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At least 217 records · Page 12Linked to original sources
PubMed1992

[The problem of the sacrum fracture. Clinical analysis of 377 cases].

Sacral fractures are rare injuries that are often neglected because of the general severity of the patient's injuries. They are typical injuries in patients with polytraumata. A "hidden" injury, they are often diagnosed late or are even missed. In a well-documented consecutive series of 1,350 patients with pelvic fractures treated in the trauma department of the Hannover Medical School between 1972 and 1991, a total of 377 sacrum fractures were evaluated in a retrospective study. The cause of the accident, mechanism of injury, concomitant injuries, diagnostic procedures, classification of the pelvic injury (TILE), as well as the classification of the sacrum injury (DENIS), treatment and outcome were analyzed in all cases. Observed complications with special attention to injuries to the lumbosacral plexus were correlated with the classification of the sacrum and pelvis, as well as with a detailed analysis of the fracture pattern and fracture characteristics. In 89.4% at least one additional body region was injured in these patients. PTS (Hannover Polytrauma Score) groups III and IV included 42.5% of the patients. With an improved diagnostic protocol (radiological a.p. views, oblique views and CT scan), the observed rate of sacrum fractures was 33%. Neurological deficits occurred in 15.1% of the patients. In contrast to the literature, the rate of neurological deficits was related more to the degree of pelvic instability (TILE) than to the specific fracture pattern in the sacrum. In stable injuries (TILE A) neurological deficits were only seen in exceptions. In type B injuries the maximum rate was 10%, whereas in unstable fractures (TILE C) the rate of neurological deficits was 32.6% in transalar fractures (DENIS zone I), 42.9% in transforaminal fractures (DENIS zone II), and 63.6% in central fracture types (DENIS zone III). Additional risk indicators for neurological impairment are avulsion fractures of the sacrum, comminuted and bilateral fracture lines. The fracture classification should thus be modified. Our own experience with operative therapy for sacral fractures (open revision of the sacral plexus together with internal stabilization of the fracture) is still limited, but based on the experience presented, further development of the treatment protocol for sacrum fractures should be considered.

Adolescent↗
PubMed1990

Neurologic deficits associated with sacral wing fractures.

Twelve of 96 patients with pelvic fractures suffered neurologic deficits. Four secondary to acetabular fractures were excluded from the study. Of the remaining eight, five were found by CT scan to be secondary to fractures of the sacral wing extending through the sacral foramina. On the basis of this study, it is believed that the neurologic injuries were due to sacral root injuries rather than lumbosacral plexus injuries. This concept potentially could lead to surgical approaches for decompression of sacral root trauma.

Adolescent↗
PubMed2005

Nerve reconstruction in lumbosacral plexopathy. Case report and review of the literature.

Neurological injury to the lumbosacral plexus associated with pelvic and sacral fractures has traditionally been treated conservatively, despite significant and often debilitating functional deficits of the lower extremities. The authors report a case of reconstruction of the lumbosacral plexus, including nerve grafting to restore lower-extremity function caused by severe trauma to the pelvis. A 16-year-old boy sustained pelvic and sacral fractures in a motor vehicle accident. After stabilization of his orthopedic injuries, he suffered from paresis of his right gluteal and hamstring muscles and had no motor or sensory function below his knee. Two months later, he underwent reconstruction of his lumbosacral plexus performed using a nerve graft from his L-5 and S-1 nerve roots proximal to the inferior gluteal nerve and distal to a branch to the hamstring muscles. After another 2 months, his recovering saphenous nerve was transferred to the sensory component of the posterior tibial nerve by using cabled sural nerve grafts to restore sensation to the sole of his foot. After 2.5 years, he experienced reinnervation of his gluteal and hamstring muscles and could perceive vibration on the sole of his foot. With the assistance of a foot-drop splint, the patient ambulates well and is able to ski. Operative details and the relevant literature are reviewed.

Accidents, Traffic↗
PubMed1982

Pudendal evoked responses.

The dorsal nerve of the penis or clitoris, a branch of the pudendal nerve, was stimulated while averaged evoked responses over the spinal cord, sensory cortex, and bulbocavernosus muscle were recorded in a series of normal subjects. The morphologic features, peak latencies, and peripheral and central conduction times were compared with spinal and cortical evoked responses from the posterior tibial nerve. These tests are of potential clinical importance in the evaluation of sacral nerve root or plexus injuries and bowel, bladder, or sexual dysfunction.

