We present a rare case of fracture-dislocation at the level of the first sacral (S1) and second sacral (S2) vertebrae. The S1 was displaced forward into the pelvic cavity and was located just in front of the S2. Because the patient also had extensive neurological injury to the lumbar plexus and instability of the pelvic ring, surgery to stabilize the pelvis and to decompress the lumbar plexus was performed. The surgery was successful and the patient experienced marked improvement in neurological function.
Dislocations ; Humans ; Lumbosacral Plexus ; Pelvis ; Sacrum ; Spine

No abstract available.
Diabetic Neuropathies* ; Lumbosacral Plexus* ; Magnetic Resonance Imaging*

In surgical approaches to the perineum in general and anal region specifically, considering the possible variations of the inferior rectal nerve is important for the surgeon. Normally, the inferior rectal nerve originates as a branch of the pudendal nerve. However, during routine dissection, a variant of the inferior rectal nerve was found where it arose directly from the third sacral nerve ventral ramus (S3). Many cases have described the inferior rectal nerve arising independently from the sacral plexus, most commonly from the fourth sacral nerve root (S4); however, few cases have reported the inferior rectal nerve arising from S3. Herein, we describe a variant of the inferior rectal nerve in which the nerve arises independently from the sacral plexus.
Anal Canal ; Lumbosacral Plexus ; Perineum ; Pudendal Nerve

We present a patient with ischemic lumbar plexopathy due to unilateral obstruction of iliolumbar artery, a branch of internal iliac artery. Although most parts of lumbar plexus and femoral nerve have rich vascularization and therefore are resistant to ischemic injury, but their poorly vascularized intrapelvic portions are vulnerable to ischeniic insults caused by stenosis or obstruction of internal iliac artery and/or its branch. So in lumbar plexopathy, angiograhpy with many other extensive examinations shoud be recommended for differentiation from various causes.
Arteries* ; Constriction, Pathologic ; Femoral Nerve ; Humans ; Iliac Artery ; Lumbosacral Plexus

Fecal incontinence is one of diseases effecting the quality of life and mental health. Germany surgeon used sacral nerve stimulation(SNS) to treat fecal incontinence at first in 1995. The aim of SNS is to mobilize the ability to control the feces through stimulating the nerves of dominating the sphincter muscles and pelvic floor muscles. Standard SNS includes two stages: evaluation stage of SNS and permanent implantation stage. Preoperative evaluation plays important role in guaranteeing the success of treatment. SNS is the primary treatment of choice for severe fecal incontinence. The complications of SNS include pain, shift of electronic probe, wound dehiscence, bowel dysfunction and infection.
Electric Stimulation Therapy ; Fecal Incontinence ; Humans ; Lumbosacral Plexus ; Quality of Life

PURPOSE: To evaluate the incidence of neurologic injury in pelvic ring injuries and to assess the risk factors for neurologic injury related to pelvic fractures. MATERIALS AND METHODS: Sixty-two patients with the pelvic ring injury were enrolled in the study from March 2010 to May 2013. When the neurologic injury was suspected clinically, the electro-diagnostic tests were performed. Combined injuries, fracture types, and longitudinal displacements were examined for correlations with the neurologic injury. RESULTS: There were 7 cases of AO/OTA type A, 37 cases of type B, and 18 cases of type C. Among them, 25 patients (40%) had combined spine fractures, and the average of longitudinal displacement was 7 mm (1-50 mm). Of the 62 patients, 13 (21%) had neurologic injury related with pelvic fractures; 5 with lumbosacral plexus injury, 5 with L5 or S1 nerve injury, 2 with obturator nerve injury, and 1 case of lateral femoral cutaneous nerve injury. There were no relationships between the neurologic injuries and fracture types (p=0.192), but the longitudinal displacements of posterior ring and combined spine fractures were related to the neurologic injury within pelvic ring injury (p=0.006, p=0.048). CONCLUSION: The incidence of neurologic injury in pelvis fracture was 21%. In this study, the longitudinal displacements of posterior ring and combined spine fractures were risk factors for neurological injury in pelvic ring injury.
Humans ; Incidence ; Lumbosacral Plexus ; Obturator Nerve ; Pelvis ; Risk Factors ; Spine

Benign solitary osteochondroma are the most common benign bone tumor, and often arise in the long bone of the extremities about 80% of lesions, particulary about the knee and the upper extremity. In rare cases, the spine is involved. We describe a case in which a solitary sacral osteochondroma compressed the lumbosacral plexus, producing sensory disturbance. The tumor was removed through the anterior midline approach. The excised mass was round, lobulated, measuring 7. 5cm×6cm, pedunculated type and the cartilage cap is complete and is 4mm in thickness.
Cartilage ; Extremities ; Knee ; Lumbosacral Plexus ; Osteochondroma ; Sacrum ; Spine ; Upper Extremity

