Coccygodynia caused by perineural cyst.
A case of typical coccygodynia caused by a sacral nerve cyst is reported. Relief of the pain by excision of the cyst occurred.
Coccyx↗
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Results for “SACRAL PLEXUS”
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[Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in four patients with severe heart failure].
We experienced four cases of anesthesia for hip fracture reduction in patients with severe heart failure, where anesthesia was attempted with combined paravertebral lumbar plexus and parasacral sciatic nerve block instead of spinal anesthesia. The anesthesia was successful without any sequelae. The patients' characteristics are as follows. Case 1: 97-year-old woman with severe heart failure and old myocardial infarction. Case 2: 91-year-old man with pacemaker, heart failure and heart valve disease. Case 3: 93-year-old woman with severe heart failure and multi-vessel coronary artery stenosis. Case 4: 83-year-old woman with congestive heart failure and heart valve disease. Paravertebral lumbar plexus block was performed with Touhy needle which was directed to lumbar transverse process, then re-directed caudally. Psoas compartment was felt with loss of resistance. Twelve ml of 0.25% bupivacaine was injected. Sciatic nerve block was performed with a needle which was inserted at the midpoint between the greater trochanter and the sacral hiatus without (case 1, 2) or with nerve stimulator (case 3, 4). Eight ml of 0.25% bupivacaine was injected. During the anesthesia, propofol was injected for light sedation. Although this combined nerve block is difficult to perform compared with spinal anesthesia, this could be applicable for hip fracture reduction anesthesia, especially in patients with severe heart failure.
Aged↗
Lumbosacral plexopathy in pelvic trauma.
We reviewed the electrophysiologic data and the etiology of lumbosacral plexopathy in 22 consecutive patients with pelvic trauma referred for electromyography (EMG). Most (68%) patients had sacral fractures or sacroiliac joint separation, 14% had acetabular fractures, and 9% had femoral fractures. Lumbosacral plexopathy was significantly more common (P = 0.0026) among patients with sacral fractures (incidence of 2.03%) than among the entire population of patients with pelvic and acetabular fractures (overall incidence 0. 7%). Patients with acetabular and femoral fractures may have suffered injury to multiple proximal nerves originating from the plexus rather than injury to the plexus, as confirmed by magnetic resonance imaging (MRI) neurogram in select cases.
Action Potentials↗
Calcitonin gene-related peptide (CGRP) in the human spinal cord: a light and electron microscopic analysis.
The distribution of CGRP immunoreactivity in the cervical, thoracic, lumbar, and sacral levels of the human spinal cord was mapped at the light microscopic level with the aid of a rabbit-generated antiserum against human calcitonin gene-related peptide (CGRP). CGRP-positive fibers formed a dense plexus in lamina I, II, the reticulated region of lamina V, and the tract of Lissauer at all spinal cord levels. The distribution of fibers showed some variations dependent on the cord level analyzed. At the light microscopic level, intervaricose fiber diameters consistently measured 1.0 micron or less, and two types of CGRP varicosities were observed: a small (1 to 2 microns in diameter), relatively round profile and a larger, (3 to 4 microns in diameter) oval or oblong profile. At the electron microscopic level, immunostained varicosities contained a mixture of round clear vesicles and vesicles that contained dense cores. The CGRP immunoreaction product was often associated with vesicles containing dense cores. The reaction product was also seen associated with clear round vesicles or in the cytoplasmic matrix. Postsynaptic elements included dendritic spines, small and large diameter dendritic shafts and vesicle containing profiles. The presence of CGRP in the superficial dorsal horn of human spinal cord is highly suggestive of a role in primary afferent transmission as postulated in lower vertebrates. This study establishes the distribution of CGRP at four different spinal levels in human cord and will serve as a basis for future studies related to the pathologic conditions affecting sensory systems.
Adult↗
Hoxb3 vagal neural crest-specific enhancer element for controlling enteric nervous system development.