Adult↗
PubMed1994

Nerve-sparing surgery in 302 resectable rectosigmoid cancer patients: genitourinary morbidity and 10-year survival.

PURPOSE: The aim of this study was to evaluate 5-year and 10-year disease-free survival, urinary dysfunction, and sexual activity after nerve-sparing radical surgery, including lumboaortic lymphadenectomy for rectosigmoid cancer. METHODS: Since 1980 to 1992, 302 consecutive patients affected with rectal (188) or sigmoid (114) resectable cancer underwent radical surgery. Lumboaortic lymphadenectomy was routinely performed and total mesorectal dissection was always accomplished in rectal cancer. Splanchnic nerves, superior hypogastric plexus, hypogastric nerves, and sacral parasympathetic nerves were sought, identified, and preserved or, when necessary, unilaterally sacrificed. Fifty-three (17.6 percent) patients were classified Dukes A, 145 (48.0 percent) B, 46 (15.2 percent) C1, and 17 (5.6 percent) C2. Thirty-nine (12.9 percent) patients were Dukes D. In 85 rectal cancer patients, tumor was located at the lower third. Eighty-six of 210 Dukes B and C patients were submitted to systemic chemotherapy and/or high-dose pelvic radiotherapy. RESULTS: The actuarial 5-year disease-free survival was 58.5 percent in rectal and 65.7 percent in sigmoid cancer patients, median follow-up time was 47 months. During the follow-up, each patient was interviewed about sexual activity and urinary dysfunction and a questionnaire was filled out. Urinary dysfunction was not frequently observed, while a definitive sexual impotence was reported in 27.6 percent of the patients. The age under 60 years and sphincter-saving surgery were demonstrated as significantly contributing to retaining a satisfactory sexual activity. CONCLUSIONS: Unexpectedly high disease-free survival was observed in the Dukes C2 subgroup. It allows us to hypothesize that lumboaortic lymphadenectomy could remove neoplastic microfoci present at this level in those patients, enhancing surgical chances of cure. The majority of male patients under 60 years old can retain a satisfactory sexual activity after undergoing a nerve-sparing sphincter-saving cancer surgery.

Adult↗
PubMed1988

Lumbosacral plexus lesions: correlation of clinical signs and computed tomography.

Neurological signs and computed tomographic morphology were compared in 60 patients. The primary neurological deficit was most commonly located in the sacral (n = 31) or lumbar plexus (n = 23) and was most commonly caused by a neoplasm (n = 40). In 78% of the patients it correlated with the lesions detected by computed tomography (CT). CT reliably demonstrates extraspinal mass lesions, but only moderately well predicts functional signs.

Fecal Incontinence↗
PubMed2000

[Anatomical basis of autonomic nerve-preserving radical resection for rectal cancer].

OBJECTIVE: To clarify anatomical basis of autonomic nerve-preserving radical resection for rectal cancer. METHOD: Of 10 cadavers, 4 were male and 2 female. Four had hemisected pelvis in the mid-sagittal plane without damaging the retrorectal anatomy. All stages of each dissection were recorded photographically. RESULTS: Hypogastric nerves were identified. The superior hypogastric plexus is the direct extension of the aortic plexus below the aortic bifurcation. It lies immediately behind the peritoneum and descends over the anterior surface of the 5th lumbar vertebra in the retroperitoneal tissue. The superior hypogastric plexus ends by bifurcating into the right and left hypogastric nerves. The two hypogastric nerves diverge from each other at about the level of the sacral promontory and run down and forward along the walls of the pelvis in the lamina of the pelvic fascia closest to the peritoneum. Both of them are strong fibres with white-grey and reticular appearance and well located just below and close to the aortic bifurcation. And after bifurcation each of them also gives rise to several branches. But it is difficult to identify the pelvic splanchnic nerves in complete samples. In mid-sagitted samples they take origin from the second to fourth sacral ventral rami just after the sacral nerves have emerged from the pelvic sacral foramina. They always form plexus at the lateral ligament and are crossed by middle rectal artery. CONCLUSIONS: It is not very difficult to preserve the hypogastric nerves to spare functions in resection for rectal cancer to the anatomical knowledge of the pelvic autonomic nerves. When the pelvic splanchnic nerves are to be preserved, dissection must be cautious at the level of the lateral ligment on the side of nerve-preservation. The operation should be performed near the rectum as close as possible to achieve functional preservation.