OBJECTIVE: In contrast to the electrical stimulation, the magnetic stimulation of motor system is a painless and noninvasive neurophysiologic technique. We attempted to establish a clinical feasibility of lumbosacral plexus conduction study by using the magnetic stimulation. METHOD: We performed a magnetic stimulation at the L5 spinous process and obtained the compound motor action potentials(CMAP) from individual muscles of pelvic area and lower extremity. RESULTS: The onset latencies of compound muscle action potentials(CMAP) were fastest in the gluteus maximus muscle and slowest in the abductor hallucis muscle. The onset latencies of compound muscle action potentials(CMAP) showed no significant difference in both sides, however, there was a positive correlation between height and onset latency in distal leg muscles. The amplitudes of compound muscle action potentials(CMAP) were the highest in the vastus medialis and lowest in the tibialis anterior muscle. CONCLUSION: Lumbosacral plexus conduction study by magnetic stimulation was easy to obtain the compound motor action potentials(CMAP) from individual muscles and was relatively comfortable to the subjects.
Electric Stimulation ; Leg ; Lower Extremity ; Lumbosacral Plexus* ; Muscles ; Quadriceps Muscle

OBJECTIVE: To ascertain the etiology of non-traumatic plexopathy and clarify the clinical, electrophysiological characteristics according to its etiology. METHOD: We performed a retrospective analysis of 63 non-traumatic plexopathy patients that had been diagnosed by nerve conduction studies (NCS) and needle electromyography (EMG). Clinical, electrophysiological, imaging findings were obtained from medical records. RESULTS: We identified 36 cases with brachial plexopathy (BP) and 27 cases with lumbosacral plexopathy (LSP). The causes of plexopathy were neoplastic (36.1%), thoracic outlet syndrome (TOS) (25.0%), radiation induced (16.7%), neuralgic amyotrophy (8.3%), perioperative (5.6%), unknown (8.3%) in BP, while neoplastic (59.3%), radiation induced (22.2%), neuralgic amyotrophy (7.4%), psoas muscle abscess (3.7%), and unknown (7.4%) in LSP. In neoplastic plexopathy, pain presented as the first symptom in most patients (82.8%), with the lower trunk of the brachial plexus predominantly involved. In radiation induced plexopathy (RIP), pain was a common initial symptom, but the proportion was smaller (50%), and predominant involvements of bilateral lumbosacral plexus and whole trunk of brachial or lumbosacral plexus were characteristic. Myokymic discharges were noted in 41.7% patients with RIP. Abnormal NCS finding in the medial antebrachial cutaneous nerve was the most sensitive to diagnose TOS. Neuralgic amyotrophy of the brachial plexus showed upper trunk involvement in all cases. CONCLUSION: By integrating anatomic, pathophysiologic knowledge with detailed clinical assessment and the results of ancillary studies, physicians can make an accurate diagnosis and prognosis.
Abscess ; Adult ; Brachial Plexus ; Brachial Plexus Neuritis ; Brachial Plexus Neuropathies ; Electromyography ; Electrophysiology ; Humans ; Lumbosacral Plexus ; Needles ; Neural Conduction ; Prognosis ; Psoas Muscles ; Retrospective Studies ; Thoracic Outlet Syndrome

OBJECTIVETo provide anatomic data for reducing lumbar plexus nerve injury.

METHODSThe applied anatomy of lumbar plexus was studied by 15 formaldehyde-preserved cadavers, two groups of sectional images of lumbar segment and three series of virtual chinese human dataset.

RESULTSArrangement of the lumbar nerve was regular. From anterior view, lumbar plexus nerve arranged from lateral to medial from L2 to L5; from lateral view, lumbar nerve arrange from ventral to dorsal from L2 to L5. The angle degree between the lumbar nerve and lumbar increased from L1 to L5. The lumbar plexus nerve was revealed to be in close contact with transverse process. By sectional anatomy, all parts of the lumbar plexus nerve were located in the dorsal third of the psoas major. The safety zone of the psoas major to prevent nerve injuries was ventrally 2/3.

CONCLUSIONSPsoas major can be considered as surgery landmark when expose the lateral anterior of lumbar by incising the psoas muscle. Incising the psoas muscle ventral 2/3 can prevent lumbar plexus injury. Transverse process can be considered as landmark for the position of lumbar plexus in operation.

Female ; Humans ; Lumbar Vertebrae ; anatomy & histology ; surgery ; Lumbosacral Plexus ; anatomy & histology ; Lumbosacral Region ; anatomy & histology ; Male ; Minimally Invasive Surgical Procedures