Sacral Plexus Research Articles

Neuroanatomy of lumbosacral and pudendal plexus in pigeon of Bangladesh

The present study aims to reveal the neuroanatomy of the lumbosacral and pudendal plexus in pigeons of Bangladesh. Six adult male domesticated pigeons were used in this study. The body cavities of the pigeons were opened after the administration of the anesthetics. The nerve roots of the plexus were dissected separately and photographed. We found that the lumbosacral plexus consisted of the lumbar plexus and the sacral plexus. The lumbar plexus was formed by the union of the ventral branches of the first, second, and third lumbar (L1-L3) spinal nerves. The lumbar plexus was branched into cutaneous femoris nerve, coxalis cranialis nerve, femoralis nerve, saphenous nerve, and obturatorius nerve. The sacral plexus was formed by the union of the ventral branches of the fourth lumbar and first, second, third, and fourth sacro-coccygeal spinal nerves. The sacral plexus gives off a large sciatic nerve and innervated as tibial and fibular nerve into musculature of the hind limb of the pigeon. The pudendal plexus was organized from the fourth, fifth, sixth and seventh sacro-coccygeal spinal nerves and were innervated into the tail region of the domesticated pigeons. This study was the first investigation of lumbosacral and pudendal plexus in domesticated pigeons and the results may serve as a basis for further investigation in other species. Bangladesh Journal of Animal Science 52 (4): 98-104

Neuroanatomy of lumbosacral and pudendal plexus in pigeon of Bangladesh

The present study aims to reveal the neuroanatomy of the lumbosacral and pudendal plexus in pigeons of Bangladesh. Six adult male domesticated pigeons were used in this study. The body cavities of the pigeons were opened after the administration of the anesthetics. The nerve roots of the plexus were dissected separately and photographed. We found that the lumbosacral plexus consisted of the lumbar plexus and the sacral plexus. The lumbar plexus was formed by the union of the ventral branches of the first, second, and third lumbar (L1-L3) spinal nerves. The lumbar plexus was branched into cutaneous femoris nerve, coxalis cranialis nerve, femoralis nerve, saphenous nerve, and obturatorius nerve. The sacral plexus was formed by the union of the ventral branches of the fourth lumbar and first, second, third, and fourth sacro-coccygeal spinal nerves. The sacral plexus gives off a large sciatic nerve and innervated as tibial and fibular nerve into musculature of the hind limb of the pigeon. The pudendal plexus was organized from the fourth, fifth, sixth and seventh sacro-coccygeal spinal nerves and were innervated into the tail region of the domesticated pigeons. This study was the first investigation of lumbosacral and pudendal plexus in domesticated pigeons and the results may serve as a basis for further investigation in other species. Bangladesh Journal of Animal Science 52 (4): 98-104

The Effectiveness of Modified Pilates Program with and without Kinesiotaping on Postnatal Urinary Stress Incontinence: A Randomized Clinical Trial

Introduction: Urinary Stress Incontinence is very common condition seen in postnatal woman. Without pelvic floor strengthening this condition will lead to social inhibition. The rate of urinary stress incontinence is more in normal vaginal delivery compared to C-Section. Few authors have demonstrated the effectiveness of Kegal exercise and Pilates on such woman with urinary stress incontinence. There is dirth in the literature related to effect of Kinesiotaping in reduction of urinary stress incontinence.
 Research Objective: The objective of the research was to find out the effect of Kinesiotape along with the Modified Pilates program on subjects with postnatal urinary incontinence.
 Methodology: This is an experimental study with randomised clinical trial design and the study setting was Bruhat Bangalore Mahanagar Palike, and the included 50 postnatal women who underwent vaginal delivery. The sample was divided into two groups: Group A (25) were subjected to Modified Pilates Program with Kinesiotaping and Group B (25) were subjected to Modified Pilates Program alone. The intervention was conducted for 6 weeks. The outcome measures like: PERFECT Scheme, Questionnaire for Urinary Incontinence Diagnosis and Urogenital Distress Inventory were assessed both pre and post therapy at 6th week.
 Results: Pre therapy both groups showed no statistical significance. Post therapy; Group A showed significant result with respect to all three outcome measures PERFECT (<0.0001), QUID (<0.001) and UDI (<0.001) and Group B showed significance only with respect to PERFECT Scheme (<0.05).
 Conclusion: The study concluded that Modified Pilates will no doubt strengthen the pelvic floor muscle; but Kinesiotape addition to it will improve the strength by maintaining it and thus increasing the quality of life of the patient. Thus, using kinesiotape during the pelvic floor rehabilitation of Postnatal women with stress incontinence will provide benefit to the patient.
 Summary: The current article concludes that Modified Pilates will strengthen the pelvic floor because of the abdominal cylinder involved along with Kinesiotape will add on to reduction in urinary incontinence because of the stimulation of sacral plexus.

