 4 figs., 2 tabs.
Optimising the image of the intradural nerve root: the value of MR radiculography
1996-01-01
We evaluated the additional value of MR radiculography for increasing the sensitivity and specificity of MRI with regard to nerve root compression in patients with sciatica. The single slices of a heavily T 2-weighted oblique coronal image set were reformatted with a maximum intensity projection protocol. This image resembles a classical contrast radiculogram and shows the intradural nerve root and its sleeve. In 43 patients studied with a standard MRI examination there was a need for further assessment of nerve root compression in 19 (44 %). In 13 (68 %) of these, MR radiculography made a definite verdict possible. (orig.). With 4 figs., 2 tabs
2008-01-01
Background The superior hypogastric plexus (SHP) that is formed anterior to the aorta and the sacral promontory and is located anterior to the L5S1 vertebrae, normally continues as the inferior hypogastric plexus. Several variations have been described from a single trunk to a plexiform arrangement. Materials and methods The SHP was dissected in 35 formalized cadavers. Results A single thin and rounded nerve was found in 17.14% of subjects. The type of a wide reticular formation was observed in 28.57% of specimens. Interestingly, a band-like nerve trunk consisting of nerve bundles connected with loose connective tissue was evident in 22.85% of cadavers. Eventually, two distinct nerves at a short distance with each other were found in 31.44% of subjects. Furthermore, we found that branch...
Definition of Total Mesorectal Excision, Including the Perineal Phase: Technical Considerations
2007-01-01
Abstract Background: Total mesorectal excision (TME) has contributed to a decline in local recurrence. The operation is difficult because of the complicated anatomy of the pelvis and the narrow spaces in the pelvis. We review the anatomy related to TME and we present our surgical technique. Anatomy: The pelvis can be divided into a parietal compartment and a visceral compartment. Both compartments are covered by a fascial layer: the parietal and the visceral fascia. A space between these fascial layers can be opened by dividing loose areolar tissue. The pelvic autonomic nerves consist of the sympathetic hypogastric nerve and the parasympathetic sacral splanchnic nerve. At the pelvic sidewall these nerves join in the inferior hypogastric plexus. Surgery: We present our surgical technique ba...
Sacral Nerve Stimulation for Treatment of Chronic Intractable Anorectal Pain -A Case Report-
2010-03-01
Despite recent methodological advancement of the practical pain medicine, many cases of the chronic anorectal pain have been intractable. A 54-year-old female patient who had a month history of a constant...Full Text Available
CT findings of retroperitoneal neurilemoma
1991-01-15
Neurilemoma or schwannoma is a benign tumor originating from the Schwann cell of the peripheral nerve sheath. Most frequently this nerve sheath tumor arises in cranial nerves, occasionally in extremity nerve, and rarely in retroperitoneum. To our knowledge, only a few reports covered CT findings of this tumor in the past and most of these were superficial in description. We present two cases of retroperitoneal neurilemoma with an emphasis on CT findings. Both neurilemomas and neurofibroma originate from Schwann cells, despite their usually distinct clinical presentations and histologic features. Neurilemomas are typically solitary, circumscribed, and encapsulated occurring eccentrically on proximal nerves or spinal nerve roots when they involve peripheral nerves.
CT findings of retroperitoneal neurilemoma
1991-01-01
Neurilemoma or schwannoma is a benign tumor originating from the Schwann cell of the peripheral nerve sheath. Most frequently this nerve sheath tumor arises in cranial nerves, occasionally in extremity nerve, and rarely in retroperitoneum. To our knowledge, only a few reports covered CT findings of this tumor in the past and most of these were superficial in description. We present two cases of retroperitoneal neurilemoma with an emphasis on CT findings. Both neurilemomas and neurofibroma originate from Schwann cells, despite their usually distinct clinical presentations and histologic features. Neurilemomas are typically solitary, circumscribed, and encapsulated occurring eccentrically on proximal nerves or spinal nerve roots when they involve peripheral nerves
MRI neurography and diffusion tensor imaging of a sciatic perineuroma in a child
2008-09-15
Perineuroma, rare in children, presents as a painless mononeuropathy of a major nerve trunk. Resection of the lesion with end-to-end sural nerve grafting appears to be the treatment of choice. This technique is not recommended if the unhealthy segment of nerve is too long or if spinal roots are involved. However, in children, reports of direct MR evaluation of nerve trunks and of the exiting nerve roots are limited. We report a 7-year-old girl with an intramural sciatic nerve perineuroma in whom the diagnosis was made by MRI and confirmed by biopsy. The MR protocol combining 3-D T2-W STIR SPACE, fat-saturated gadolinium-enhanced T1-W images, and diffusion tensor imaging with tractography was a valuable tool for depicting peripheral nerve and roots in order to plan surgical treatment. (orig.)
MRI neurography and diffusion tensor imaging of a sciatic perineuroma in a child
2008-01-01
Perineuroma, rare in children, presents as a painless mononeuropathy of a major nerve trunk. Resection of the lesion with end-to-end sural nerve grafting appears to be the treatment of choice. This technique is not recommended if the unhealthy segment of nerve is too long or if spinal roots are involved. However, in children, reports of direct MR evaluation of nerve trunks and of the exiting nerve roots are limited. We report a 7-year-old girl with an intramural sciatic nerve perineuroma in whom the diagnosis was made by MRI and confirmed by biopsy. The MR protocol combining 3-D T2-W STIR SPACE, fat-saturated gadolinium-enhanced T1-W images, and diffusion tensor imaging with tractography was a valuable tool for depicting peripheral nerve and roots in order to plan surgical treatment. (orig.)
2006-01-01
The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc. The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for L5 nerve root) if the nerve root compression was at the level of the ...
Gadolinium-DTPA enhancement of symptomatic nerve roots in MRI of the lumbar spine
1998-01-01
Disc prolapse presenting with sciatica may be associated with enhancement of the symptomatic nerve root following magnetic resonance imaging (MRI) with intravenous gadolinium (Gd)-DTPA. Previous studies have shown, however, that this does not occur in all cases. The aim of this study was to assess the incidence of nerve root enhancement in patients with sciatica and disc prolapse and to try to identify any specific features that might be associated with the phenomenon. A total of 227 patients presenting with low back pain and/or sciatica underwent a MRI study of the lumbar spine with intravenous contrast enhancement. Nineteen of 81 (23.5 %) patients with disc prolapse demonstrated nerve root enhancement. Nerve root enhancement had a highly significant association with sequestrated disc lesions (13/19, 68 %. P
A review of approaches and techniques for lower extremity nerve blocks.
PURPOSE: The purpose of this narrative review is to summarize the evidence derived from randomized controlled trials (RCTs) regarding approaches and techniques for lower extremity nerve blocks. SOURCE: Using the MEDLINE (January 1966 to April 2007) and EMBASE (January 1980 to April 2007) databases, medical subject heading (MeSH) terms "lumbosacral plexus", "femoral nerve", "obturator nerve", "saphenous nerve", "sciatic nerve", "peroneal nerve" and "tibial nerve" were searched and combined with the MESH term "nerve block" using the operator "and". Keywords "lumbar plexus", "psoas compartment", "psoas sheath", "sacral plexus", "fascia iliaca", "three-in-one", "3-in-1", "lateral femoral cutaneous", "posterior femoral cutaneous", "ankle" and "ankle block" were also queried and combined with the MESH term "nerve block". The search was limited to RCTs involving human subjects and published in the English language. Forty-six RCTs were identified. PRINCIPAL FINDINGS: Compared to its anterior counterpart (3-in-1 block), the posterior approach to the lumbar plexus is more reliable when anesthesia of the obturator nerve is required. The fascia iliaca compartment block may also represent a better alternative than the 3-in-1 block because of improved efficacy and efficiency (quicker performance time, lower cost). For blockade of the sciatic nerve, the classic transgluteal approach constitutes a reliable method. Due to a potentially shorter time for sciatic nerve electrolocation and catheter placement than for the transgluteal approach, the subgluteal approach should also be considered. Compared to electrolocation of the peroneal nerve, electrostimulation of the tibial nerve may offer a higher success rate especially with the transgluteal and lateral popliteal approaches. Furthermore, when performing sciatic and femoral blocks with low volumes of local anesthetics, a multiple-injection technique should be used. CONCLUSIONS: Published reports of RCTs provide evidence to formulate limited recommendations regarding optimal approaches and techniques for lower limb anesthesia. Further well-designed and meticulously executed RCTs are warranted, particularly in light of new techniques involving ultrasonographic guidance.
Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma
2002-06-01
Haemangioblastomas are vascular tumours which mainly involve the central nervous system and retina, often in the setting of von Hippel-Lindau disease. Haemangioblastomas occurring outside the central nervous system are uncommon. Wherever it is, recognising this tumour prior to surgery is desirable, as preoperative embolisation may be considered. We report the clinical, imaging and pathological features of a sporadic sacral root haemangioblastoma in a 58-year-old man with chronic sciatica and myelopathy. The diagnosis was questioned preoperatively because an enlarged sacral foramen, seen to be filled by a highly vascular, enhancing mass and dilated vessels. Myelopathy was attributed to the presumed high venous pressure resulting from increased flow in veins draining the vascular tumour. Microneurosurgical excision was performed after endovascular embolisation and led to persistent clinical improvement. (orig.)
Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma
2002-01-01
Haemangioblastomas are vascular tumours which mainly involve the central nervous system and retina, often in the setting of von Hippel-Lindau disease. Haemangioblastomas occurring outside the central nervous system are uncommon. Wherever it is, recognising this tumour prior to surgery is desirable, as preoperative embolisation may be considered. We report the clinical, imaging and pathological features of a sporadic sacral root haemangioblastoma in a 58-year-old man with chronic sciatica and myelopathy. The diagnosis was questioned preoperatively because an enlarged sacral foramen, seen to be filled by a highly vascular, enhancing mass and dilated vessels. Myelopathy was attributed to the presumed high venous pressure resulting from increased flow in veins draining the vascular tumour. Microneurosurgical excision was performed after endovascular ...
Sacral neuromodulation as a treatment for neuropathic clitoral pain after abdominal hysterectomy
2010-01-01
Sacral neuromodulation (SNM) may be beneficial in the treatment of patients with chronic pelvic pain, although it is not an FDA-approved indication. We present a case of a 51-year-old patient that presented with symptoms of lower urinary tract dysfunction and clitoral pain after an abdominal hysterectomy. Electrophysiological evaluation suggested a pudendal nerve lesion. After failure of conservative treatment, she was offered SNM as a treatment for her voiding symptoms. During test stimulation, she experienced only moderate improvement in voiding symptoms, but a striking improvement in pain symptoms. She underwent a two-stage implantation of a neurostimulator with a successful outcome after 6months follow-up. The results of this report suggest that SNM may be effective in patients wi...
