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PubMed2006

[The use of pelvic packing for intraoperative hemorrhage during pelvic exenteration--case reports].

This is a report of two cases of haemorrhage after pelvic exenteration in patients with vulvar cancer and cervical cancer treated by temporary pelvic packing at the Department of Gynaecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 and 48 hours. There were no major postoperative complications in both cases and one wound dehiscence. Both patients recovered after surgery. In cases with severe intraoperative haemorrhage, intraabdominal packing can be effective mode of treatment, especially in bleeding which originates from the sacral venous plexus.

Blood Loss, Surgical↗
PubMedDate not supplied

[Intra- and extra-pelvic venous connections. Anatomical study].

Regarding to clinical diseases, the authors emphasize the important part of pelvic veins as collateral flows when iliac channels are occluded. They point out the three mains streams of this collateral network: the obturator veins, the gluteal veins, and the pudendal veins. Longitudinal anastomoses are connected each other by transversal veins such as Santorini plexus, and sacral veins; they allow venous supply from one side to the other when two levels or more are involved.

Female↗
PubMed2006

The craniospinal venous system.

The valveless craniospinal venous system consists of veins and plexuses that communicate freely and whose flow is bidirectional. It comprises (1) the intracranial-cortical veins, dural sinuses, cavernous sinuses and ophthalmic veins, and (2) the vertebral venous plexuses, which freely anastomose with the intracranial venous system. The vertebral venous plexuses anastamose with the sacral, pelvic and prostatic venous plexus. It is clinically important since it provides a route for the spread of tumours, infection or emboli. This route may go unrecognised.

Animals↗
PubMed2000

Sacral neural crest cells colonise aganglionic hindgut in vivo but fail to compensate for lack of enteric ganglia.

The vagal neural crest is the origin of majority of neurons and glia that constitute the enteric nervous system, the intrinsic innervation of the gut. We have recently confirmed that a second region of the neuraxis, the sacral neural crest, also contributes to the enteric neuronal and glial populations of both the myenteric and the submucosal plexuses in the chick, caudal to the level of the umbilicus. Results from this previous study showed that sacral neural crest-derived precursors colonised the gut in significant numbers only 4 days after vagal-derived cells had completed their migration along the entire length of the gut. This observation suggested that in order to migrate into the hindgut and differentiate into enteric neurons and glia, sacral neural crest cells may require an interaction with vagal-derived cells or with factors or signalling molecules released by them or their progeny. This interdependence may also explain the inability of sacral neural crest cells to compensate for the lack of ganglia in the terminal hindgut of Hirschsprung's disease in humans or aganglionic megacolon in animals. To investigate the possible interrelationship between sacral and vagal-derived neural crest cells within the hindgut, we mapped the contribution of various vagal neural crest regions to the gut and then ablated appropriate sections of chick vagal neural crest to interrupt the migration of enteric nervous system precursor cells and thus create an aganglionic hindgut model in vivo. In these same ablated animals, the sacral level neural axis was removed and replaced with the equivalent tissue from quail embryos, thus enabling us to document, using cell-specific antibodies, the migration and differentiation of sacral crest-derived cells. Results showed that the vagal neural crest contributed precursors to the enteric nervous system in a regionalised manner. When quail-chick grafts of the neural tube adjacent to somites 1-2 were performed, neural crest cells were found in enteric ganglia throughout the preumbilical gut. These cells were most numerous in the esophagus, sparse in the preumbilical intestine, and absent in the postumbilical gut. When similar grafts adjacent to somites 3-5 or 3-6 were carried out, crest cells were found within enteric ganglia along the entire gut, from the proximal esophagus to the distal colon. Vagal neural crest grafts adjacent to somites 6-7 showed that crest cells from this region were distributed along a caudal-rostral gradient, being most numerous in the hindgut, less so in the intestine, and absent in the proximal foregut. In order to generate aneural hindgut in vivo, it was necessary to ablate the vagal neural crest adjacent to somites 3-6, prior to the 13-somite stage of development. When such ablations were performed, the hindgut, and in some cases also the cecal region, lacked enteric ganglionated plexuses. Sacral neural crest grafting in these vagal neural crest ablated chicks showed that sacral cells migrated along normal, previously described hindgut pathways and formed isolated ganglia containing neurons and glia at the levels of the presumptive myenteric and submucosal plexuses. Comparison between vagal neural crest-ablated and nonablated control animals demonstrated that sacral-derived cells migrated into the gut and differentiated into neurons in higher numbers in the ablated animals than in controls. However, the increase in numbers of sacral neural crest-derived neurons within the hindgut did not appear to be sufficiently high to compensate for the lack of vagal-derived enteric plexuses, as ganglia containing sacral neural crest-derived neurons and glia were small and infrequent. Our findings suggest that the neuronal fate of a relatively fixed subpopulation of sacral neural crest cells may be predetermined as these cells neither require the presence of vagal-derived enteric precursors in order to colonise the hindgut, nor are capable of dramatically altering their proliferation or d