Autonomic Pathways↗
PubMed2006

Vagal neural crest contribution to the chick embryo cloaca.

Intrinsic innervation of the developing chick cloaca is provided by the enteric nervous system, a network of neurons and glia that lies within its walls. The enteric nervous system originates from neural crest cells that migrate from the vagal and sacral regions of the neural tube during the early stages of development. Abnormal cloacal development can cause a number of anorectal anomalies including persistent cloaca. Our study aimed to investigate the contribution of vagal neural crest cells to the total population of enteric neurons and glia within the chick embryo cloaca, using quail-chick chimeras. Chicken embryos were incubated until the 10-12 somite stage (ss). The vagal neural tube, corresponding to somites 1-7, was then microsurgically ablated in ovo and isochronic and isotopic quail grafts were performed. The eggs were then reincubated until embryos were harvested at E12. Whole embryos were fixed in Bouin's fluid, embedded in paraffin wax and sectioned. Immunohistochemistry was carried out using the HNK-1 antibody to label all neural crest cells, and the quail-specific antibody, QCPN, to label quail cells. QCPN-immunoreactive cells were seen to make up a large proportion of enteric neurons and glia within the walls of the embryonic cloaca. HNK-1 labelled all neural crest cells in the myenteric and submucosal plexuses as well as the sacral crest-derived nerve of Remak, while QCPN-positive cells were evident in both plexuses but mostly in the submucosal plexus, where they appeared to make up the majority of neurons. Results show that the chick embryo cloaca is primarily innervated by vagal neural crest cells. Further studies to investigate the contribution of sacral neural crest cells to the same region will give further insight into the development of the enteric nervous system within the embryonic cloaca.

Animals↗
PubMed1999

Complications during anterior surgery of the lumbar spine: an anatomically based study and review.

Procedures involving anterior surgical decompression and fusion are being performed with increasing frequency for the treatment of a variety of pathological processes of the spine including trauma, deformity, infection, degenerative disease, failed-back syndrome, discogenic pain, metastases, and primary spinal neoplasms. Because these operations involve anatomy that is often unfamiliar to many neurological and orthopedic surgeons, a significant proportion of the associated complications are not related to the actual decompressive or fusion procedure but instead to the actual exposure itself. To understand the nature of these injuries, a detailed anatomical study and dissection was undertaken in six cadaveric specimens. Critical structures at risk in the abdomen and retroperitoneum were identified, and their anatomical relationships were categorized and photographed. These structures included the psoas muscle, kidneys, ureters, diaphragm and crura, esophageal hiatus, thoracic duct, greater splanchnic nerves, phrenic nerves, sympathetic chains, medial arcuate ligament, superior and inferior hypogastric plexus, segmental and radicular vertebral vessels, aorta, vena cava, median sacral artery, common iliac vessels, iliolumbar veins, lumbosacral plexus, and presacral hypogastric plexus. Based on these dissections and an extensive review of the literature, the authors provide a detailed anatomically based discussion of the complications associated with anterior lumbar surgery.

Journal Article↗
PubMed1999

The posterior sacral foramina: an anatomical study.

The vascular and nervous structures and their relations with the spinal nerve roots were examined in the 2nd, 3rd and 4th posterior sacral foramina in relation to percutaneous needle insertion for neuromodulation. A foraminal branch provided by the lateral sacral artery to each foramen entered the inferior lateral quadrant of each foramen, adjacent to the nerve root medially. Facing the posterior sacral aperture and around the sacral nerves, there was no venous plexus. A venous plexus was sometimes present near the median line, and always around the proximal part of the spinal ganglion. The sacral nerve roots, especially the 3rd, had a long extradural course in the foramen, presenting a potential risk of nerve lesions during procedures involving needle insertion.

Aged↗
PubMed1983

[Neural apparatus of the wall of the ductus deferens in the dog].