2007-01-01
Capillary blood flow in the spinal roots was studied in 52 patients with lumbar osteochondrosis during discectomy for lumbar disk herniation, before and after decompression. It was determined that the value of the capillary blood flow in the nerve root influenced markedly the severity of the pain syndrome, the threshold of sensitivity to pain in the dermatome involved, and the strength of the indicator group of muscles. It was shown that the level of intact reserves of the spinal nerve root microcirculation influenced the degree of functional restoration after the discectomy.
A review of the thoracic splanchnic nerves and celiac ganglia
2010-01-01
Anatomical variation of the thoracic splanchnic nerves is as diverse as any structure in the body. Thoracic splanchnic nerves are derived from medial branches of the lower seven thoracic sympathetic ganglia, with the greater splanchnic nerve comprising the more cranial contributions, the lesser the middle branches, and the least splanchnic nerve usually T11 and/or T12. Much of the early anatomical research of the thoracic splanchnic nerves revolved around elucidating the nerve root level contributing to each of these nerves. The celiac plexus is a major interchange for autonomic fibers, receiving many of the thoracic splanchnic nerve fibers as they course toward the organs of the abdomen. The location of the celiac ganglia are usually described in relation to surrounding structures, and al...
Effects of nicorandil on the recovery of reflex potentials after spinal cord ischaemia in cats.
1995-09-01
Full Text Available.1. The pathophysiological significance of ATP-sensitive K+ (KATP) channels in the central nervous system is not fully understood. In this study the effects of nicorandil (a hybrid vasodilator having a dual mechanism of action as a K+ channel opener and a nitrate) on the recovery of the spinal cord reflex potentials after spinal cord ischaemia were examined and compared with those of pinacidil and nitroprusside in anaesthetized spinal cats. 2. Spinal cord ischaemia was produced by occlusion of the thoracic aorta and the bilateral internal mammary arteries for 10 min. Regional blood flow in the spinal cord was continuously measured with a laser-Doppler flow meter. The monosynaptic (MSR) and polysynaptic reflex (PSR) potentials, elicited by electrical stimulation of the tibial nerve, were recorded from the lumbo-sacral ventral root. The recovery process of spinal reflex potentials was reproducible when the occlusion was repeated twice at an interval of 120 min. 3. Pretreatment with nicorandil (30-100 micrograms kg-1) accelerated the recovery of PSR potentials after spinal cord ischaemia. Such an accelerating effect on the recovery of PSR potentials was also shared by pinacidil (100 micrograms kg-1), another K+ channel opener. In addition, the accelerating effect of nicorandil (100 micrograms kg-1) on the recovery of PSR potentials was abolished by co-administration of glibenclamide (3 mg kg-1), a sulphonylurea KATP channel blocker. Nitroprusside (8 micrograms kg-1min-1) retarded rather than improved the recovery of PSR potentials after spinal cord ischaemia. All of these drugs failed to improve the spinal cord blood flow during ischaemia and reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Urinary Incontinence After Bilateral Parasacral Sciatic-Nerve Block: Report of Two Cases
2006-01-01
Objective The authors describe the occurrence of urinary incontinence after bilateral parasacral sciatic-nerve blocks. Case Report Two female patients scheduled for bilateral hallux valgus corrective surgery under bilateral parasacral sciatic-nerve block developed urinary incontinence manifested by 3 episodes of enuresis in the first 5 hours after surgery. Physical examination revealed bilateral perineal and gluteal anesthesia and no bladder distention in both patients. Ten hours after block placement, both patients had recovered perineal sensibility and were able to control micturition. Conclusion Given the anatomic relations between the sacral plexus and the autonomic and somatic afferent and efferent innervation of the bladder and urethra, the urinary incontinence observed in our 2 pati...
Localization of motor nerve branches of the human psoas muscle
2010-01-01
Endplate-targeted botulinum toxin injections can achieve optimal neuromuscular blockade. The goal of this study was to identify the motor endplate (MEP) zone in the human psoas muscle through dissection. In 24 human cadaver psoas muscles the nerve branches and their intramuscular course were followed by stereoscopic microscopic dissection as far as their terminal ramifications. From the lumbar plexus, an average of 3.7 (range 2-7) nerve branches enter the psoas muscle. The proximal and distal limit of the MEP-zone are situated at about 30% and 70%, respectively, of the distance between the twelfth thoracic vertebra (Th12) and the passing of the psoas under the inguinal ligament. In reference to the sacral promontory (P), these limits are respectively from 50% of the Th12-P distance to 20% ...
Hypoganglionic colorectum in the chick embryo: a model of human hypoganglionosis
2009-01-01
Introduction The enteric nervous system is an intrinsic network of nerve cells and glia within the gastrointestinal wall, which originates in the vagal and sacral neural tube. The vagal neural tube is known to supply the colorectum with the majority of its nerve cells, and its ablation during early development produces a hypoganglionic colorectum. We hypothesized that the cholinergic nerve activity in the chick embryo hypoganglionic colorectum is decreased similar to the human situation and, therefore, this study is designed to investigate cholinergic innervations in the chick embryo hypoganglionic colorectum. Materials and methods Chicken eggs were incubated until embryos reached the 1012 somite stage. The vagal neural tube was microsurgically ablated and eggs were returned to the incu...
3-D MRI/CT fusion imaging of the lumbar spine
2010-03-15
The objective was to demonstrate the feasibility of MRI/CT fusion in demonstrating lumbar nerve root compromise. We combined 3-dimensional (3-D) computed tomography (CT) imaging of bone with 3-D magnetic resonance imaging (MRI) of neural architecture (cauda equina and nerve roots) for two patients using VirtualPlace software. Although the pathological condition of nerve roots could not be assessed using MRI, myelography or CT myelography, 3-D MRI/CT fusion imaging enabled unambiguous, 3-D confirmation of the pathological state and courses of nerve roots, both inside and outside the foraminal arch, as well as thickening of the ligamentum flavum and the locations, forms and numbers of dorsal root ganglia. Positional relationships between intervertebral discs or bony spurs and nerve roots could also be depicted. Use of 3-D MRI/CT fusion imaging for the lumbar vertebral region successfully revealed the relationship between bone construction (bones, intervertebral joints, and intervertebral disks) and neural architecture (cauda equina and nerve roots) on a single film, three-dimensionally and in color. Such images may be useful in elucidating complex neurological conditions such as degenerative lumbar scoliosis(DLS), as well as in diagnosis and the planning of minimally invasive surgery. (orig.)
1989-10-01
CT myelography (CTM) and conventional myelography were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. A traumatic meningocele was detected in 45 roots by CTM, and in 35 roots by myelography. CTM misinterpreted only one root with a very small meningocele. CTM was superior to myelography in delineating a traumatic meningocele, because CTM is sensitive to a poorly enhanced meningocele. On the other hand, CTM missed 9 avulsed roots without a meningocele. By myelography, these 9 roots were diagnosed as 6 roots of complete avulsion injury and 3 roots of incomplete avulsion. Myelography is indispensable in evaluating nerve root avulsion. (author).
1989-01-01
CT myelography (CTM) and conventional myelography were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. A traumatic meningocele was detected in 45 roots by CTM, and in 35 roots by myelography. CTM misinterpreted only one root with a very small meningocele. CTM was superior to myelography in delineating a traumatic meningocele, because CTM is sensitive to a poorly enhanced meningocele. On the other hand, CTM missed 9 avulsed roots without a meningocele. By myelography, these 9 roots were diagnosed as 6 roots of complete avulsion injury and 3 roots of incomplete avulsion. Myelography is indispensable in evaluating nerve root avulsion. (author)
A case of neurofibromatosis developing facial paralysis following treatment with a gamma knife
2002-12-01
Neurofibromatosis is generally classified into types I and II: the latter may be life-threatening when the acoustic nerve tumor becomes enlarged. The author reports on a patient with bilateral acoustic nerve tumors, as well as large tumors at the neck and sacral regions, who developed facial nerve paralysis following surgery in which a gamma knife was used. The patient, a 30-year-old woman with no family history of neurofibromatosis, had a prominent neurofibroma at the pharyngeal region surgically removed when she was about 23. The procedure left her with dysfunctions of the vocal cords and lingual movements. At the age of 30 (March 2001), a tumor originating at S1 of the sacral nerve plexus was removed, which caused her leg movements to be restricted. Later, an acoustic nerve tumor was found to have enlarged; and in July 2001, the left acoustic nerve tumor was extirpated by using a gamma knife. Starting in early 2002, her left facial movements appeared to be compromised but during the follow-up observation period, she regained the movements. Patients with neurofibromatosis are often plagued by the development of multiple tumors and surgical sequelae. One is reminded that it is necessary to plan treatment with sufficient consideration given to quality of life (QOL) (including the problem of an acoustic nerve tumor that may develop in future) as well as individual patients wishes. (author)
The usefulness of MR myelography for evaluation of nerve root avulsion in brachial plexus injury
2002-10-01
Myelography has been the most popular and reliable method for evaluation of nerve root avulsion in brachial plexus injury. However, it is invasive because it requires the use of contrast medium, dural puncture and exposure to radiation. In addition, it has a fault. When a nerve rootlet is not filled with contrast medium, it is impossible to evaluate it. It has sometimes been a problem in the injury to upper roots. Recently, MRI also has been used for diagnosis of brachial plexus injury. But it was not until recently that it has had a high resolution to detect affected nerve rootlets. We have used MR myelography with high resolution for diagnosis of brachial plexus injury. The purpose of this study is to investigate the usefulness of it. MR myelography was preoperatively performed in 14 cases, consisting of 13 traumatic brachial plexus injuries and an obstetrical palsy. In them, 12 cases had root avulsion injuries and 2 cases had infraclavicular injuries. A 1.5 Tesla MR system (Philips) and a cervical coil were used. Coronal sections with 2 mm-overcontiguous thickness were obtained by heavily T2-weighted sequence fast spin echo (TR/TE=3000/450). The fat signal was suppressed by a presaturation inversion-pulse. The scanning time was about five minutes. The three-dimensional image was reconstructed by using maximum intensity projection (MIP) method. MIP images and individual coronal images were used for evaluation for root avulsion. In evaluation the shape of a nerve sleeve and nerve rootlets was compared on both sides. The abnormal shape of a nerve sleeve or the defect of nerve rootlets was diagnosed as root avulsion. The brachial plexus lesions were exposed operatively and examined with electrophysiologic methods (SEP and/or ESCP) in all cases. Operative findings were compared with MR myelography. Twenty-four roots had been diagnosed as normal and 46 roots had been diagnosed as root avulsion with MR myelography preoperatively. In the former only one root was diagnosed as postganglionic lesion (Zone 2) intraoperatively. In the latter all roots except two roots were diagnosed as preganglionic lesion intraoperatively. ESCPs of low amplitude were recorded in the two roots. The sensitivity and the specificity of MR myelography were 100% and 97.1% respectively. MR myelography has several advantages compared with conventional myelography. It is non-invasive and quick. It provides imaging of full column in multiple projections. It delineates the deformity of a nerve sleeve and/or the defect of nerve rootlets. Therefore, MR myelography is now superior to conventional myelography for evaluation of nerve root avulsion in brachial plexus injury. (author)
MR imaging of the lumber spine; Visualization capability of the nerve root
1991-01-01
We studied visualization capability of the nerve root in mainly coronary section pattern using magnetic resonance imaging (MRI). MRI was carried out in 91 patients with lumbago and sciatica. Coronary section was additionally photographed in 58 cases of these patients (32 with intervertebral hernia, 20 with spinal canal stenosis, 2 with spondylolytic spondylolisthesis, 2 with compression fracture and the other 2 patients). The visualization capability of the nerve root was studied with photographing 2 pulse systems of the coronary section by using spin echo and field echo methods. The high signal area of the cerebrospinal fluid and nerve root in the normal lumbar vertebra was noted by field echo method, and pattern that is visualized by myelogram was obtained. The coincidence of the main foci (disturbed lesions of the nerve root) in the intervertebral hernia and coronary section pattern was noted in 21 of 32 cases (64.5%) with considerably high ratio. The condition of the nerve root in the blocked lesion was visualized in the spinal canal stenosis. (author).