Animals↗
PubMed2003

Midline sagittal sacral fractures in anterior-posterior compression pelvic ring injuries.

OBJECTIVE: To evaluate the outcome of an uncommon variant of the anterior-posterior compression pelvic injury, in which the posterior ring injury is a midline sagittal sacral fracture extending into the spinal canal. DESIGN: Prospective, consecutive series. SETTING Two regional trauma centers. PATIENTS: A consecutive series of 10 patients with rotationally displaced, vertically stable anterior-posterior compression pelvic ring fractures (OTA type 61-B1) in which the posterior ring injury is a midline sagittally oriented sacral fracture involving the spinal canal (Denis zone III). This injury pattern comprised 0.6% of pelvic fractures and 1.4% of sacral fractures treated at these two institutions during a 10-year period. INTERVENTION: Patients were treated according to the same principles used in more commonly seen types of anterior-posterior compression pelvic ring injuries. Nine patients were treated with reduction and anterior pelvic stabilization at an average of 5 days after injury, 8 of whom were treated with open reduction and internal fixation and 1 with external fixation. No posterior pelvic fixation was used. One patient with nondisplaced bilateral pubic ramus fractures was treated nonoperatively. Immediate weight bearing was allowed as tolerated. MAIN OUTCOME MEASUREMENTS: Prospectively collected clinical follow-up data emphasized a detailed neurologic examination, whereas radiographic evaluation involved anteroposterior, inlet, and outlet plain radiographic views of the pelvis. RESULTS: An anatomical or near-anatomical reduction of the pelvis was achieved and maintained in all patients. Fractures healed at an average of 10 weeks. At an average follow-up of 31 months (range 20-46 months), there were no objective neurologic deficits that could be attributed to sacral root injury and no significant residual pain or gait disturbance related to the pelvic fracture. Loss of bowel or bladder function, loss of perianal sensation or sphincter tone, and lumbosacral radicular pain or sensorimotor deficit were specifically absent in all patients. Three patients, however, complained of sexual dysfunction at final follow-up. None of these patients had clinical evidence of sacral root/plexus injury secondary to the fracture. One additional patient, who sustained a urethral tear, required a chronic suprapubic catheter because of stricture. Six patients, one of whom had needed repair of a retroperitoneal bladder tear, had no urogenital sequelae. DISCUSSION AND CONCLUSION: Patients who sustain sagittally oriented midline fractures of the sacrum that extend into the spinal canal (Denis zone III) as part of displaced, vertically stable anterior-posterior compression pelvic injuries, have a low incidence of neurologic deficit attributable to sacral root or plexus injury. This is in contrast to the high rate of neurologic deficit (>50%) otherwise reported in zone III sacral fractures, particularly in those associated with a displaced transverse component. In the midline sagittal fracture variant, simultaneous lateral displacement of both bony and neural elements through the midline may protect the sacral roots and plexi from significant traction or shear injury by maintaining the spatial orientation between the sacral foramina and sciatic notch. Long-term sequelae were related to urogenital complaints rather than to musculoskeletal problems, as 4 of the 10 patients in this series had either sexual or urologic dysfunction.

Adult↗
PubMed1993

[Follow-up and prognosis of neurologic sequelae of pelvic ring fractures with involvement of the sacrum and/or the iliosacral joint].

