The purpose of this study was to classify the spinal nerve compositions of the terminal branches of the lumbosacral plexus, providing data of their participating quantities. Twenty-five sides of the lumbosacral plexus extracted from Korean adult cadavers were used in this study. The iliohypogastric nerve was mostly arisen from L1 (88.2%, thickness L1 0.7 mm). The ilioinguinal nerve was arisen from only L1 (100%, thickness L1 0.6 mm). The genitofemoral nerve was commonly arisen from L1 and L2 (62.5%, thickness L1 0.6 mm, L2 0.7 mm). The lateral femoral cutaneous nerve was classified into 4 types, and the most common type was that L2 and L3 composed this nerve (56.0%, thickness L2 0.8 mm, L3 0.4 mm). The femoral nerve was classified into 2 types, and it was usually composed of L2, L3 and L4 (88.0%, thickness L2 1.4 mm, L3 2.7 mm, L4 2.3 mm). The obturator nerve was arisen from L2, L3 and L4 in all cases (100%, thickness L2 0.5 mm, L3 1.3 mm, L4 1.1 mm). The common fibular component of sciatic nerve was mostly arisen from L4, L5, S1 and S2 (84.0%, thickness L4 0.9 mm, L5 2.0 mm, S1 2.1 mm, S2 1.2 mm). The tibial component of sciatic nerve was mainly arisen from L4, L5, S1 and S2 (96.0%, thickness L4 0.9 mm, L5 1.9 mm, S1 2.2 mm, S2 1.9 mm). The superior gluteal nerve was commonly derived from L4, L5 and S1 (56.0%, thickness L4 0.7 mm, L5 1.1 mm, S1 0.9 mm). The inferior gluteal nerve was comprised of L5, S1 and S2 in several cases (54.2%, thickness L5 0.9 mm, S1 1.3 mm, S2 0.8 mm). The posterior femoral cutaneous nerve was composed of S1 and S2 in higher freqeuncy (40.0%, thickness S1 0.9 mm, S2 1.0 mm, S3 0.8 mm). The perforating cutaneous nerve was arisen from S2 and S3 in higher frequency (56.0%, thickness S1 0.7 mm, S2 0.9 mm, S3 1.1 mm). The pudendal nerve was derived from S3 in many cases (52.9%, thickness S3 1.5 mm). These anatomical results may be helpful to predict the spinal nerve root lesions of the lumbosacral plexus.
Adult ; Cadaver ; Femoral Nerve ; Humans ; Lumbosacral Plexus ; Obturator Nerve ; Pudendal Nerve ; Sciatic Nerve ; Spinal Nerve Roots ; Spinal Nerves

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

BACKGROUND: Different types of injury to the sciatic nerve branches produces different levels of each kind of nociception. In this study, we undertook to identify the nature of the partial sciatic nerve injury that affects nociceptive reaction to subcutaneous formalin injection, and to determine the branch of the sciatic nerve involved. METHODS: Sprague-Dawley rats were randomly divided into 4 groups, control group (n = 9) in which a sham operation was performed, a sural nerve transection group (n = 5), a tibial nerve transection group (n = 5), and a common peroneal nerve transection group (n = 5). Under enflurane anesthesia, sural, tibial, or common peroneal nerves were injured and responses to formalin test were compared for the four groups 24 hours after surgery. RESULTS: Pain behavior in the tibial and common peroneal nerve transected groups reduced in phase 2, but not in phase 1, while sural nerve transected group showed no change in response in either phase. CONCLUSIONS: Tibial and common peroneal nerves mainly affect phase 2 reaction in the formalin test in this partial sciatic nerve injury model.
Anesthesia ; Animals ; Control Groups ; Enflurane ; Formaldehyde* ; Models, Animal ; Nociception ; Pain Measurement* ; Peroneal Nerve ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve* ; Sciatic Neuropathy ; Sural Nerve ; Tibial Nerve

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

A case of chest wall malignant peripheral nerve sheath tumor(MPNST) was reported in the U.S.A by Mark and coworkers(1991), but none in kerea. MPNST accounts for approximately 10% of all soft tissue sarcoma, mostly in patients between 20 and 50 years of age. MPNST arises in association with a major nerve trunk, including the sciatic nerve, brachial plexus, and sacral plexus and the most common anatomical site is the proximal portion of the upper and lower extremity and trunk. Surgical treatment is local excision of mass in low grade sarcoma but enblock resection is necessary in high grade sarcoma. We experienced multiple huge low grade MPNST on left chest wall of a 50 years old man. The tumor and invalved chest wall were removed, and the chest wall defect(15 X 8 cm) was reconstructed with Teflon. Postoperative course was unevenful.
Brachial Plexus ; Humans ; Lower Extremity ; Lumbosacral Plexus ; Middle Aged ; Neurilemmoma ; Peripheral Nerves* ; Polytetrafluoroethylene ; Sarcoma ; Sciatic Nerve ; Thoracic Wall* ; Thorax*