1996-01-01
To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc . Type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases . 58%) was more frequently observed than the posterolateral ...
2010-01-01
We report a rare case of congenital absence of the L5-S1 facet joint, which was associated with a conjoined nerve root. Combination of these two anomalies has been quite rarely reported in the literature. A 39-year-old man presented with acute low back pain and right leg radiating pain. Muscle weakness and sensory disturbance of the right leg were also apparent in the region innervated by L5 and S1 nerve roots. Preoperative multidetector three-dimensional computed tomography (3D-CT) showed complete absence of the right S1 superior articular process. Magnetic resonance (MR) images showed lumbar disc herniation at right L5-S1 level that migrated cranially. Intraoperative findings revealed that the right L5 nerve root and S1 nerve root were conjoined, and the conjoined nerve root was compress...
1994-12-01
To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.).
Clinical and imaging characteristics of foraminal nerve root disorders of the lumbar spine
2009-01-01
We analyzed cases of lumbar nerve root compression at intervertebral foramina, by comparing 19 cases of foraminal stenosis (FS), and 38 cases of foraminal hernia (FH) with 21 cases of lumbar canal stenosis (LCS). Japan Orthopedic Association (JOA) scores, intervertebral disc degeneration, anatomical measurements of the nerve root foramina and the MRI findings were reviewed. The scores for pain in the lower extremities, and walking ability were both lowest in the FS group. The scores for low back pain, lower extremities, and sensory disturbances were lowest in the FH group. Anterior-posterior diameters of the nerve root foramina were smaller in the FS group and FH group than in the LCS group. More degenerated discs and short length of upper part of the nerve root foramina were seen in FS group than in the other groups. The MRI images of so-called black out nerve root foramina were ...
A Case of Delusional Parasitosis Associated with Multiple Lesions at the Root of Trigeminal Nerve
Full Text Available.The authors present a patient with multiple pontine lesions who exhibited symptoms consistent with delusional parasitosis. The trigeminal nerve nuclei are located throughout the brainstem. Pathology in either the nuclei or the branches of the fifth cranial nerve has been associated with both sensory and motor disturbances. Delusional parasitosis is a condition in which the patient has the firm belief that small, living organisms have infested his or her skin or other organs. To our knowledge, this is the first case report of delusional parasitosis associated with lesions at the root of the trigeminal nerve.
MRI in diagnosing nerve root edema in patients with lumbar disk herniation
2002-01-01
Over the period 1995 through 2000, thirty-six patients presenting radicular pains in the lower limbs are subjected to MRI study, with myelography and CT-myelography bein also performed in the same series. The obtained images undergo comparative assessment with electromyography findings. In 73 per cent of the patients edema of nerve roots in the vicinity of disk herniation at L4/L5 level, and in 27 per cent - edema in the region of herniated intervertebral disk L5/S1 are observed. In the cases with median disk herniation there are bilateral edematous changes involving the roots of the respective nerves. (authors)
Lumbar nerve root avulsions with secondary ipsilateral hip dysplasia in a child
2002-09-01
We report on an 8-year-old child with avulsions of the left L3, L4 and L5 nerve roots and traumatic meningoceles that were not associated with lumbar spine or pelvic girdle fractures. The patient had a history of a road traffic accident. Plain radiographs of the pelvis revealed left hip dysplasia. The magnetic resonance imaging findings of the lumbar spine are illustrated. The pathogenesis of lumbar nerve root avulsions and their association with ipsilateral hip dysplasia are discussed. (orig.)
2010-01-01
Background Neurogenic bladder represents a major cause of morbidity in patients with spinal cord injuries (SCI). Herein, we evaluated a novel reconstructive surgical technique designed to restore afferent and efferent nerve function in atonic bladder caused by conus medullaris injury. Materials and Methods A new reflex pathway was established by extradural transfer of the left L5 ventral root (VR) to the left S2 VR root together with extradural postganglionic spinal nerve transfer of the L5 dorsal root (DR) to the S2 DR with a nerve graft in a canine model. The corresponding nerves on the right side were kept intact and served as a control. After the new reflex pathway was reestablished, the early function of the reflex arc was evaluated by electrophysiologic study, intravesical pressure, ...
2003-12-01
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history. (orig.)
2003-01-01
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots. However, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history. (orig.)
2009-01-01
Background To clarify the neurologic function with respect to puborectalis muscle (PM) in patients after low anterior resection (LAR) for low rectal cancer, author examined the sacral nerve terminal motor latency (SNTML) of the PM. Methods The latency of the response in the PM following transcutaneous magnetic stimulation of the cauda equina at the levels from S3 to S4 by SNTML was measured in 33 patients after LAR. They were divided into groups. Group A, which experienced soiling, comprised 15 patients (11 men, 4 women) aged 58 to 77years (mean 63.5years). Group A was further divided into patients having soiling with mucous secretions and feces on underwear on awaking everyday (group A1, 9 cases) and those with soiling during the daytime only when diarrhea occurred (group A2, 6 cases)...
[Vascular network of the entrance area of the trigeminal nerve root into the brainstem]
High-tech methods of surgical treatment of neural diseases require detailed data on the microanatomy on the base of the brain. Using an original method of dissection of the posterior cranial fossa and brain removal from the skull, the data on microanatomical peculiarities of the entrance area of the trigeminal nerve root into the brainstem were received at autopsies on 48 human subjects. Three variants of arterial blood supply to the trigeminal nerve root and three variants of venous drainage from the cerebellopontine angle are described. The suggested method of posterior cranial fossa dissection during an autopsy allows to detect a topographical-anatomical interrelations between the trigeminal nerve root and the vessels of the skull base, which existed in the living patients. Taking into consideration the variants of the superior petrosal vein structure the allows to decrease the probability of complications during the surgical access to the brainstem structures.
2010-01-01
Regeneration of sensory neurons is limited in response to lesion of their central axons when compared to lesion of their peripheral axons. To identify transcriptional changes underlying this differential regenerative response between dorsal root and spinal nerve axons, the L5 dorsal root ganglion (DRG) of adult rats was investigated three days after crushing the respective nerve branches by performing high density genome oligonucleotide microarrays. RT-PCR, in situ hybridization and immunohistochemistry confirmed the up-regulation of the vasodilator peptide apelin in non-neuronal cells of the DRG after dorsal root but not after spinal nerve lesion. Induction of apelin mRNA and peptide is accompanied by increased vascular permeability around neuronal cell bodies as demonstrated by Evans-blu...
Nerve Root Enhancement on Spinal MRI in Pediatric Guillain-Barre Syndrome
2010-01-01
Guillain-Barre syndrome diagnosis is based on clinical presentation and supportive diagnostic testing. In its early stage, no single, reliable diagnostic test is available. However, a finding of nerve root enhancement on spinal magnetic resonance imaging may be useful. We evaluated the frequency of nerve root enhancement on spinal magnetic resonance imaging in children with Guillain-Barre syndrome. At a single tertiary pediatric center, we conducted a retrospective chart review of children with Guillain-Barre syndrome who had complete spinal or lumbosacral spinal magnetic resonance imaging with gadolinium administration from January 2002-January 2009. Twenty-four consecutive patients were identified. Spinal nerve root enhancement with gadolinium was present in 92% (22/24) of children with ...
2003-01-01
The Author describes a new magnetic resonance (MR) imaging technique of the cervical nerve roots in traumatic brachial plexus injury. The overlapping coronal-oblique slice MR imaging procedure of the cervical nerve root was performed in 35 patients with traumatic brachial plexus injury. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet partial injuries, avulsion, and meningocele), after diagnosis by surgical exploration. In this study, the sensitivity of detection of the cervical nerve root avulsion in MR imaging was the same (92.9%) as that of myelography and CT myelography. The reliability and reproducibility of the MR imaging classification was prospectively in 10 patients with traumatic brachial plexus injury, assessed by eight independent observers, and its diagnostic accuracy was compared with ...