While studying the innervation sources of the deferent duct in 10 dogs, 2-3 nerves have been revealed that take their origin at the pelvic neural plexus and approach the duct together with the blood vessels at the pelvic neural plexus and approach the duct together with the blood vessels at the place where it crosses the ureter ("the vascular-neural hilus"). In the experiment performed in 65 dogs the nature of these sources has been revealed. The motor innervation is presented by the nodes of the celiac plexus, of the lumbar and sacral parts of the sympathetic trunk, of the subceliac, gonadal and splanchic pelvic nerves, and the sensitive innervation is multisegmental and is performed by the intravertebral nodes L2-S3. Quantitative investigation of the degenerated neural fibers in the dog deferent duct wall demonstrates that the innervation sources mentioned above participate te a various degree along the course of the organ. In the "hilus" the nerves of the dog deferent duct are divided into the proximal nad distal groups. The proximal group runs towards the prostate and forms a plexus with large loops connected with the neural plexuses of the urinary bladder, the ureter and the prostate. It has small neural nodes. The distally directed nerves run, together with the blood vessels, in the deferent duct towards the epididymis. In the deferent duct wall, adventitila, muscular and mucous neural plexus are found, the cholinergic component prevailing the adrenergic one. The plexuses are somewhat better developed at the beginning of the deferent duct and they are especially pronounced in the ampule. The receptors of the organ's wall are simple, poorly branching.

Adrenergic Fibers↗
PubMed2006

Dual origin of avian lymphatics.

The earliest signs of the lymphatic vascular system are the lymph sacs, which develop adjacent to specific embryonic veins. It has been suggested that sprouts from the lymph sacs form the complete lymphatic vascular system. We have studied the origin of the jugular lymph sacs (JLS), the dermal lymphatics and the lymph hearts of avian embryos. In day 6.5 embryos, the JLS is an endothelial-lined sinusoidal structure. The lymphatic endothelial cells (LECs) stain (in the quail) positive for QH1 antibody and soybean agglutinin. As early as day 4, the anlagen of the JLS can be recognized by their Prox1 expression. Prox1 is found in the jugular section of the cardinal veins, and in scattered cells located in the dermatomes along the cranio-caudal axis and in the splanchnopleura. In the quail, such cells are positive for Prox1 and QH1. In the jugular region, the veins co-express the angiopoietin receptor Tie2. Quail-chick-chimera studies show that the peripheral parts of the JLS form by integration of cells from the paraxial mesoderm. Intra-venous application of DiI-conjugated acetylated low-density lipoprotein into day 4 embryos suggests a venous origin of the deep parts of the JLS. Superficial lymphatics are directly derived from the dermatomes, as shown by dermatome grafting. The lymph hearts in the lumbo-sacral region develop from a plexus of Prox1-positive lymphatic capillaries. Both LECs and muscle cells of the lymph hearts are of somitic origin. In sum, avian lymphatics are of dual origin. The deep parts of the lymph sacs are derived from adjacent veins, the superficial parts of the JLS and the dermal lymphatics from local lymphangioblasts.

Animals↗
PubMed1991

[Achieving urinary continence].

Development of urinary continence, which is necessary for species survival and comfort of human being, begins with the organization of vesico-sphincteric automatism, as part of nervous system growth. Micturitional reflex are successively integrated inside the ganglionic plexuses in the foetus, the sacral spinal cord in the newborn and the pontine center in the child. Voluntary control of this automatism needs, at first, feeling an sensitive information about the bladder fullness, that is to say a "desire of urinate". Child first controls his striated sphincter, what makes him able to avoid urine leakage and enlarges his bladder capacity. Latter, he can initiate or refuse, voluntarily, bladder contraction, doing his bladder the most intelligent organ and, consequently, the most psychologically vulnerable one. Timing of these different steps is variable; in addition to the natural maturity processes which progress more or less quickly, training adds it effects, more useful for developing continence during daytime than during night-time.

Adolescent↗
PubMed2004

Anatomy of the presacral venous plexus: implications for rectal surgery.

The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to the sacral promontory as in rectal prolapse surgery exposes the patient to the risk of injury to the presacral venous plexus. The aim of this study was to identify some avascular areas in the anterior aspect of the sacrum in order to lower the occurrence of such injuries during rectal surgery. The pelvis of 10 fresh cadavers was dissected after injection of a colored resin into the inferior vena cava, and the presacral venous plexus was studied. Four avascular tetragonal areas were common to all the specimens. The corners of a square with a side of 3 cm, centered on the anterior aspect of the body of sacrum, were always contained in the avascular areas. The upper side of this square was parallel to a line passing through the sacral promontory, at a 3 cm distance from it. Staples or sutures should be placed in the avascular areas to avoid injuries to the presacral venous plexus.

Cadaver↗