The extent of neurological lesions following an injury of the pelvic ring is often not initially recognized, as interest is then focused on the treatment of the pelvic ring fracture. Once the fracture has healed, the patient suffers from the sequelae of the neurological injury. Our series of 323 pelvic ring injuries includes 161 sacral fractures and 12 complete disruptions of the sacroiliac joint. Twenty-three patients sustained an injury of the lumbosacral plexus, and 20 patients were examined retrospectively. The different parts of the lumbosacral plexus showed variable recovery potential. An important or complete recovery was noted in 8 of 9 patients suffering from a motor deficit of the lumbar plexus, the obturator nerve, the superior gluteal nerve or the inferior gluteal nerve. Four out of 8 patients with a motor deficit of the sacral plexus had an important or complete improvement. In contrast to these results was the poor recovery of lesions of the lumbosacral trunk. Eight out of 11 patients showed no or only minor recovery, although the pelvic ring was stabilized by operative means in 9 patients. In 2 patients the lumbosacral trunk was directly decompressed by a dorsal approach. In both cases the recovery was complete. In 6 patients the sphincter function was damaged. Recovery was dependent on the localization of the sacral fracture. If the fracture traversed the sacral canal, no neurological improvement was noted.

Adult↗
PubMed1987

Organization of lumbar spinal outflow to distal colon and pelvic organs.

The lumbar sympathetic outflow projects through the lumbar splanchnic, lumbar colonic, and hypogastric nerves (and to a lesser degree through the sacral sympathetic chain and pelvic nerves). It is thought to be involved in the regulation of the storage and evacuation functions of the following three organ systems: lower urinary tract, hindgut, and reproductive organs. In addition, it controls vascular resistance and capacitance. Thus the target tissues of the postganglionic neurons are vascular smooth muscle, visceral smooth muscles, probably secretory epithelia, and also neurons in the enteric nervous system and the pelvic ganglia. The preganglionic neurons are situated in the caudal part of the spinal representation, neurons associated with the colon being located rostral to those associated with the pelvic organs. Most lie medial to the classical intermediolateral cell column that may contain mainly vasoconstrictor neurons. Most (if not all) preganglionic neurons are cholinergic; some also contain an identified peptide. Most of the postganglionic neurons are situated in the inferior mesenteric ganglion (or equivalent structures); again, those projecting to the colon lie rostral to those projecting to the pelvic organs. Others lie in intercalated prevertebral ganglia, in the pelvic plexus, and in sacral paravertebral ganglia. The majority is noradrenergic, and most also contain one or several peptides, the topographical distribution of which appears to characterize functional subgroups of neurons. The terminations of noradrenergic axons in many pelvic organs probably make close contact with both vascular and nonvascular effectors. In the colon, most endings are located in the enteric plexuses. The responses of these organs to electrical stimulation of visceral nerves, and their reflex responses (together with those observed in the efferent axons of visceral nerve trunks) to electrical and natural stimulation of afferent fibers, lead to the general conclusion that several distinct classes of pre- and postganglionic neurons exist. 1) Vasoconstrictor neurons demonstrate ongoing activity with cardiac rhythm and appropriate reflexes to stimulation of cardiovascular afferent receptors and respond only weakly to natural stimulation of visceral receptors. 2) MR neurons respond to visceral stimuli but are not influenced from arterial baro- and chemoreceptors. These show at least two different response patterns consistent with their separate involvement in the reciprocal behavior of the colon and bladder. 3) Other neurons are silent in anesthetized animals and do not respond to any stimuli used thus far.(ABSTRACT TRUNCATED AT 400 WORDS)

Afferent Pathways↗
PubMedDate not supplied

The human cervical and lumbo-sacral evoked electrospinogram. Data from intra-operative spinal cord surface recordings.