2002-06-01
The purpose of this study was to evaluate the feasibility of the MRI-guided periradicular nerve root infiltration therapy. Sixty-seven nerve root infiltrations under MRI guidance were done for 61 patients suffering from lumbosacral radicular pain. Informed consent was acquired from all patients. A 0.23-T open-MRI scanner with interventional tools (Outlook Proview, Philips Medical Systems, MR Technologies, Finland) was used. A surface coil was used in all cases. Nerve root infiltration was performed with MRI-compatible 20-G needle (Chiba type MReye, Cook, Bloomington, Ind.; or Manan type, MD Tech, Florida). The evaluation of clinical outcome was achieved with 6 months of clinical follow-up and questionnaire. The effect of nerve root infiltration to the radicular pain was graded: 1=good to excellent, i.e., no pain or not disturbing pain allowing normal physical activity at 3 months from the procedure; 2=temporary, i.e., temporary relief of pain; 3=no relief of pain; and 4=worsening of pain. As an adjunct to MRI-guided positioning of the needle the correct needle localization by the nerve root was confirmed with saline injection to nerve root channel and single-shot fast spin echo (SSFSE) imaging. The MRI guidance allowed adequate needle positioning in all but 1 case (98.5%). This failure was caused by degeneration-induced changes in anatomy. Of patients, 51.5% had good to excellent effect with regard to radicular pain from the procedure, 22.7% had temporary relief, 21.2% had no effect, and in 4.5% the pain worsened. Our results show that MRI guidance is accurate and safe in performing nerve root infiltration at lumbosacral area. The results of radicular pain relief from nerve root infiltration are comparable to CT or fluoroscopy studies on the subject. (orig.)
... lamina, to relieve pressure on the nerve roots. Spinal Fusion ? A procedure in which bone is grafted onto ... through a discectomy, the spine must be stabilized. Spinal fusion is often performed in conjunction with a laminotomy. ...
Therapeutic receptor targets for lower urinary tract dysfunction
2008-01-01
The functions of the lower urinary tract, to store and periodically release urine, are dependent on the activity of smooth and striated muscles in the bladder, urethra, and external urethral sphincter. During urine storage, the outlet is closed, and the bladder smooth muscle is quiescent. When bladder volume reaches the micturition threshold, activation of a micturition center in the dorsolateral pons (the pontine micturition center) induces a bladder contraction and a reciprocal relaxation of the urethra, leading to bladder emptying. During voiding, sacral parasympathetic (pelvic) nerves provide an excitatory input (cholinergic and purinergic) to the bladder and inhibitory input (nitrergic) to the urethra. These peripheral systems are integrated by excitatory and inhibitory regulation at ...
OBJECTIVE: To describe an ultrasound-guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. STUDY DESIGN: Prospective experimental trial. ANIMALS: Four hound-cross dogs aged 2 +/- 0 years (mean +/- SD) weighing 30 +/- 5 kg and four Beagles aged 2 +/- 0 years and weighing 8.5 +/- 0.5 kg. METHODS: Axillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation-guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. RESULTS: Axillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve block Landmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve block. Ultrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.
1988-04-15
High resolution computed tomography is the most accurate diagnostic tool to define a lumbar herniated disc disease, because it provides a complete in vivo analysis of bony framework of lumbar spine as well as the supporting soft tissue structures and neural elements. The purpose of this study is to estimate the valve of CT in athe evaluation of nerve root compression caused by herniated disc disease. We analyzed 52 roots of 26 patients of single level herniated disc disease with definite evidence of bilateral or unilateral neurologic deficit who had both CT and myelography at Pusan National University Hospital from May 1983 to March, 1987. The results were as follows: 1. Sensitivity and specificity of CT is 77% and 81%, respectively in the diagnosis of nerve root compression caused by lumbar herniated disc disease. 2. Sensitivity and specificity of myelography is 77% and 81% respectively, in the diagnosis of nerve root compression caused by lumbar herniated disc disease. 3. The results of this study indicate that high resolution CT was equivalent to myelography in the diagnosis of nerve root compression caused by lumar herniated disc disease.
3-D MRI/CT fusion imaging of the lumbar spine
2010-01-01
The objective was to demonstrate the feasibility of MRI/CT fusion in demonstrating lumbar nerve root compromise. We combined 3-dimensional (3-D) computed tomography (CT) imaging of bone with 3-D magnetic resonance imaging (MRI) of neural architecture (cauda equina and nerve roots) for two patients using VirtualPlace software. Although the pathological condition of nerve roots could not be assessed using MRI, myelography or CT myelography, 3-D MRI/CT fusion imaging enabled unambiguous, 3-D confirmation of the pathological state and courses of nerve roots, both inside and outside the foraminal arch, as well as thickening of the ligamentum flavum and the locations, forms and numbers of dorsal root ganglia. Positional relationships between intervertebral discs or bony spurs and nerve roots could also be depicted. Use of 3-D MRI/CT fusion imaging for the lumbar vertebral ...
Lumbar nerve root avulsion following trauma: balanced fast field-echo MRI
2004-02-01
Lumbosacral nerve root avulsion uncommonly complicates major trauma. Most patients also have pelvic or lumbar fractures. We present a patient who had a high-velocity vehicle accident with traumatic hip dislocation without fractures of the spine or pelvis. MRI demonstrated lumbosacral traumatic pseudomeningoceles. We used balanced fast field echo and MR myelography to make the diagnosis and show the extent of the pseudomeningocele. (orig.)
Lumbar nerve root avulsion following trauma: balanced fast field-echo MRI
2004-01-01
Lumbosacral nerve root avulsion uncommonly complicates major trauma. Most patients also have pelvic or lumbar fractures. We present a patient who had a high-velocity vehicle accident with traumatic hip dislocation without fractures of the spine or pelvis. MRI demonstrated lumbosacral traumatic pseudomeningoceles. We used balanced fast field echo and MR myelography to make the diagnosis and show the extent of the pseudomeningocele. (orig.)
Gadolinium-DTPA enhancement of symptomatic nerve roots in MRI of the lumbar spine
1998-02-01
Disc prolapse presenting with sciatica may be associated with enhancement of the symptomatic nerve root following magnetic resonance imaging (MRI) with intravenous gadolinium (Gd)-DTPA. Previous studies have shown, however, that this does not occur in all cases. The aim of this study was to assess the incidence of nerve root enhancement in patients with sciatica and disc prolapse and to try to identify any specific features that might be associated with the phenomenon. A total of 227 patients presenting with low back pain and/or sciatica underwent a MRI study of the lumbar spine with intravenous contrast enhancement. Nineteen of 81 (23.5 %) patients with disc prolapse demonstrated nerve root enhancement. Nerve root enhancement had a highly significant association with sequestrated disc lesions (13/19, 68 %; P < 0.0005), and was primarily seen in the symptomatic ipsilateral nerve root (16/19, 84 %). The sensitivity of nerve root enhancement associated with disc prolapse was 23.5 % with a specificity of 95.9 %, a positive predictive value of 76 % and a negative predictive value of 69.3 %. Nerve root enhancement may be indicative of the symptomatic level but its poor sensitivity negates the routine use of Gd-DTPA in MRI for sciatica. (orig.) With 4 figs., 1 tab., 37 refs.
Ultrasound-Guided Cervical Selective Nerve Root Block: A Fluoroscopy-Controlled Feasibility Study
2009-01-01
Background and Objectives Reports of intravascular injection during cervical transforaminal injections, even after confirmation by contrast fluoroscopy, have led some to question the procedures safety. As ultrasound allows for visualization of soft tissues, nerves, and vessels, thus potentially improving precision and safety, we evaluated its feasibility in cervical nerve root injections. Methods This is a prospective series of 10 patients who received cervical nerve root injections using ultrasound as the primary imaging tool, with fluoroscopic confirmation. Our radiologic target point was the posterior aspect of the intervertebral foramen just anterior to the superior articular process in the oblique view and at the midsagittal plane of the articular pillars in the anteroposterior (AP) v...
The usefulness of MR myelography for evaluation of nerve root avulsion in brachial plexus injury
2002-01-01
Myelography has been the most popular and reliable method for evaluation of nerve root avulsion in brachial plexus injury. However, it is invasive because it requires the use of contrast medium, dural puncture and exposure to radiation. In addition, it has a fault. When a nerve rootlet is not filled with contrast medium, it is impossible to evaluate it. It has sometimes been a problem in the injury to upper roots. Recently, MRI also has been used for diagnosis of brachial plexus injury. But it was not until recently that it has had a high resolution to detect affected nerve rootlets. We have used MR myelography with high resolution for diagnosis of brachial plexus injury. The purpose of this study is to investigate the usefulness of it. MR myelography was preoperatively performed in 14 cases, consisting of 13 traumatic brachial plexus injuries and an obstetrical palsy. In them, 12 cases ...
2008-01-01
We describe a new computed tomography (CT) myelography technique with coronal and oblique coronal views to demonstrate the status of the cervical nerve rootlets that are involved in brachial plexus injury. We discuss the usefulness of this technique for the diagnosis of nerve root avulsion compared with that of CT myelography with axial view. CT myelography was performed with enhancement of the cervical subarachnoid space by using a contrast medium. Subsequently, coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified in the presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was based on the findings of extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyltransferase activity ...
Isthmic lumbar spondylolisthesis with sciatica; MR imaging vs myelography
1990-09-01
Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: Normal nerve (n=8), II: Compressed nerve (n=16); III: Disappearance of fat, nerve not possible to identify (n=9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information. (orig.).
2004-01-01
Neurons in pelvic ganglia receive nicotinic excitatory post-synaptic potentials (EPSPs) from sacral preganglionic neurons via the pelvic nerve, lumbar preganglionic neurons via the hypogastric nerve or both. We tested the effect of a range of calcium channel antagonists on EPSPs evoked in paracervical ganglia of female guinea-pigs after pelvic or hypogastric nerve stimulation. omega-Conotoxin GVIA (CTX GVIA, 100 nM) or the novel N-type calcium channel antagonist, CTX CVID (100 nM) reduced the amplitude of EPSPs evoked after pelvic nerve stimulation by 50-75% but had no effect on EPSPs evoked by hypogastric nerve stimulation. Combined addition of CTX GVIA and CTX CVID was no more effective than either antagonist alone. EPSPs evoked by stimulating either nerve trunk were not inhibited by the P/Q calcium channel antagonist, omega-agatoxin IVA (100 nM), nor the L-type calcium channel antagonist, nifedipine (30 muM). SNX 482 (300 nM), an antagonist at some R-type calcium channels, inhibited EPSPs after hypogastric nerve stimulation by 20% but had little effect on EPSPs after pelvic nerve stimulation. Amiloride (100 muM) inhibited EPSPs after stimulation of either trunk by 40%, while nickel (100 muM) was ineffective. CTX GVIA or CTX CVID (100 nM) also slowed the rate of action potential repolarization and reduced afterhyperpolarization amplitude in paracervical neurons. Thus, release of transmitter from the terminals of sacral preganglionic neurons is largely dependent on calcium influx through N-type calcium channels, although an unknown calcium channel which is resistant to selective antagonists also contributes to release. Release of transmitter from lumbar preganglionic neurons does not require calcium entry through either conventional N-type calcium channels or the variant CTX CVID-sensitive N-type calcium channel and seems to be mediated largely by a novel calcium channel. (C) 2004 IBRO. Published by Elsevier Ltd. All rights reserved. Publisher: Pergamon-Elsevier Science Ltd Coverage: 2004-01-01T00:00:00Z
1988-01-01
High resolution computed tomography is the most accurate diagnostic tool to define a lumbar herniated disc disease, because it provides a complete in vivo analysis of bony framework of lumbar spine as well as the supporting soft tissue structures and neural elements. The purpose of this study is to estimate the valve of CT in athe evaluation of nerve root compression caused by herniated disc disease. We analyzed 52 roots of 26 patients of single level herniated disc disease with definite evidence of bilateral or unilateral neurologic deficit who had both CT and myelography at Pusan National University Hospital from May 1983 to March, 1987. The results were as follows: 1. Sensitivity and specificity of CT is 77% and 81%, respectively in the diagnosis of nerve root compression caused by lumbar herniated disc disease. 2. Sensitivity and specificity of myelography is 77% and 81% ...