OBJECTIVE: To determine if stretching the sciatic nerve in control and patients with lumbosacral radiculopathy significantly alters F-wave parameters. METHOD: We studied F-waves in the deep peroneal & posterior tibial nerves of 20 patients with unilateral lumbosacral radiculopathies and 22 controls. F-waves were recorded bilaterally in the neutral position and supine in 30o & 60o straight leg raising (SLR). F-wave parameters included minimal latency (F min), maximal latency (F max), mean latency (F mean), latency difference between F min and F max (chronodispersion), mean duration (F dur) and side to side difference in F min, F max, F mean and F dur. RESULTS: In controls, the F-wave latency was found to be longer in supine with SLR than in neutral position. In patients with lumbosacral radiculopathy, significant differences of F max, F mean and F dur between sides during 30o SLR were noted in the deep peroneal nerves, but all parameters in the posterior tibial nerves during SLR were not changed. CONCLUSION: In this study, we observed significant changes in F-wave latency in control during straight leg raising, but no significant changes in patients with lumbosacral radiculopathy. For the clinical application to lumbosacral radiculopathy, further study is needed.
Humans ; Leg* ; Peroneal Nerve ; Radiculopathy* ; Sciatic Nerve ; Tibial 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

OBJECTIVE: The sural nerve is a sensory nerve in the lower extremity which is formed by the union of the medial sural cutaneous nerve of tibial nerve and the communicating branch of the common peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique of proximal conduction of sural nerve and to investigate the usefulness of the technique in evaluation for the patients with peripheral neuropathy. METHOD: Fifty eight extremities in 29 normal adults without the clinical signs and symptoms of peripheral neuropathy were evaluated with sural nerve conduction study. The active recording electrode was placed over 14 cm proximal to the lateral malleolus, and the reference electrode was placed over 4cm distal to the active electrode. The antidromic evoked responses were recorded with stimulation at points 7, 14, 21 cm proximal to the recording electrode and directly over the sural nerve. RESULTS: The mean values of proximal conduction study of sural nerve in normal adults were 2.40 1.03 msec for peak latency, 11.55 +/-7.31 microvolt in amplitude with stimulation at 7 cm proximal to the recording electrode; 3.43 +/-0.78 msec for peak latency, 10.87 5.86 microvolt in amplitude with stimulation at 14 cm; 4.51 +/-0.83 msec for peak latency, 8.78+/- 4.10 microvolt in amplitude with stimulation at 21 cm. CONCLUSION: A method of proximal conduction study of sural nerve was introduced which could be used as a valuable technique for the evaluation of peripheral neuropathy.
Adult ; Electrodes ; Extremities ; Humans ; Lower Extremity ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Sural Nerve* ; Tibial Nerve

OBJECTIVES: This study is a case report of 2,5-hexanedione induced occupational peripheral polyneuropathy. We also investigated the peripheral nerve function of all workers who had been exposed to 2,5-hexanedione in the same process. METHODS: In June, 2006, a 2,5-hexanedione exposed worker complained of both hand numbness. He received neurologic, radiologic, laboratorial and electrophysiologic evaluation, including measurements of workplace environment. Five months after cessation of exposure to 2,5-hexanedione, a follow-up electrophysiologic examination was done. We evaluated the peripheral nerve function of 2,5-hexanedione exposed workers by comparing 13 male 2,5-hexanedione exposed workers who were in same company with the patient and 5 male workers who had not been exposed to 2,5-hexanedione. RESULTS: Under electrophysiologic examination, there were abnormalities in sensory and motor nerve velocity, terminal latency, and F-latency of both median nerve and ulnar nerve. After 5 months, the patient symptoms and the results of follow-up electrophysiologic examinations were improved. Comparing the 2,5-hexanedione exposed group with the unexposed group, the sensory nerve velocity of the median and ulnar nerves in the exposed group was decreased. The motor nerve velocity of the peroneal nerve, and sensory nerve velocity of the median and sural nerves were decreased. Terminal latency of median, ulnar, peroneal, and tibial nerves in the exposed group were increased compared with the unexposed group(<0.05). CONCLUSIONS: 2.5-hexandione can induce peripheral polyneuropathy in male workers.
Follow-Up Studies ; Hand ; Humans ; Hypesthesia ; Male ; Median Nerve ; Peripheral Nerves ; Peroneal Nerve ; Polyneuropathies* ; Sural Nerve ; Tibial Nerve ; Ulnar Nerve

Gluteal compartment syndrome is a rare disorder which often occurs in conjunction with prolonged immobility after an overdose of sedative. Signs of sciatic nerve compression frequently occur, and rhabdomyolysis may be associated with the syndrome. We recently encountered a patient with lumbosacral plexopathy, complicated by gluteal compartment syndrome. A 42-year-old man presented with weakness and swelling in the right lower extremity and gluteal area after an overdose of antipsychotic drug, accompanied by prolonged immobilization. Serum creatine phosphokinase and urinary myoglobin were markedly elevated, and a T2-weighted pelvis MRI showed hyperintensities and swelling in the gluteal muscles. An electrodiagnosis study showed incomplete lumbosacral plexopathy. The patient received medical treatment and rehabilitation. Six months later, his right lower limb weakness had improved and he could walk independently. Lumbosacral plexus injury with rhabdomyolysis is a rare but debilitating disorder. Therefore, early diagnosis and treatment are crucial for prevention of neurologic deterioration.
Adult ; Compartment Syndromes ; Creatine Kinase ; Early Diagnosis ; Electrodiagnosis ; Humans ; Immobilization ; Lower Extremity ; Lumbosacral Plexus ; Muscles ; Myoglobin ; Pelvis ; Rhabdomyolysis ; Sciatic Nerve