Endovascular treatment of sciatic pain from venous congestion in the pelvis

Klippel-Trénaunay Syndrome (KTS) is a vascular disorder characterized by a combination of vascular malformations (capillary, lymphatic, and venous) and limb overgrowth. Pelvis involvement is less frequent and is often underrecognized. We report a case of a patient affected by KTS with persistent sciatic pain. Phlebography demonstrated significant pelvic venous congestion mainly due to reflux at the level of the sacral plexus venous. A minimally invasive approach was successfully utilized to treat reflux with complete pain regression.

Pulsed Radiofrequency Ablation of the Lumbar and Sacral Plexus for Intractable Pain in Pediatric Patients

Severe and persistent pain of cancer and noncancer origin in pediatric patients can pose significant challenge to manage. The application of Radiofrequency ablation in Pediatric patients for pain management is not well reported in the literature. Here, we present pediatric cases where pulsed radiofrequency (PRF) treatment of the Lumbosacral plexus was done for pain relief.

Clinical data, guidelines and real-world outcomes of endovascular iliac aneurysm repair with the GORE® EXCLUDER® Iliac Branch EndoprosthesisProvision of Services for People with Vascular Disease 2021

Isolated aneurysms of the iliac arteries are extremely rare. They most frequently occur in the common iliac artery (CIA) and are least frequent in the external iliac artery (EIA).1 Most (95%) affected patients are male and the median age of diagnosis is in the seventh decade of life.2 The underlying pathology of isolated iliac artery aneurysms is similar to that of abdominal aortic aneurysms. This includes degenerative aneurysm, pseudoaneurysm, penetrating ulcer, post-dissection aneurysm mycotic aneurysm, and traumatic aneurysm.3 Unlike patients with abdominal aortic aneurysms, those with iliac artery aneurysms present with symptoms of compression of other structures, particularly the ureter, sacral plexus and iliac veins. Reported growth rate of isolated iliac artery aneurysms is similar to that of abdominal aortic aneurysms. Ruptured isolated iliac artery aneurysms are associated with significant mortality,4 which is higher when treatment is undertaken as an emergency rather than an elective surgical procedure. Effective and timely intervention is therefore essential to improve survival. The aim of surgical treatment is to exclude the aneurysm from the circulation to prevent further growth and rupture. Traditional open surgical repair (OSR) was the mainstay of treatment but is technically challenging due to the location of the aneurysms in the pelvis and a frequent prior history of abdominal aortic aneurysms.1 Endovascular repair (EVAR) of isolated iliac artery aneurysms is a less invasive alternative to OSR. It is performed by a combination of branch-vessel coil embolisation and stent grafting, and has potential advantages over OSR in reducing perioperative morbidity and mortality.5 This supplement is a report of a satellite symposium held during the Vascular Societies' Annual Scientific Meeting in November 2022. It reviews clinical data, guidelines and real-world outcomes of endovascular iliac aneurysm repair with the GORE® EXCLUDER® Iliac Branch Endoprosthesis.