Radicular avulsion resulting from spinal injury: Assessment of diagnostic modalities
1992-01-01
The diagnostic utility of imaging techniques in injuries to the intramedullary and subarachnoid portions of the brachial plexus, with possibly complete avulsion of one or more nerve roots from the spinal cord and extramedullary meningocoele was compared in 18 patients studied by unenhanced computed tomography (CT), cervical myelography, myelographic CT (MCT) and magnetic resonance imaging (MRI). Emphasis was placed on the lesions of the subarachnoid roots. CM was the only diagnostic modality to show avulsion of 18 nerve roots and their levels in 8 patients (100% = gold standard), and to verify 2 incomplete avulsions. MCT reliably revealed 8 of 18 (45%) and MRI 1 out of 18 (6%) avulsions. Myelography with MCT showed intact subarachnoid nerve roots in 10 additional patients. MRI and MCT (16 out of 16 = 100%) were superior to myelography (14/16 = 88%) for demonstrating 16 traumatic ...
2010-01-01
Abstract The central projections of primary sensory afferents innervating the caudal region of the pectoral fin of the long-tailed stingray (Himantura fai) were labeled by applying the lipophilic carbocyanine dye DiI to the dorsal roots in fixed tissue. These observations were complemented by examination of hemotoxylin and eosin-stained paraffin sections of the dorsal root entry zone, and transmission electron microscopy of the dorsal horn. Transverse sections of the sensory nerve and dorsal root revealed two distinct myelinated axon sizes in the sensory nerve. Although the thick and thin axons do not appear to group together in the sensory nerves and dorsal root, they segregate into a dorsally directed bundle of thin fibers and a more horizontally directed bundle of thick fibers soon afte...
2009-01-01
The aim of this work was to study whether the vestibular afferent fibers establish direct connections with the motoneurons of glossopharyngeal and vagus nerves of the frog, Rana esculenta. In anaesthetized animals the vestibulocochlear nerve and the common root of glossopharyngeal-vagus and accessory (IX-X-XI) nerves were simultaneously labeled with fluorescein dextran amine (vestibulocochlear nerve) and tetramethylrhodamine dextran amine (IX-X-XI). With a confocal laser scanning microscope we could detect close appositions between the vestibular afferent fibers and somatodendritic components of the general and special visceral motoneurons of the ambiguus nucleus of IX-X nerves. The direct impulse transmission may provide a quick and immediate response of cardiovascular and gastrointestina...
Cadaveric study of nerves supplying the membranous urethra
2010-01-01
Aims To better understand the anatomy of the region of the male membranous urethra in order to preserve continence during radical cystectomy and prostatectomy. Methods Cadaveric dissections of 15 male specimens were undertaken to investigate the nerves to membranous urethra. The nerves were traced from both an intrapelvic approach and a perineal approach. The origin, course, and distribution of the branches to the membranous urethra region were investigated in detail. Results The membranous urethra is innervated by branches of inferior hypogastric plexus (IHP) and intrapelvic and extrapelvic branches of pudendal nerve (PN). The pelvic nerve from IHP originated from the caudal most root of the pelvic splanchnic nerve, running along the surface of the levator ani muscle (LAM) to enter the me...
1989-10-01
Full Text Available.1. An isolated spinal cord-peripheral nerve preparation of the newborn rat was developed. In this preparation it is possible to record spinal reflexes from a lumbar ventral root in response to stimulation of the ipsilateral saphenous or obturator nerve. 2. Single shock, weak intensity stimulation of the saphenous nerve induced a fast conducted compound action potential in the L3 dorsal root and a fast depolarizing response in the ipsilateral L3 ventral root. As a stronger stimulus was applied to the saphenous nerve, a slowly conducted compound action potential appeared in the dorsal root and a slow depolarizing ventral root potential (v.r.p.) in the L3 ventral root. 3. Single shock stimulation of the obturator nerve induced a rapidly conducted compound action potential in the L3 dorsal root and monosynaptic and polysynaptic reflexes, with a fast time course, in the ipsilateral L3 ventral root. 4. The slow v.r.p. evoked by saphenous nerve stimulation was depressed by the tachykinin antagonist, [D-Arg1, D-Trp7,9, Leu11] substance P (spantide), 4-16 microM. The response recovered its original shape and size 30-60 min after the removal of this antagonist. 5. The saphenous nerve-evoked slow v.r.p. was depressed by [Met5] enkephalin (0.1-1 microM), dynorphin (1-13)(0.2 microM) and morphine (1-2 microM), and these effects were reversed by naloxone (1 microM). 6. Two endogenous peptides, galanin (1-2 microM) and somatostatin (1-2.5 microM), inhibited the slow v.r.p. evoked by saphenous nerve stimulation, whereas another endogenous peptide, calcitonin gene-related peptide (0.1-0.5 microM), potentiated the slow v.r.p. The slow v.r.p. was also inhibited by gamma-aminobutyric acid (GABA, 20 microM) and muscimol (0.2 microM), and their effects were antagonized by bicuculline (1 microM). 7. The present results suggest that substance P and neurokinin A are involved in the saphenous nerve-evoked C-fibre response in the spinal cord of the newborn rat.
Muscle hypertrophy of the lower leg caused by L5 radiculopathy
2009-01-01
We report on a case with hypertrophy of the tibial muscles and to a lesser extent of the calf muscles preceded by a lumbar syndrome and sciatica. Lumbar myelography disclosed a discogenic compression of the L5 nerve root. Muscle biopsy of the peroneal muscles showed a marked type I fibre predominance and hypertrophy but no inflammatory infiltration. We consider the possibility that radiculopathy not only of the S1 nerve root but also of the L5 root can trigger hypertrophy of the musculature and must be taken into account of the differential diagnosis of unilateral focal hypertrophy of the lower leg.
2002-09-01
Abstract Objective. To compare MR morphologic parameters of spinal nerve roots and their range of variability in normal and abnormal spinal segments.Design and patients. Ninety-six consecutive lumbar spine MRI examinations were segregated into three groups: group 1 was composed of 30 patients with disc bulge, protrusion or extrusion at the L5-S1 segment measuring 3 mm or more; group 2 consisted of 31 patients with no disc pathology; and group 3 was composed of 35 patients with no disc abnormality at the L5-S1 level but with coexisting spine pathology at other segments. Measurements of 192 S1 nerve root sleeves were performed at three consecutive levels on T1-weighted images. Differences between right and left nerve root sleeve diameters (delta value) at three slice levels were calculated in each group. Data were analyzed by ANOVA.Results. No significant differences between the mean values of traversing S1 nerve root sleeve diameter on three corresponding consecutive slices were found among groups (P=0.733, P=0.824, P=0.365 respectively), nor were significant differences in delta values between groups found (P=0.639, P=0.113, P=0.722).Conclusions. S1 nerve root sleeve diameter and the differences between right and left in the abnormal group were not significantly different from normal and therefore can not be used as an objective criterion of nerve root pathology. (orig.)
Visualization of pelvic splanchnic nerve and pelvic plexus by magnetic resonance imaging
2001-06-01
Magnetic resonance imaging (MRI) was used to identify the pelvic splanchnic nerve and/or pelvic plexus using the resected surgical specimen in vitro. The distance between splanchnic nerve or pelvic plexus and the rectal wall was then measured preoperatively in patients with rectal cancer. In the resected surgical specimen, the fourth splanchnic nerve (S4) was recognized in 5 of 5 cases (100%) and the pelvic plexus in 4 of 5 cases (80%) as low-intensity fibers in T1-weighted sagittal imaging. Preoperatively, S4 was recognized in 36 of 42 patients (86%) by T1-weighted sagittal imaging, at least on one side. The pelvic plexus was recognized in 33 of 42 (79%). Continuity from the sacral foramen and anatomical location on the axial section confirmed the accuracy of imaging. Projecting nerves on the axial image, we measured the distance between S4 or pelvic plexus and the rectal outer margin (the tumor itself or muscle proper). The distance averaged 8.8 mm when the tumor was on the same level as the pelvic plexus, and 14.0 mm when the tumor was located cephalad or caudal to the pelvic plexus. MRI is thus useful in evaluating the location of the pelvic splanchnic nerve and plexus, and this information aids in conducting nerve-preserving surgery for advanced rectal cancer. (author)
2009-01-01
Sacral vertebroplasty, or sacroplasty, entails the percutaneous insertion of 1 or more bone needles into the sacral ala and, less commonly, the sacral vertebra with fluoroscopic and/or computed tomographic guidance. Acrylic bone cement is then injected under imaging guidance to treat the lesion and stabilize the sacrum. Sacroplasty is indicated for the treatment of painful sacral insufficiency fractures and painful sacral masses, both of which destabilize the sacrum. In properly selected patients, sacroplasty is an extremely efficacious procedure with a low-risk profile when performed with meticulous imaging guidance and a thorough appreciation of the complex sacral anatomy. Complete pain relief is observed in the overwhelming majority of patients that are treated for sacral insufficiency ...
2010-01-01
The phenomenon of windup has often been used to assess excitability increases of spinal neurons induced by repetitive stimulation of nociceptive afferents. Windup has been studied in individual spinal cord neurons and in spinal motor reflexes neither of which accurately reflect the forward transmission of nociceptive signals to the brain. In addition, most in vitro studies of spinal windup have been conducted on immature or juvenile animals and it is challenging to extrapolate these results to the adult spinal cord. In the present study, we have used an in vitro whole spinal cord preparation from functionally mature mice (up to 8weeks old) to record windup activity in ascending axons in the mid-thoracic region evoked by electrical stimulation of a lumbar or sacral dorsal root. Windup respo...