We have undertaken the analysis of the human 'evoked electrospinogram' during intra-dural surgical explorations in 20 patients. Averaged spinal cord surface evoked potentials to peripheral nerve electrical stimulation were obtained from various restricted loci on the pial surface of the cervical and lumbo-sacral spinal cord. The brachial plexus P9 potential and its lumbo-sacral counterpart P17 were recorded as ubiquitous initial far-field positivities. The pre-synaptic compound action potentials N11 and N21 dwelt on the ascending slope of N13 and N24 respectively. They were composed of 1-5 sharp peaks and collected from the dorsal and dorso-lateral positions mainly, on the cervical and lumbo-sacral cord respectively. They are thought to be generated in the proximal portion of the dorsal root, the dorsal funiculus and the afferent collaterals to the dorsal horn. Compound action potentials could also be gathered from the surface of the dorsal roots, the cervical N10 and lumbo-sacral N19 potentials. The large cervical N13 and lumbo-sacral N24 waves originate from a dorso-ventral post-synaptic dipole, generated in deep laminae of the dorsal horn during the activation of large diameter afferent fibers. These waves were maximal on the main entry cord segments of the stimulated nerves and fell off on the 1-4 more rostral and caudal segments. The N2 wave is the dorsal component of another post-synaptic dorso-ventral dipole generated in deep laminae of the dorsal horn but activated by medium diameter afferent fibers. The latest event was the N3 wave, also possibly part of a dorso-ventral post-synaptic dipole, and generated by cells in the dorsalmost and deep dorsal horn laminae during the activation of small diameter afferent fibers. The P wave was a prolonged positive deflection which carried the N2 and N3 waves. It is the manifestation of pre-synaptic inhibition on primary afferent fibers. A supra-segmental ascending spinal cord volley was also described, composed of a long succession of sharp and low voltage peaks.

Adult↗
PubMed1983

Substance P, somatostatin, and methionine enkephalin immunoreactive elements in the spinal cord of the domestic fowl, Gallus domesticus.

The occurrence and distribution of substance P (SP), somatostatin (SOM), and enkephalin (ENK) immunoreactive elements were examined in the spinal cord of the domestic fowl, Gallus domesticus. SP immunoreactive fibers and their varicosities were densest in laminae I and II, although they were also found within deeper regions of the dorsal horn. In contrast, the intermediate gray area, the area around the central canal, and the ventral horn, contained fewer SP immunoreactive fibers. The distribution of ENK immunoreactivity in the gray matter was similar to that described for SP although immunoreactive fibers were denser around the central canal and in the intermediate zone. Few SOM immunoreactive fibers were present in the dorsal horn, the area around the central canal, and the ventral horn. All three peptidergic immunoreactive elements were found in and around the nucleus of Terni, an autonomic area. Throughout the lumbosacral enlargement SP, SOM, and ENK immunoreactive varicosities were found adjacent to the lumbosacral sinus and in fibers traversing the glycogen body. In addition, at caudal lumbar and rostral sacral levels a plexus of SP and SOM immunoreactive fibers was observed to be in close relationship with presumed motoneurons.

Animals↗
PubMed1992

Muscles of the pelvic outlet in the fowl (Gallus gallus domesticus) with special reference to their nerve supply.

The manner of innervation of the pelvic outlet muscles in fowl (Gallus gallus domesticus) was examined in detail in four male pelvic halves. The segmental arrangement of the nerve supply in the sacral and pudendal plexuses was compared to that of Lacertilia and Urodela as a basis for a morphological analysis of the pelvic outlet muscles. From the viewpoint of innervation, the pelvic outlet muscles of fowl are classified into two groups: a sphincter muscle group and a levator muscle group. These two groups are closely related to the ventral muscles of the pelvic limb. In contrast to the morphology of pelvic outlet muscles in lacertilians, in fowl the caudal muscle element does not contribute to the formation of these muscles.

Animals↗
PubMed1978

Untoward effects of ketamine combined with diazepam for supplementing conduction anaesthesia in young and middle-aged adults.