The neural and glial cells of the intrinsic ganglia of the enteric nervous system (ENS) are derived from the hindbrain neural crest at the vagal level. The Hoxb3 gene is expressed in the vagal neural crest and in the enteric ganglia of the developing gut during embryogenesis. We have identified a cis-acting enhancer element b3IIIa in the Hoxb3 gene locus. In this study, by transgenic mice analysis, we examined the tissue specificity of the b3IIIa enhancer element using the lacZ reporter gene, with emphasis on the vagal neural crest cells and their derivatives in the developing gut. We found that the b3IIIa-lacZ transgene marks only the vagal region and not the trunk or sacral region. Using cellular markers, we showed that the b3IIIa-lacZ transgene was expressed in a subset of enteric neuroblasts during early development of the gut, and the expression was maintained in differentiated neurons of the myenteric plexus at later stages. The specificity of the b3IIIa enhancer in directing gene expression in the developing ENS was further supported by genetic analysis using the Dom mutant, a spontaneous mouse model of Hirschsprung's disease characterized by the absence of enteric ganglia in the distal gut. The colonization of lacZ-expressing cells in the large intestine was incomplete in all the Dom/b3IIIa-lacZ hybrid mutants we examined. To our knowledge, this is the only vagal neural crest-specific genetic regulatory element identified to date. This element could be used for a variety of genetic manipulations and in establishing transgenic mouse models for studying the development of the ENS.
Animals↗
[Routes of blood flow away from human spinal ganglia].
Blood outflow from the spinal ganglia is accomplished along the deferent veins of the lateral part of the ganglia into the intravertebral veins (for most of cervical ganglia--into the veins surrounding the spinal cord artery), from the medial part of the ganglia--along the deferent veins into the longitudinal veins of the interal spinal plexus. Analysing total cross section area of the deferent veins of the spinal ganglia, we were able to reveal a gradual increases in cross section area from the cervical towards the lumbar veins, and a decrease towards the sacral veins. A ratio of total cross section area of the deferent veins to the volume unit of the ganglia substance characterizes capacitance density of the deferent venous bed of the spinal ganglia and is 0.01--0.014 mm2 per 1 mm3.
Adult↗
Urinary bladder response to hypogastric nerve stimulation after bilateral resection of the pelvic nerve or spinal cord injury in rats.
BACKGROUND: We examined the mechanism of urinary bladder motility return after bladder areflexia induced by interruption of the sacral parasympathetic outflow to the urinary bladder following damage to the sacral cord or pelvic nerves in the rat. METHODS: The L6 and S1 nerve bundles were resected near the vertebrae, and bilateral pelvic nerve resections (PNR) performed. Spinal cord injury (SCI) was performed by means of a legion generator at the T12 vertebra. Thirty days after PNR and SCI, cystometrograms were recorded under anesthesia. RESULTS: In all rats subjected to PNR or SCI, overflow incontinence continued, yet some rats subjected to SCI recovered within 2 weeks after the operation. Cystometrograms showed that repetitive bladder contractions appeared in rats subjected to SCI irrespective of hypogastric nerve (HGN) innervation, while bladder contractions did not appear in rats subjected to PNR. Electrical stimulation of the HGN induced higher bladder pressure elevation in rats who underwent PNR than in rats subjected to SCI. CONCLUSIONS: These results suggest that the generation of repetitive bladder contractions induced by bladder distention after bladder areflexia requires the presence of intact pelvic nerves that transmit sacral cord-originating excitatory information to the bladder. However, the HGN system and functioning pelvic nerve ganglia are not involved in this process. Also, the connection from the preganglionic HGN to the postganglionic parasympathetic nerves in the pelvic plexus did not form after PNR.
Animals↗
Urethral responses to sacral stimulation in chronic spinal dog.
Urethral activity was investigated in the awake chronic spinal-injured canine using urodynamic recordings, video cystofluoroscopy, and urethral pressure recordings without anesthesia. Bladder contractions and voiding were induced by electrical stimulation with epidural electrodes inserted into the sacral canal. Urethral pressure remained elevated during stimulation and for 1-3 s afterward. Poststimulation voiding occurred with three different patterns: 1) pulsatile voiding in which squirting of urine was associated with contractions in the membranous urethra; 2) "on and off" voiding in which pulsatile flow was interrupted for brief periods of time; and 3) steady-stream voiding in which nonpulsatile flow was followed by pulsatile flow. Viewing these voiding patterns with fluoroscopy indicated that the proximal membranous urethra was important in all of the patterns. We conclude that in the chronic spinal-injured canine the skeletal muscle within the membranous urethra (rhabdosphincter) is involved in responses to sacral stimulation and various voiding patterns.