2010-01-01
Background Injury of a peripheral nerve may lead to neuropathic pain, a form of chronic pain that does not respond to traditional pain therapies. The aim of this study was to investigate the effect of pulsed radiofrequency (PRF) applied to the L5 and L6 dorsal roots on the neuropathic pain that develops after sciatic nerve injury in rabbits. Methods In this study, 18 New Zealand rabbits were used. These were divided into 3 groups. In groups 1 and 2, the left sciatic nerve was tightly ligated as a partial ligation model with 4-0 silk sutures. Group 3 was a sham group. Pulsed radiofrequency was applied to group 1 rabbits on both dorsal roots at 42degreeC for 8 mins. The responses of all the groups to thermal and mechanical stimuli were measured for a period of 4 weeks after this process. Res...
2010-01-01
There is general agreement that lumbosacral nerve root compression is a prime factor in the pathogenesis of sciatica and neurogenic claudication, although humoral and vascular factors certainly play a role as well. This book focuses on imaging of the various ways in which nerve root compression can come about, and assessing which anatomic features are reliably associated with the occurrence of radicular pain, as opposed to morphologic findings which are probably coincidental. After a discussion of the nature of radicular pain and related symptoms, spinal imaging techniques and options are reviewed, with emphasis on the role of MR myelography in assessing the condition of the intradural nerve roots. A chapter on normal topographic, sectional, and functional (dynamic) radiologic anatomy is followed by a presentation on pathologic anatomy, addressing the various ...
1996-01-01
The MRI examinations of 52 patients with proven inflammatory lesions (39 patients) or tumorous/postactinic lesions of the spinal cord (6 patients) and vasuclar malformations of the spinal cord (7 patients) were retrospectively analyzed. All examinations were performed on a 1.5 T MR unit, using bi- or triplanar T1-w pre- and postcontrast as well as T2-w SE sequences. Clinical and radiological examinations allow a subdivision of inflammations of the spinal cord and the nerve roots into (mening-oradiculo) myelitis and meningoradiculo (myelitis). The MRI patterns of these two inflammatory subtypes vary: Meningoradiculitis presents with an enhancement of the nerve roots and the leptomeninges. Myelitis itself is characterized by single or multiple, diffuse or multifocal, with or without nodular, patchy or diffusely enhancing intramedullary lessions, with or without ...
Hypertrophic neuropathy of the cauda equina
2010-01-01
A 72-year-old woman with a history of lower extremity weakness, pain, and sensory loss in the right thigh for the last 15months had deteriorated during a period of 6months. Magnetic resonance imaging of the lumbosacral spine revealed apparent nerve root thickening from L1 to S and spinal canal stenosis. An L1L3 decompressive laminectomy and durotomy revealed multiple segmentally enlarged and congestive nerve roots. A 1-mm segment of nerve root was resected and submitted for pathological analysis. The pathological examination revealed hypertrophic neuropathy, with nonspecific inflammation. After steroid use, the patients symptoms improved. HNCE is a rare disorder that can cause pain and lower extremity weakness, sensory loss, and hyporeflexia. One possible cause is chronic inflamm...
Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations
2010-01-01
Unidentified nerve root anomalies, conjoined nerve root (CNR) being the most common, may account for some failed spinal surgical procedures as well as intraoperative neural injury. Previous studies have failed to clinically discern CNR from herniated discs and found their surgical outcomes as being inferior. A comparative study of CNR and disc herniations was undertaken. Between 2002 and 2008, 16 consecutive patients were diagnosed intraoperatively with CNR. These patients were matched 1:2 with 32 patients diagnosed with intervertebral disc herniations. Matching was done according to age (within 5years), gender and level of pathology. Surgery for patients with CNR or disc herniations consisted of routine microsurgical techniques with microdiscectomy, hemilaminotomy, hemilaminectomy and f...
2001-07-01
In the field of lumbar spine disorders, three-dimensional (3-D) magnetic resonance imaging (MRI) can clearly depict a lumbar nerve root from the distal region to the dorsal root ganglion. In this study, we used a gadoliniumdiethylenetriaminepentaacetic acid (Gd-DTPA) enhanced-three-dimensional (3-D) fast low-angle shot (FLASH) sequence when examining lumbosacral disorders. The subjects were 33 patients (14 men and 19 women) in whom lumbosacral neural compression had been diagnosed clinically. Twenty-one patients had lumbar disc herniation, 11 had lumbar spinal stenosis, and 1 had lumbar radiculopathy caused by rheumatoid arthritis. Five subjects with low back pain were also studied as a control group. In all patients and in all 5 of the controls, the dorsal root ganglion of every root was enhanced clearly. There was no root enhancement in the 5 controls. Enhancement of the symptomatic nerve roots, caused by compression, was found in 11 of the 33 patients. All 11 patients had rediculopathy, and muscle weakness was more frequent in patients with enhanced nerve roots than in those without enhancement. There was no enhancement of the cauda equina, even in the patients with cauda syndrome. The enhancement effect may reflect some pathological condition of the compressed nerve root and needs to be studied further. (author)
Treatment of dysautonomia associated with Parkinsons disease
2009-01-01
Summary Non-motor symptoms are increasingly recognized to adversely impact on the quality of life of patients with in Parkinsons disease (PD), particularly as the disease progresses. Autonomic symptom severity in patients with PD seems to correlate with older age, greater disease severity, psychiatric complications, sleep disorders, and higher doses of dopaminergic medication. The following therapeutic strategies are frequently used in the treatment of PD-related dysautonomia: 1. Orthostatic hypotension: fludrocortisone, midodrine, and droxidopa; 2. Sialorrhea: glycopyrrolate and botulinun toxin injections; 3. Constipation: symbiotic yogurt and bulking agents, macrogol, lubiprostone, mosapride citrate and tegaserod, pyridostigmine bromide, botulinum toxin injections and sacral nerve stimul...
Role of lymphadenectomy for invasive bladder cancer
2009-12-01
Full Text Available.Radical cystectomy with lymph node dissection remains the standard of care in the treatment of muscle-invasive and refractory non-invasive bladder cancer. Over the past decade, the extent of lymphadenectomy has varied to include dissection up to the common iliac vessels and aortic bifurcation proximally (may also extend up to the level of the inferior mesenteric artery), the genitofemoral nerve laterally, the circumflex iliac vein and lymph node of Cloquet distally, and the hypogastric vessels posteriorly (obturator fossa, presciatic nodes bilaterally and the presacral lymph nodes over the sacral promontory). Evidence supports the role of lymphadenectomy as both a therapeutic and prognostic variable in patients with invasive bladder cancer. We review the literature regarding the role and extent of lymphadenectomy, as well as its impact on patient outcomes.
2010-01-01
Abstract Objective. Describe the clinical presentation, diagnostic evaluation, and successful treatment of a case of symptomatic unilateral lumbosacral junction pseudarticulation using a novel radiofrequency nerve ablation technique. Case. A 56-year-old female patient who had suffered with low back and right upper buttock pain for 16 years experienced incomplete relief with L4/5 facet joint radiofrequency ablation. She was found to have an elongated right L5 transverse process that articulated with the sacral ala (Bertolotti's syndrome). Fluoroscopically guided local anesthetic/corticosteroid injection into the pseudarthrosis eliminated her residual right buttock pain for the duration of the local anesthetic only. Complete pain relief was achieved by injecting local anesthetic circumferent...
2008-01-01
ObjectivesLaparoscopic surgery of deep endometriosis, including uterosacral ligament and rectal localisation, generally induces postoperative urinary disorders, caused by sacral plexus nerve lesions. However, during presurgical consultation, patients with these symptoms frequently present some urinary disorders. Our objective was to prospectively evaluate the reality of preexistant urinary disorders by performing urodynamic tests.Patients and methodsThis study is a prospective, descriptive and non-comparative study about 12 consecutive patients consulting for a surgical assumption of deep endometriosis, including clinical and radiological lesions on the uterosacral ligaments, on the uterine torus and/or on the rectum.ResultsA total of 12 patients whose ages ranged from 24 to 42 (mean age 3...
2000-01-01
Evaluate the usefulness of the magnetic resonance (MRI) in the diagnosis of traumatic and compressive pathology of the peripheral nerves and analyze the etiology of the lesions and their severity. 25 MRI in patients with compressive and traumatic lesions of the peripheral nerves are analyzed. They were studied with MRI (1,5T) using T1 weighted spin-echo (SE), T2 gradient echo (GE) and STIR sequences. The morphological and nerve signal alterations make it possible to locate the lesion site and to assess the course of the lesion with successive studies. In our series, the most frequent cause of compressive pathology is fibrosis. Brachial plexus root avulsion is the most frequent finding in traumatic lesions. The MTI capacity for multiplanar study and its high resolution make it possible for us to detect small lesions in the peripheral nerves and to plan the best treatment. ...
2008-01-01
This study describes the innervation patterns for the cerebral nerves which project to the cephalic sensory organs (CSOs) in the opisthobranch Haminoea hydatis (Linnaeus 1758) and uses axonal tracing techniques (backfilling) to reveal the central cellular origins for these cerebral nerves. Cell clusters projecting into the cerebral nerves can be defined by their positions in the ganglion relative to other clusters, nerve roots and lobes. The number of cell clusters and the relative sizes of somata are constant in a given cluster, whereas the absolute number of somata and absolute sizes of single somata in a given cluster increase with the size of the animal. Additionally, the invariable morphological characteristics of the cell clusters are used to define criteria for the assessment of pos...
2009-01-01
Full Text Available.This study used dissection of 34 lumbar plexes to look at the prevalence of anatomical variations in the lumbar plexus and the six peripheral branches from the origin at the ventral roots of (T12) L1-L4 to the exit from the pelvic cavity. Prevalence of anatomical variation in the individual nerves ranged from 8.8–47.1% with a mean prevalence of 20.1%. Anatomical variations included absence of the iliohypogastric nerve, an early split of the genitofemoral nerve into genital and femoral branches, an aberrant segmental origin for the lateral femoral cutaneous nerve, bifurcation of the lateral femoral nerve prior to exiting the pelvic cavity, bifurcation of the femoral nerve into two to three slips separated by psoas major muscle fibers, the presence of a single anterior femoral cutaneous nerve rather than the normal presentation of two separate anterior femoral cutaneous branches, and the presence of an accessory obturator nerve. Comparison with relevant research literature showed a wide variation in reported prevalence of the anatomical variations noted in this study. Clinical implications and directions for future research are proposed.