Robotic Surgery for Severe Endometriosis: A Preliminary Comparative Study of Cost Estimation

To compare the postoperative outcomes and the overall expenses between conventional laparoscopy and robotic surgery, in a series of consecutive patients managed for only severe endometriosis in our institute. A cohort comparative study. Center of Excellence in Multidisciplinary Endometriosis Care. A total of 175 symptomatic patients undergoing surgery for only severe endometriosis from March 2021 to August 2022. We treated patients with endometriosis involving the digestive tract such as rectum, sigmoid colon, and ileocecal junction by rectal shaving, discoid resection, or segmental resection (141 surgeries) with or without bladder (23 surgeries), sacral plexus (19 surgeries), and diaphragm involvements (14 surgeries). Postoperative outcomes were evaluated in terms of total surgical time (total surgical room occupancy time and total operating time), hospitalization period, postoperative complications, rehospitalization, and second surgical procedures. A statistically higher total surgical room occupancy (203 minutes vs 151 minutes) and operating time (150 minutes vs 105 minutes) were observed in the robotic group (p=.001). No differences in terms of mean hospital stay (p=.06), postoperative complications (p=.91), rehospitalization (p=.48), and secondary surgical treatment (p=.78) were identified. Concerning the cost analysis only for disposable supply, the cost of colorectal resection was totaled at 2604 euros for the laparoscopic conventional approach vs 2957 euros for the robotic approach (+352.6 euros, +14%). The cost of rectal disc excision was 1527 euros for the laparoscopic conventional approach vs 1905.85 euros (+378 euros, +25%). Our study confirms the feasibility of the robotic approach for the treatment of severe endometriosis, with however a higher cost of robotic approach. Next studies should identify specific indications for robotic surgery, where technical advantages provided by the technology are followed by objective improvement of patients' outcomes.

A Comparative Gross Study on the Sacral Plexus of the Magpie (Pica Pica) and Chukar Partridge (Alectoris Chukar)

In poultry, sacral plexus usually occurs as a result of a combination of ventral branches of 1-5 sacral spinal nerves. The aim of this study is comparatively determination the sacral plexus and its branches of magpie (Pica pica) and chukar partridge (Alectoris chukar) and anatomic differences between two species. In the present study, there were used 20 magpies (Pica pica) and 20 chukar partridges (Alectoris chukar). All animals were sacrificed under anesthesia and the nerves forming sacral plexus were separately dissected and photographed in the both species. In the present study, it was determined that forming of sacral plexus and general anatomic distribution of nerves arising from plexus in the both species were similar with other many bird species. However, nerves forming the sacral plexus and their branches were thicker in chukar partridge than magpie.

OC09.03: Identification and characteristics of deep endometriosis infiltrating the sacral plexus with transvaginal ultrasound

OC09.03: Identification and characteristics of deep endometriosis infiltrating the sacral plexus with transvaginal ultrasound

Radiation Induced Lumbar Plexopathy (RILP) in Patients of Cancer Cervix Treated by IMRT Technique: A Study of Dosimetry and Clinical Correlation