Animals↗
Urodynamic analysis of differential sacral nerve blocks and sacral neurectomy.
Urodynamic analysis in 17 patients after long-acting anaesthetic root blocks of S2-S4 has shown that it is possible to increase bladder capacity and reduce uninhibited contractions without significant adverse effects on sphincter function. Satisfactory voiding dynamics are observed after blocks. This has provided a physiological rationale for selective sacral neurectomy in eight patients. Initial improvement after operation has been noted in seven cases.
Anesthesia, Conduction↗
[Anal sphincter electromyography, bulbocavernosus reflex and pudendal somatosensory evoked potentials in diagnosis of neurogenic lumbosacral lesions with disorders of bladder and large intestine emptying and erectile dysfunction].
The diagnostic value of anal sphincter electromyography (EMG), electrical bulbocavernosus reflex (BCR) and pudendal somatosensory evoked potentials (SEP) was studied in 16 male patients with disturbances of bladder function or defecation or with erectile dysfunction (ED) of at least several weeks' duration. All 16 patients had proven neurogenic disorders in the lumbosacral region. Eleven presented with bladder dysfunction, four with defecation problems, and nine with ED (some had more than one symptom). Fifteen patients had a pathological sphincter EMG, 14 patients a pathological BCR, and six patients a pathological pudendal SEP. Thus, the sphincter EMG was the most sensitive technique in the diagnosis of chronic pudendal lesions. However, pure afferent lesions cannot be detected by the sphincter EMG. In this case, the BCR, using unilateral stimulation of the dorsal nerves of the penis, provides the opportunity to distinguish between afferent and efferent lesions of the sacral reflex arc.
Adult↗
Sacral nerve stimulation in patients with chronic, intractable pelvic pain.
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Electric Stimulation Therapy↗
Outcome of operatively treated type-C injuries of the pelvic ring.
BACKGROUND: Internal fixation has become the preferred treatment for type-C pelvic ring injuries, but controversies persist regarding surgical approach and surgical technique. PATIENTS: We evaluated 101 consecutive patients with type C1-C3 pelvic ring injuries who had been treated with standardized reduction and internal fixation techniques. RESULTS: Our findings suggest a correlation between excellent reduction followed by sufficient fixation of the pelvic ring and functional outcome. Unsatisfactory reduction (displacement > 5 mm), failure of fixation, loss of reduction and a permanent lumbosacral plexus injury were the commonest reasons for an unsatisfactory functional result. All 40 patients with an associated lumbosacral plexus injury showed at least some evidence of neurological recovery. 14 underwent complete neurologic recovery. 8 had only sensory deficits and the remaining 18 also had motor deficits at the final followup. Complications were rare, but some of them were severe: loss of reduction in 8%, malunion in 10%, deep wound infection in 2%, and a lesion of the L5 nerve root in 1%. INTERPRETATION: Our results suggest that special attention should be paid to preoperative planning, reduction of the fracture, decompression of the nerve roots, and fixation of the most severe sacral fractures. Our results seem to favor internal fixation of displaced (> 10 mm) and unstable rami fractures and symphyseal disruptions in conjunction with posterior fixation, to achieve better stability of the whole pelvic ring.
Adolescent↗
Nerve root infiltration of the first sacral root with MRI guidance.