1979-01-01
Sacral agenesis is a central component in the spectrum of anomalies comprising the caudal regression syndrome. Sacral agenesis occurs more frequently in an infant born to mother of diabetes, rubella infection in first trimester than normal mothers. In a patient of sacral agenesis, it is important to recognize the neurologic deficit, neurogenic bladder dysfunction and other congenital anomalies. A case of partial sacral agenesis of 10 years old girl and another case of complete total agenesis associated with multiple anomalies in autopsied newborn are reported
Bilateral C5 motor paralysis following anterior cervical surgery-a case report
2006-01-01
Numerous authors have reported C5 root palsies following posterior cervical surgery, and several mechanisms of injury have been proposed. Similar deficits after anterior cervical procedures are considered to occur less commonly. We report on a 48-year-old male who underwent multi-level anterior discectomy and fusion for cervical spondylotic myelopathy. Bilateral C5 nerve root deficits were noticed in the immediate postoperative period, and treated non-operatively. A postoperative magnetic resonance imaging (MRI) scan showed an increase in cervical lordosis accompanied by a posterior shifting of the spinal cord. Potential mechanisms of nerve root injury in this situation are discussed, and the literature on postoperative C5 root deficits is reviewed.The patient returned to his preoperative ...
1986-10-01
High resolution computed neurosonography now displays the details of the spinal canal, subarachnoid space, spinal cord and some emerging nerve roots in axial and sagittal planes. Those familiar with this anatomy may use sonography to detect spinal pathology.
BackgroundIt is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy....Full Text Available
2010-07-01
There is general agreement that lumbosacral nerve root compression is a prime factor in the pathogenesis of sciatica and neurogenic claudication, although humoral and vascular factors certainly play a role as well. This book focuses on imaging of the various ways in which nerve root compression can come about, and assessing which anatomic features are reliably associated with the occurrence of radicular pain, as opposed to morphologic findings which are probably coincidental. After a discussion of the nature of radicular pain and related symptoms, spinal imaging techniques and options are reviewed, with emphasis on the role of MR myelography in assessing the condition of the intradural nerve roots. A chapter on normal topographic, sectional, and functional (dynamic) radiologic anatomy is followed by a presentation on pathologic anatomy, addressing the various mechanisms of nerve root compression. In the chapter on pre- and postoperative imaging, features which may help to predict the evolution of the symptoms are discussed, with an eye to selecting candidates for surgical treatment. This is followed by a discussion of the role and limitations of imaging studies in various adverse postoperative conditions. In illustrations involving patient studies, imaging features are linked where possible to the clinical symptoms and history of the individuals involved. (orig.)
Background: Neuropathic pain is characterized by hyperalgesia, allodynia and spontaneous pain. It often occurs as a result of injury to peripheral nerves, dorsal root ganglions (DRG), spinal...Full Text Available
Head-Down Tilt with Balanced Traction as a Model for Simulating Spinal Acclimation to Microgravity
Astronauts experience total body height increases of 4 to 7 cm in microgravity. Thus, stretching of the spinal cord, nerve roots, and muscular and ligamentous tissues may be responsible for the hyperreflexia, ...
Clinical classification of cauda equina syndrome for proper treatment
2010-06-01
Background and purposeCauda equina syndrome (CES) is a severe complication of lumbar spinal disorders; it results from compression of the nerve roots of the cauda equina. The purpose...Full Text Available
Cauda Equina Syndrome November, 2005 Low back pain affects millions of people every year, and in most cases, it ... is not well known and is often misdiagnosed. Cauda equina syndrome (CES) occurs when the nerve roots of the ...
20 CFR 220.177 - Terms and definitions.
...prior decision granting the claimant an annuity he had had a laminectomy. Postoperatively, a myelogram still shows evidence...1: The annuitant has a back impairment and has had a laminectomy to relieve the nerve root impingement and weakness in...
A Novel CT-Guided Transpsoas Approach to Diagnostic Genitofemoral Nerve Block and Ablation
2010-05-01
Full Text Available.BackgroundInguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines.CaseA 39-year-old woman with chronic lancinating right groin pain after inguinal hernia repair underwent multiple pharmacologic interventions and invasive procedures without relief. Using CT and Stimuplex nerve stimulator guidance, the genitofemoral nerve was localized on the anterior surface of the psoas muscle and a diagnostic block with local anesthetic block was performed. The patient had immediate relief of her symptoms for 36 hours, confirming the diagnosis of genitofemoral neuralgia. She subsequently underwent CT-guided radiofrequency and phenol ablation of the genitofemoral nerve but has not achieved long-term analgesia.ConclusionCT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery.
Successful excision of a rare cervical neurofibroma arising from the phrenic nerve: a case report
2010-01-01
Introduction The patient had an enlarging left-side neck mass without neurological symptoms. Methods Magnetic resonance (MR) imaging revealed a well-demarcated mass close to the left root of C4. Results During the surgery, we confirmed a tumour arising from the cervical phrenic nerve. Although neurogenic tumours of the phrenic nerve are associated with a high risk of causing hemidiaphragm palsy after the total excision, we could carry out a total excision without deficit. Conclusion The pathological examination revealed a neurofibroma.
Benign neurilemmoma in the infratemporal fossa involving maxillary sinus and pterygopalatine fossa
2004-12-15
Neurilemmoma is a benign tumor of the nerve sheath that arises on cranial and spinal nerve roots as well as along the course of peripheral nerves. A case of a neurilemmoma that arose in the left infratemporal fossa of a 29- year-old male was presented. Plain radiographs, enhanced computed tomography scan, and magnetic resonance imaging demonstrated a large, well-circumscribed, heterogeneously enhanced mass with extension into the pterygopalatine fossa. Displaced by the large mass, bowing-in of the posterior maxillary antral wall was noted and a provisional diagnosis of a benign soft tissue tumor was made. The mass was completely excised and a diagnosis of neurilemmoma was confirmed.
Benign neurilemmoma in the infratemporal fossa involving maxillary sinus and pterygopalatine fossa
2004-01-01
Neurilemmoma is a benign tumor of the nerve sheath that arises on cranial and spinal nerve roots as well as along the course of peripheral nerves. A case of a neurilemmoma that arose in the left infratemporal fossa of a 29- year-old male was presented. Plain radiographs, enhanced computed tomography scan, and magnetic resonance imaging demonstrated a large, well-circumscribed, heterogeneously enhanced mass with extension into the pterygopalatine fossa. Displaced by the large mass, bowing-in of the posterior maxillary antral wall was noted and a provisional diagnosis of a benign soft tissue tumor was made. The mass was completely excised and a diagnosis of neurilemmoma was confirmed
1996-11-01
The article is intended to show the value of MRI for diagnostic visualisation and evaluation of posttraumatic nerve root avulsion as a brachial plexus injury. (orig./MG) [Deutsch] Das Ziel der Arbeit besteht in der Darstellung des Wertes der MRT-Diagnostik bei der Abklaerung traumatischer Wurzelausrisse im Bereich des Plexus brachialis. (orig./MG)
Sector computed tomographic spine scanning in the diagnosis of lumbar nerve root entrapment
The diagnosis of lumbar nerve root entrapment was made by sector computed tomography (CT) scanning in 25 patients whose myelograms were normal at the site of the CT scan abnormalities. Sector CT scanning demonstrates preoperatively which neural foramina are narrow. This information, correlated with the patient's history and physical examination, indicates which foramina should be operated on and prevents unnecessary exploration of normal neutral foramina. CT findings were confirmed surgically in 14 patients. Eleven of these 14 patients had excellent postoperative results and remain pain free.
Sector computed tomographic spine scanning in the diagnosis of lumbar nerve root entrapment
1982-04-01
The diagnosis of lumbar nerve root entrapment was made by sector computed tomography (CT) scanning in 25 patients whose myelograms were normal at the site of the CT scan abnormalities. Sector CT scanning demonstrates preoperatively which neural foramina are narrow. This information, correlated with the patient's history and physical examination, indicates which foramina should be operated on and prevents unnecessary exploration of normal neutral foramina. CT findings were confirmed surgically in 14 patients. Eleven of these 14 patients had excellent postoperative results and remain pain free.
Idiopathic scoliosis from the point of view of the neuroradiologist
1981-04-01
There is a simple morphological interrelation between the growing spinal cord-nerve root complex and the vertebral column, not unlike that between the growing brain and skull. The shape of the enveloping vertebral skeleton mirrors the anatomical features of the enclosed neural contents. During the cranio-caudally directed growth, spurts of elongation of the vertebral column may be too rapid for the slower growth rate of the spinal cord and nerve roots. The resulting disproportion of growth between spine and nervous system is compensated for by adaptive scoliotic curvature of the otherwise normally growing spine. The proposed pathogenetic concept readily explains the main clinical features of the deformity and is supported by a spring model experiment.
Unilateral rhythmic testicular movements
2010-01-01
A male patient came to our clinic because of a continuous up and down movement of his right testis, which was present even during sleep. The nature and localization of the unilateral rhythmic cremasteric activity is investigated by electrophysiological methods. Investigations of the cremasteric muscles and genitofemoral nerve determined that the movement was similar to myokymia. The localization of this peculiar spontaneous movement is probably in motor fibers somewhere between the L1-L2 motor neuron pool, motor roots and/or the genitofemoral nerve.
A new study of the brain of the predatory dinosaur Tarbosaurus bataar (Theropoda, Tyrannosauridae)
2007-01-01
The brain morphology and the topography of the cranial nerves on an endocranial mold of the theropod dinosaur Tarbosaurus bataar (Tyrannosauridae) are examined. The brain of this dinosaur was constructed based on the reptile archetype, with a well-developed specialized olfactory analyzer. In terms of development, the visual centers were superseded not only by the olfactory centers, but also by the auditory centers. Comparative analysis of the brain structure of Tarbosaurus and Tyrannosaurus shows clear distinctions in the topography of roots of the accessory and trigeminal nerves.
Sacroplasty: a treatment for sacral insufficiency fractures.
Sacral insufficiency fracture is a debilitating injury for which no active treatment is currently available. We present three consecutive cases of elderly patients with sacral insufficiency fractures whose symptoms were relieved immediately by treatment of the fractures by polymethylmethacrylate injections, a so-called sacroplasty.
Sacroplasty: a new treatment for sacral insufficiency fracture.
Sacroplasty, a variation of the vertebroplasty technique for treatment of a sacral insufficiency fracture, is described herein in technical detail. The procedure provided symptom relief and resulted in no complications. This result suggests that successful treatment of a sacral insufficiency fracture with use of sacroplasty is technically feasible.