To assess the Dosimetric parameters of lumbo sacral plexus in carcinoma cervix patients treated with concurrent chemo-radiation by Intensity modulated radiotherapy (IMRT) technique & to clinically correlate these Dosimetric parameters with the lumbo sacral plexus toxicity. Total twenty-four patients were included in this study between December 2020 to December 2021. They were all treated by Intensity modulated radiotherapy (IMRT) technique. Radiotherapy dose delivered was 50Gy in 25 fractions at 2Gy/#, it was followed by 3 applications of intracavitary brachytherapy of 7Gy/ fraction each. The lumbo-sacral plexus was delineated according to guidelines given by Sun and Xi et al. No dose constraint was prescribed to the lumbo-sacral plexus prior to the treatment. Magnetic resonance imaging (MRI) of bilateral lumbo-sacral plexus test was done prior to the treatment and 12 months' post treatment. Dose received by the lumbo-sacral plexus was calculated DVH parameters was evaluated. The lumbo-sacral plexus toxicity was assessed by the 10-point questionnaire pre-treatment & post treatment and was compared. Assessment of toxicity was done by RTOG (Radiation Therapy Oncology Group) scoring criteria. Out of the 24 patients treated, 7 patients had gross nodes which were treated with a boost dose of 60 Gy. Out of these patients 9 patients (37.5%) developed signs and symptoms of radiation induced lumbar plexopathy (RILP). Among these patients, the most common symptom was weakness in the lower limbs followed by impaired leg movement and activities interfering daily activities such as walking, squatting and getting up from the chair. Other positive findings included stiffness, lower limb pain, lower back ache radiating the lateral aspect of the thigh and numbness of the lower limbs. Total prescribed dose to 95% of the planned target volume ranged from 49.2Gy - 61.9 Gy (median - 57 Gy). The mean volume of the LS plexus was 128 cc (range, 92- 143 cc). The mean of the D-max of LS plexus was 56.2 Gy (range, 43.2 Gy- 61.9 Gy). The V30 Gy was received by 84 % of LS plexus, whereas V40, V50, V60 was received by 64 %, 13 % and 4%. The most common significant findings on MRI post treatment were unilateral thickening of the nerve roots followed by hyperintensity in T2 weighted image and STIR sequencing. Mild contrast uptake and edema were present in the nerve roots. Radiation induced lumbar plexopathy (RILP) is one of the late complications after chemoradiotherapy in patients of carcinoma cervix, which is often misdiagnosed or missed on follow up. Therefore, lumbar plexus must be contoured in all pelvic malignancies which are treated by chemoradiotherapy with IMRT technique as it prevents dose dumping in that region. Further studies with longer follow up are needed.

SOME OPTIONS OF FETAL TOPOGRAPHY OF THE LONG BRANCHES OF THE CROSS PLEXUS

In the conditions of wartime, the frequency of damage to the nerves of the lower extremity increased sharply. Open injuries make up the vast majority of peripheral nerve injuries. Understanding variations in the topography and the condition of the surrounding soft tissue structures allows for a detailed assessment of the condition of the peripheral nerves of the lower limb, to diagnose the exact site of damage, the type of neuropathy, and to choose treatment and rehabilitation tactics. The purpose of the study will be to establish variants of the fetal topography of the long branches of the sacral plexus. The material for the study of topographical and anatomical features of the long branches of the sacral plexus was 26 human fetuses of 5-7 months. The sciatic nerve is the largest nerve in humans, originating from the ventral division of spinal nerves L4 to S3 and containing fi bers from both the posterior and anterior lumbosacral plexuses. The sciatic nerve runs along the entire back surface of the lower limb up to the foot. The sciatic nerve innervates a signifi cant part of the skin and muscles of the thigh, lower leg, and foot. It was established that the long branches of the sacral plexus can be subjected to compression or damage in diff erent parts of its anatomical course. Among the variants of the anatomical variability of the long branches of the sacral plexus, the topography of the sciatic nerve is the most common. In the three studied fetuses of 180.0 mm, 215.0 mm, 255 mm TKD, a high branching variant of the sciatic nerve was detected, and the features of the long branches of the sacral plexus in the specifi ed fetuses were unilateral. In this case, when assessing clinical symptoms, practicing doctors should take into account options for bilateral asymmetry. Prospects for further research. Deepening the study of the variant anatomy of the long branches of the sacral plexus in human fetuses of diff erent ages.

Ketofol Infusion versus Isoflurane as Maintenance of Anesthesia on Hemodynamics in Radical Cystectomy Operation

Abstract Background radical cystectomy is a major operation where bleeding from sacral plexus during dissection of the bladder may occurs leading to hemodynamic instability and organ ischemia due to hypo perfusion. So using anesthetic drugs that provide hemodynamic stability will decrease intraoperative and post-operative morbidity and ICU and hospital stay. Objectives The Aim of this study is to compare the effect of anesthetic agent ketofol infusion versus isoflurane inhalation on hemodynamics in maintenance of anesthesia in radical cystectomy operation as a primary outcome and recovery time as a secondary outcome. Methods and material This prospective randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent radical cystectomy were included in the study their ages range between 50 and 70 years old and classified as ASA I and II, III. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30), Group I received isoflurane inhalation while group K received Ketofol infusion. Results this study demonstrated that maintenance of anesthesia by ketofol infusion provides more hemodynamic stability with maintaining of blood pressure and heart rate rather than isoflurane inhalation. Conclusions We conclude that maintenance of anesthesia with ketofol infusion provides more hemodynamic stability and least intraoperative and postoperative morbidity than isoflurane inhalation in patients undergoing radical cystectomy.