Fifty-six young and 29 middle-aged adults who were scheduled for lower abdominal, anorectal or extremity surgery under epidural, sacral or brachial plexus blockades received intravenous analgesic or anaesthetic doses of ketamine, combined with diazepam, immediately before the start of the operation. Forty-one patients received no supplementary drugs for the conduction anaesthesia and were divided into two groups of controls. On the day following the operation, all the patients were asked about their postanaesthetic reactions and their acceptance of the anaesthetic technique, and the nursing staff expressed their opinion on the amount of work and supervision needed during the post-operative care of the patients. Administration of ketamine 0.5 mg/kg with diazepam 0.15 mg/kg to young or middle-aged patients was not associated with more side-effects or a greater need for post-operative care and supervision than in the control groups. Administration of anaesthetic doses of ketamine 1.5 mg/kg and 3.0 mg/kg with 0.15 mg/kg and 0.3 mg/kg of diazepam, respectively, caused significantly (P less than 0.05) more post-operative anxiety and confusion, as well as a significantly greater need for post-operative care and supervision than in the control patients. It is concluded that, in young or middle-aged patients, supplementing conduction anaesthesia with ketamine 0.5 mg/kg plus diazepam 0.15 mg/kg is not associated with the untoward effects which can be expected after anaesthetic doses of 1.5 mg/kg (or more) of ketamine.

Adult↗
PubMed1980

Failure of intramuscularly administered lorazepam and scopolamine-morphine premedication to produce amnesic effects to supplement conduction anaesthesia.

Patients undergoing surgery under regional anaesthesia often prefer to be sedated and do not later want to recall the procedure. One hundred and twenty-one patients scheduled for various surgical procedures under epidural, spinal, sacral, or brachial plexus blockades received 1 mg/kg of pethidine, 0.007 mg/kg of scopolamine, plus 0.14 mg/kg of morphine, or 0.03 mg/kg or 0.06 mg/kg or lorazepam intramuscularly as preanaesthetic medication before the operation. The patients's self-assessments of degree of fatigue and apprehension were similar after each premedication when assessed before operation. Postoperative anxiety and confusion as well as need for postoperative care and supervision were greatest after 0.06mg/kg of lorazepam. Significantly (P smaller than 0.05 to P smaller than 0.01) fewer patients given 0.06 mg/kg or lorazepam remembered different events and procedures carried out on them before and after operation than those given other premedications, but no significant differences were noted in patients' ability to recall the performance of operation when asked on the following day. Seventy-seven, 63, and 57% of patients receiving 0.06 mg/kg of lorazepam remembered the start of blockade, performance of operation, and stay in recovery room, respectively. Intravenous sedation should be preferred to these intramuscularly administered premedications if drug-induced amnesia is sought to supplement local anaesthetic techniques.

Adult↗
PubMed2005

Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.

OBJECT: Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement. METHODS: After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrapment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%). Open MR-guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injection (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recurrence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%. CONCLUSIONS: This Class A quality evaluation of MR neurography's diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitivity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p < 0.01). Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved.

Adult↗
PubMed1978

[Innervation of the urogenital venous plexus].

The neural apparatus of the urogenital venous plexus is represented by intrafascial perivasal, adventitial and intramural plexus, perivasal and adventitial ganglia. Afferent venous innervation is mediated by the sacral cerebrospinal ganglia. Vegetative plexus of the abdominal and pelvic cavities are the ways of venous innervation in the urogenital plexus. Perivasal plexus and ganglia of the veins in the urogenital plexus localized in the distal sections of urogenital organs in both sex are separated as zones concentrating neural elements and must be taken into consideration when intrapelvic operations are performed. A single nerve plexus of the venous wall in the urogenital plexus is subdivided into perivasal (periadventitial), adventitial and intramural plexus. Receptor venous apparatuses of the urogenital plexus are represented by noncapsulated interstitial nerve terminals.

Animals↗
PubMed2001

Enteric nervous system development: analysis of the selective developmental potentialities of vagal and sacral neural crest cells using quail-chick chimeras.