Percutaneous Sacroplasty for Sacral Metastatic Tumors Under Fluoroscopic Guidance Only
2008-01-01
Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed...Full Text Available
2006-06-15
The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc. The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3(very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed. Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement, The difference between the two approaches in terms of TFESI effectiveness was of borderline significance ({rho} = 0.056; odds ratio: 10.483). We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the difference between the two treatments had borderline statistical significance.
The significance of both lateral bending view as functional myelography of lumbar spine
1989-04-15
CT and myelography are the most accurate diagnostic tools to define a lumbar herniated disc disease. But they may not demonstrated organic lesion of the cause of clinical symptoms or may not agree the site of lesion and lateralizing sign, so they may give a confusion to radiologist and clinicians. The purpose of this study is to estimate the value of lateral bending as functional myelography in the evaluation of the change of filling of nerve root sleeve compared with that of static myelography. We analysed 84 disc spaces of 28 patients of bulging disc or central HNP who had undergone both lumbar CT and functional myelography at Pusan National University Hospital from Aug.1987 to Aug.1988. The results were as follows: 1. In normal disc, there were tendencies of the same or increased filling of nerve root sleeve in the flexion site of lateral bending in functional myelography compared with that of static myelography, and of the same or decreased filling of nerve root sleeve in the extension site of lateral bending in functional myelography. 2. In bulging disc and central HNP, diagnostic method of functional myelography increased agreement of clinical symptoms and imaging diagnosis regarding the change of filling in nerve root sleeve in functional myelography from static one as a functional impairment of nerve root. 3. Lateral bending in functional myelography was expected as precise and genuine diagnostic tool that might represent functional impairment of nerve root.
1999-07-01
To investigate the association between postoperative nerve root displacement and epidural scar tissue, one hundred patients who had undergone lumbar microdiscectomy were included in a prospective cohort study with a 1-year follow-up. The patients were classified as failures or successes at the 12-month follow-up according to a clinical score. Patients with signs of recurrent disc herniation on MR were excluded from the study. All the 13 patients classified as failures were investigated with MR at the 1-year follow-up, and 40 patients classified as successes were picked at random for MR imaging; thus MR was performed in 53 patients. The MR images were independently evaluated by two neuro radiologists. The images were rated according to the presence or absence of nerve root displacement at the surgically treated disc interspace. Scar formation was rated according to two different classification systems. Nerve root displacement was observed in 13 patients. No evidence of scar formation was found in 4 patients, a small amount in 11, intermediate in 37 and extensive scar formation in 1 patient. No association between nerve root displacement and the amount of scar tissue was found. Postoperative nerve root displacement seems to be an independent clinical entity not associated to postoperative scar tissue.
1996-04-01
To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc ; type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases ; 58%) was more frequently observed than the posterolateral type(48cases ; 40%) or lateral type(3cases ; 2%). The totals of types I, II, and III were 44(36%), 43(35%) and 35 cases(29%), respectively. Seventy-seven %(34/44) of type I and 65%(28/43) of type II were of the central type but for type III, the corresponding figure was only 26%(9/35). On MR imaging, most of lumbar disk herniations were observed at L4-5 and L5-S1, with a predominance of the central type rather than the posterolateral one. Most of the central types were either type I or type II.
2010-01-01
Relationships between nerve root compression, behavioral sensitivity, spinal cytokines, and glial reactivity are not fully defined for painful cervical nerve root compression. Spinal cytokines were quantified after mechanical root compression (10gf), root exposure to inflammatory chromic gut material (chr), the combination of both insults together (10gf+chr) or sham. TNF and IL-1 significantly increased at 1h (psham and chr at 1h following 10gf and over normal and sham after 10gf+chr (p10gf remained elevated over normal (p=0.038). Accordingly, the soluble TNF receptor-1 (sTNFR1) and the IL-1 receptor antagonist (IL-1ra) were separately administered at early time points after each injury. With sTNFR1, behavioral sensitivity was significantly decreased for 7days aft...
2010-01-01
Placement of C1 lateral mass screws may be facilitated by intentional C2 root sacrifice. Functional outcomes and morbidity following intentional sacrifice of the C2 root have not been reported in the literature. The objective is to find out if intentional C2 nerve root sacrifice affects functional outcomes and operative morbidity in patients undergoing posterior cervical fusion with C1 lateral mass screws. The study is a case report. Twenty-two consecutive elderly patients (10 males, 12 females with an average age of 77years) with C12 instability were treated with posterior cervical fusion using C1 lateral mass screw placement. Five patients had preservation of the bilateral C2 nerve roots (PRES group) and 18 patients had intentional sacrifice of the bilateral C2 nerve root (SAC group...
Magnetic resonance appearance of sacral insufficiency fractures
1990-10-01
We present 5 patients with sacral insufficiency fractures imaged with MR. Metastatic disease was a leading clinical suspicion as all patients were elderly and three had known primary neoplasms. T{sub 1}-weighted sequences demonstrated bands of decreased signal intensity, usually paralleling the sacral aspect of the sacroiliac joints and occasionally occurring as a horizontal band across the sacral body. Four of five patients underwent further evaluation with computed tomography (CT) or nuclear bone scanning, which confirmed the diagnosis of sacral insufficiency fracture. We conclude that MRI is sensitive but not specific in detecting sacral insufficiency fractures. (orig./DG).
Magnetic resonance appearance of sacral insufficiency fractures
1990-01-01
We present 5 patients with sacral insufficiency fractures imaged with MR. Metastatic disease was a leading clinical suspicion as all patients were elderly and three had known primary neoplasms. T1-weighted sequences demonstrated bands of decreased signal intensity, usually paralleling the sacral aspect of the sacroiliac joints and occasionally occurring as a horizontal band across the sacral body. Four of five patients underwent further evaluation with computed tomography (CT) or nuclear bone scanning, which confirmed the diagnosis of sacral insufficiency fracture. We conclude that MRI is sensitive but not specific in detecting sacral insufficiency fractures. (orig./DG)
Diagnostic imaging of the lumbar disc herniation for radiculopathy by 3D-MRI (MR-myelography)
2002-02-01
We have developed a new method of three-dimensional MRI (3D-MRI) which enables a stereoscopic view of the spinal cord and both sides of spinal nerve roots in one image. Anatomical study for normal subjects, the S1 angulations and length were significantly smaller than those of others. The S1 DRG was oval and was the largest. In a pathological study the use of 3D-MRI defects the signal changes following damage to the spinal nerve roots or ganglion in lumbar disc herniation. With regard to signal changes in damaged root ganglion, a good correlation between root compression and root inflammation was detected by experiments. We are currently examining the relationship between the damaged root ganglion, pain sensory disturbance. This study showed that the dorsal root ganglion plays an important role in sensory control of radiculopathy on 3D-MRI. (author)
Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas
Purpose: Radiotherapy (XRT) for spine sarcomas is constrained by spinal cord, nerve, and viscera tolerance. Negative surgical margins are uncommon; hence, doses of {>=}66 Gy are recommended. A Phase II clinical trial evaluated high-dose photon/proton XRT for spine sarcomas. Methods and Materials: Eligible patients had nonmetastatic, thoracic, lumbar, and/or sacral spine/paraspinal sarcomas. Treatment included pre- and/or postoperative photon/proton XRT with or without radical resection; patients with osteosarcoma and Ewing's sarcoma received chemotherapy. Shrinking fields delivered 50.4 cobalt Gray equivalent (Gy RBE) to subclinical disease, 70.2 Gy RBE to microscopic disease in the tumor bed, and 77.4 Gy RBE to gross disease at 1.8 Gy RBE qd. Doses were reduced for radiosensitive histologies, concurrent chemoradiation, or when diabetes or autoimmune disease present. Spinal cord dose was limited to 63/54 Gy RBE to surface/center. Intraoperative boost doses of 7.5 to 10 Gy could be given by dural plaque. Results: A total of 50 patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n = 25) or subtotal (n = 12) resection or biopsy (n = 13). With 48 month median follow-up, 5-year actuarial local control, recurrence-free survival, and overall survival are: 78%, 63%, and 87% respectively. Two of 36 (5.6%) patients treated for primary versus 7/14 (50%) for recurrent tumor developed local recurrence (p < 0.001). Five patients developed late radiation-associated complications; no myelopathy developed but three sacral neuropathies appeared after 77.12 to 77.4 Gy RBE. Conclusions: Local control with this treatment is high in patients radiated at the time of primary presentation. Spinal cord dose constraints appear to be safe. Sacral nerves receiving 77.12-77.4 Gy RBE are at risk for late toxicity.
PHASE II STUDY OF HIGH DOSE PHOTON/PROTON RADIOTHERAPY IN THE MANAGEMENT OF SPINE SARCOMAS
2009-07-01
Full Text Available.PurposeRadiotherapy (XRT) for spine sarcomas is constrained by spinal cord, nerve, and viscera tolerance. Negative surgical margins are uncommon; hence, doses of ≥ 66 Gy are recommended. A Phase II clinical trial evaluated high dose photon/proton XRT for spine sarcomas.Materials/MethodsEligible patients had non-metastatic, thoracic, lumbar, and/or sacral spine/paraspinal sarcomas. Treatment included pre- and/or post-op photon/proton XRT +/- radical resection; patients with osteosarcoma and Ewing's sarcoma received chemotherapy. Shrinking fields delivered 50.4 cobalt Gray equivalent (GyRBE) to subclinical disease, 70.2 GyRBE to microscopic disease in the tumor bed, and 77.4 GyRBE to gross disease at 1.8 GyRBE q.d. Doses were reduced for radiosensitive histologies, concurrent chemoradiation, or when diabetes or autoimmune disease present. Spinal cord dose was limited to 63/54 GyRBE to surface/center. Intra-operative boost doses of 7.5-10 Gy could be given by dural plaque.Results50 patients (29 chordoma, 14 chondrosarcoma, 7 other) underwent gross total (n=25) or subtotal (n=12) resection or biopsy (n=13). With 48 month median follow-up, five-year actuarial local control, recurrence-free survival, and overall survival are: 78%, 63%, and 87% respectively. Two of 36 (5.6%) patients treated for primary versus 7/14 (50%) for recurrent tumor developed local recurrence, p<0.001. Five patients developed late radiation-associated complications; no myelopathy developed but three sacral neuropathies appeared following 77.12-77.4 GyRBE.ConclusionsLocal control with this treatment is high in patients radiated at the time of primary presentation. Spinal cord dose constraints appear to be safe. Sacral nerves receiving 77.12-77.4 GyRBE are at risk for late toxicity.
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