Recommendations for anesthesia management of hip and hip surgery: literature review

The authors analyzed studies on the issues of perioperative analgesia in hip and hip joint surgery. Based on the analysis, modern recommendations are presented regarding the choice of optimal anesthetic techniques for proximal femoral fractures and hip arthroplasty. Early surgical intervention in older patients contributes to the restoration of the supporting function of the limb, enables rapid rehabilitation, and reduces the risk of life-threatening complications. This requires pain relief for preoperative preparation and high-quality intraoperative and postoperative pain relief, allowing early rehabilitation of the patient. The review included materials from recent congresses, and webinars of the European Society of Regional Anesthesia Pain Treatment. According to many authors, ileofascial blockade is the method of choice for preoperative anesthesia for proximal femoral fractures. Variants of the blockades of the branches of the lumbar and sacral plexuses in various anatomical spaces and plane blocks are considered. In addition, recommendations of the PROSPECT group (Procedure Specific Postoperative Pain Management) on the use of various technologies in the perioperative period are considered based on data from multicenter randomized trials and meta-analyses in relation to a specific procedure. The effectiveness of new approaches to the branches of the lumbar plexus was also considered, for example, suprainguinal ileofascial blockade and blockade of the pericapsular nerves. Anesthesiologists have used relatively new and traditional tools available to reduce pain and speed up postoperative recovery for patients with injuries and undergoing surgery for the proximal femur. Although the effectiveness of not all of them is confirmed by evidence-based medicine, clinical practice shows a positive effect on their use.

ID: 217375 Dorsal Root Ganglion Stimulation: An Off-Label Indication for Targeted Coverage of Chronic Pelvic Pain

Chronic pelvic pain (CPP) is a treatment-resistant, complex neuropathic pain state which encompasses a number of painful pelvic disorders affecting women in a range of reproductive ages including inguinal and pudendal neuralgia, coccydynia, and vulvodynia. A majority of the sensory neuroinnervation to the pelvis is derived from the sacral plexus, specifically the pudendal nerve. In contrast to traditional dorsal column stimulation, dorsal root ganglion (DRG) stimulation offers more targeted therapy to focal areas of pain.

ID: 215950 Near or Far: Retrograde Neuromodulation for Out of Reach Neural Targets

Neuromodulation uses the complex neuro-anatomical structure of the central and peripheral nervous systems to achieve therapeutic results. Neuromodulation has been used to treat bladder spasticity, by stimulating the tibial nerve, a distal structure, to achieve retrograde sacral plexus stimulation to affect the bladder. The role of retrograde stimulation in pain management to reduce pain in distant anatomic areas has not been investigated in depth but can provide a new avenue for treatment.

Origin, course, and distribution of the posterior femoral cutaneous nerve and the spatial relationship among its branches

This study aimed to elucidate the origin, course, and distribution of the branches of the posterior femoral cutaneous nerve, considering the segmental and dorsoventral compositions of the sacral plexus, including the pudendal nerve. The buttocks and thighs of five cadavers were analyzed bilaterally. The branches emerged from the sacral plexus, which was divided dorsally to ventrally into the superior gluteal, inferior gluteal, common peroneal, tibial, and pudendal nerves. It descended lateral to the ischial tuberosity and comprised the thigh, gluteal, and perineal branches. As for the thigh and gluteal branches, the dorsoventral order of those originating from the sacral plexus corresponded to the lateromedial order of their distribution. However, the dorsoventral boundary was displaced at the inferior margin of the gluteus maximus between the thigh and gluteal branches. The perineal branch originated from the ventral branch of the nerve roots. In addition, the pudendal nerve branches, which ran medially to the ischial tuberosity, were distributed in the medial part of the inferior gluteal region. These branches should be distinguished from the gluteal branches; the former should be classified as the medial inferior cluneal nerves and the latter as the lateral ones. Finally, the medial part of the inferior gluteal region was distributed by branches of the dorsal sacral rami, which may correspond to the medial cluneal nerves. Thus, the composition of the posterior femoral cutaneous nerve is considered necessary when considering the dorsoventral relationships of the sacral plexus and boundaries of the dorsal and ventral rami.