The majority of the enteric nervous system (ENS) is derived from vagal neural crest cells (NCC). For many years, the contribution from a second region of the neuraxis (the sacral neural crest) to the ENS has been less clear, with conflicting reports appearing in the literature. To resolve this longstanding issue, we documented the spatiotemporal migration and differentiation of vagal and sacral-derived NCC within the developing chick embryo using quail-chick grafting and antibody labelling. Results showed that vagal NCC colonised the entire length of the gut in a rostrocaudal direction. The hindgut, the region of the gastrointestinal tract most frequently affected in developmental disorders, was found to be colonised in a complex manner. Vagal NCC initially migrated within the submucosa, internal to the circular muscle layer, before colonising the myenteric plexus region. In contrast, sacral NCC, which colonised the hindgut in a caudorostral direction, were primarily located in the myenteric plexus region from where they subsequently migrated to the submucosa. We also observed that sacral NCC migrated into the hindgut in significant numbers only after vagal-derived cells had colonised the entire length of the gut. This suggested that to participate in ENS formation, sacral cells may require an interaction with vagal-derived cells, or with factors or signalling molecules released by them or their progeny. To investigate this possible inter-relationship, we ablated sections of vagal neural crest (NC) to prevent the rostrocaudal migration of ENS precursors and, thus, create an aganglionic hindgut model. In the same NC ablated animals, quail-chick sacral NC grafts were performed. In the absence of vagal-derived ganglia, sacral NCC migrated and differentiated in an apparently normal manner. Although the numbers of sacral cells within the hindgut was slightly higher in the absence of vagal-derived cells, the increase was not sufficient to compensate for the lack of enteric ganglia. As vagal NCC appear to be more invasive than sacral NCC, since they colonise the entire length of the gut, we investigated the ability of transplanted vagal cells to colonise the hindgut by grafting the vagal NC into the sacral region. We found that when transplanted, vagal cells retained their invasive capacity and migrated into the hindgut in large numbers. Although sacral-derived cells normally contribute a relatively small number of precursors to the post-umbilical gut, many heterotopic vagal cells were found within the hindgut enteric plexuses at much earlier stages of development than normal. Heterotopic grafting of invasive vagal NCC into the sacral neuraxis may, therefore, be a means of rescuing an aganglionic hindgut phenotype.

Animals↗
PubMed1985

Three serial neurones in the innervation of the colon by the sacral parasympathetic nerve of the dog.

Electrophysiological and histological techniques were used to study the nature of the innervation of the colon by the sacral parasympathetic nerve of the dog. Many cells which incorporate horseradish peroxidase (HRP) were observed in ganglia of the pelvic plexus, but not in the sacral cord, after HRP was injected into the wall of the distal colon. Stimulation of the pelvic ganglia by an application of dimethylphenylpiperazinium contracted the distal colon. The contraction was reduced by nicotine applied to the colon. Compound action potentials in responses of rectal strands of the pelvic nerve to stimulation of the sacral ventral roots decreased or disappeared after hexamethonium bromide (C6) was applied to the pelvic plexus. Conduction velocities of the potentials showed that most of the preganglionic fibres were B fibres, and nearly all the post-ganglionic fibres were C fibres. Many C fibres were observed by electron microscopy in the rectal strands after degeneration of the pelvic and hypogastric nerves. Stimulation of such rectal strands caused a contraction of the colon, which diminished after C6 was applied to the distal colon. These results show that the sacral parasympathetic nerve innervating the colon comprises three serial neurones located in the sacral spinal cord, the pelvic plexus and the myenteric plexus.

Action Potentials↗
PubMed1978

Traumatic and postoperative lesions of the lumbosacral plexus.

In 53 cases of injury of the lumbosacral plexus, 31 were due to trauma and 22 followed operations on the hip joint. Post-traumatic lesions occur mostly in conjunction with severe bony injuries, especially fractures of the acetabulum and of the pelvic ring. Nearly always, it is the sacral portion of the plexus that is involved, either predominantly or exclusively. Seventeen of the 22 postoperative pareses followed complete hip-joint replacement. In the postoperative lesions the lumbar plexus portion is most frequently involved. Ninety-one percent of all of our cases were misdiagnosed in previous clinical examinations, that is, as a lesion of the femoral or sciatic nerve, or they were unrecognized because of lack of awareness of the possibility of plexus damage or because the signs were obscured by the associated bony injuries or hip-joint disease. In order to make an exact diagnosis, a detailed electromyographic investigation is necessary.

Adolescent↗