Anatomy of the lumbar and sacral plexuses and lower limb peripheral neuropathies

Anatomy of the lumbar and sacral plexuses and lower limb peripheral neuropathies

Anatomical description of the perforating cutaneous nerve.

The perforating cutaneous nerve/perforating nerve of the sacrotuberous ligament is rarely observed. It usually arises from the posterior division of the sacral plexus or the pudendal nerve and perforates the sacrotuberous ligament. The anatomy of this nerve and its variants is poorly described in the literature, but there are data indicating its role in pudendal neuralgia. Herein, we present an anatomical study of six formalin-fixed cadavers with descriptions of the topography of spinal nerves S2-S4, the pudendal bundle, the perforating cutaneous nerve and the sacrotuberous ligament. We found three perforating cutaneous nerves and described each of them in detail, with measurements of length and width, and point of perforation of the sacrotuberous ligament. We distinguished three types of perforating cutaneous nerve on the basis of our findings and previous publications; two of the three types were observed in our study.

Neurolymphomatosis diagnosed on [18F]FDG PET/CT.

Fluorine-18-deoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has been shown to be superior to other conventional imaging modalities in the detection of extra-nodal lymphomatous localizations. Especially in neurolymphomatosis which is rarely encountered in high-grade lymphomas. We report a case of a woman diagnosed with non-Hodgkin lymphoma, whose initial staging with [18F]FDG PET/CT showed increased [18F]FDG uptake along the brachial and sacral plexuses. [18F]FDG PET/CT remains the most appropriate diagnostic tool in these cases, whose prognosis is often poor.

Management of a Large Endometriotic Nodule of the Right Parametrium Involving the Sacral Roots, Vagina, Rectum, and Sigmoid Colon, with Intraoperative Bleeding

Deep endometriotic lesions may involve the deep parametrium which is highly vascular and includes numerous somatic and autonomous nerves (1,2). Surgeons who dissect in this area, must always be prepared to deal with major bleeding, and to master the different techniques of hemostasis. The goal of this video is to show the steps of laparoscopic excision of deep endometriotic lesion of the parametrium and the steps taken to control the bleeding encountered from one of the venous branches. Surgical educational video. Endometriosis referral center. Excision of the endometriotic parametrial nodule and the release of the sacral plexus, with excision of the vaginal involvement, rectal disc excision, and segmental resection of the sigmoid colon. The video shows the excision of a deep endometriosis involving the right parametrium, the mid rectum, the sigmoid colon, and the vagina. The excision of deep endometriosis of the parametrium followed the 10 steps previously described (1). During this procedure, careful dissection of arteries and veins branching from the internal iliac vessels is a crucial step. However, injury of one or more of the vessels can still occur. The movie presents the different techniques used to control the bleeding from a venous injury faced during the dissection around the nodule in the parametrium, including energy use, clips, hem-o-loks, and direct continuous pressure. Of note, hemostatic agents are available, however we have not yet successfully employed them in these circumstances in which large veins were injured. The ultimate solution in our case was the clamping of the injured vessels, allowing meticulous dissection and sectioning of all the feeding vessels, while taking care not to injure the sacral roots which were just beneath these veins. Total operative time was 4 hours. Surgery of deep endometriosis involving the sacral plexus may be successfully done laparoscopically. Thorough knowledge of the deep pelvis anatomy is mandatory, and the surgeon should master various techniques of hemostasis, particularly on deep veins.