The purpose of this clinical trial was to describe the methodology and evaluate the accuracy of optical tracking-based magnetic resonance (MR)-guided infiltration of the first sacral (S1) root. Thirty-five infiltrations were performed on 34 patients with a 0. 23-T open C-arm magnet installed in a fully equipped operation room with large-screen (36 inches) display and optical navigator utilizing infrared passive tracking. T1 and T2 fast spin-echo (FSE) images were used for localizing the target and fast field echo for monitoring the procedure. Saline as contrast agent in single-shot (SS)FSE images gave sufficient contrast-to-noise ratio. Twenty-four patients had unoperated L5/S1 disc herniation, and 10 had S1 root irritation after failed back surgery. Needle placement was successful in 97% of the cases, and no complications occurred. Outcome was evaluated 1-6 months (mean 2.2 months) after the procedure and was comparable to that of other studies using fluoroscopy or computed tomography guidance. MR-guided placement of the needle is an accurate technique for first sacral root infiltration.
Bupivacaine↗
Effect of sacral nerve stimulation in patients with fecal and urinary incontinence.
PURPOSE: Preliminary studies have shown improvement in fecal incontinence in several patients who received temporary or permanent stimulation. The purpose of this study was to report our experience in sacral nerve stimulation in the treatment of fecal incontinence and to target patients who would benefit most from stimulation. METHODS: Patients with fecal incontinence were studied clinically and manometrically before, during, and after temporary nerve stimulation. If temporary nerve stimulation was clinically successful, the patient was implanted and followed up for six months. RESULTS: Nine patients (6 female) with a mean age of 50.7 +/- 12.3 years underwent temporary nerve stimulation. Temporary nerve stimulation was successful in eight patients, six of whom were implanted. Of the patients who could be evaluated, three of five had improved at the six-month follow-up visit, particularly in relation to the number of urgency episodes and delay in postponing defecation. All implanted patients had urinary symptoms. Urinary urgency was also improved by stimulation. During temporary nerve stimulation, the maximal squeeze pressure amplitude increased. After implantation, only the duration of maximal squeeze pressure seemed to improve. CONCLUSION: Sacral nerve stimulation can be used in the management of fecal incontinence, particularly in cases of urge fecal incontinence associated with urinary urgency. This study seems to confirm the effect of sacral nerve stimulation on striated sphincter function.
Adult↗
Sacral neuromodulation and lower urinary tract dysfunction in cerebral palsy.
Given the emerging role of sacral neuromodulation in treatment of neurogenic voiding dysfunction, the author describes the use of sacral neuromodulation in a patient with voiding dysfunction caused by cerebral palsy (CP). A 45-year-old patient with cerebral palsy presented with progressive complaints of urgency and overflow incontinence and was found to be in retention. She underwent sacral neuromodulation and had complete resolution of her symptoms. The literature of lower urinary tract dysfunction in CP is reviewed. It is concluded that sacral neuromodulation may be a valuable tool in treating storage and voiding disorders associated with CP.
Cerebral Palsy↗
Contraction of urinary bladder by central norepinephrine originating in the locus coeruleus.
Studies were performed to elucidate the role of the locus coeruleus, which is rich in norepinephrine-containing cell bodies, in vesical function using alpha-chloralose anesthetized cats. Stimulation of the locus coeruleus caused contraction of the urinary bladder, which was not affected by transection of the bilateral hypogastric nerves, but blocked by intravenous administration of hexamethonium, a ganglion blocking agent. In animals with transected hypogastric nerves, the locus coeruleus-induced contraction was inhibited by intrathecal administration of phentolamine (alpha-blocker) and prazosin (alpha 1-blocker), but not affected by intrathecal sotalol (beta-blocker) or yohimbine (alpha 2-blocker). In animals treated with reserpine, the locus coeruleus-induced contraction was enhanced by intravenous application of L-dopa, a precursor of norepinephrine. These results suggest that norepinephrine derived from the locus coeruleus activated preganglionic neurons in the sacral intermediolateral nuclei via alpha 1-receptors, thereby producing urinary bladder contraction.
Animals↗
Urodynamic findings and clinical status following vesical denervation procedures for control of incontinence.
We compared the results of intrathecal chemical rhizotomy performed in 3 patients, complete sacral rhizotomy in 3 and dorsal root ganglionectomy in 3. Dorsal root ganglionectomy (S2 to S4) obviated reflex bladder contractility and autonomic dysreflexia, and did not induce detrusor hypertonia. Chemical rhizotomy failed to abolish reflex activity or autonomic dysreflexia and was unsatisfactory. Complete intradural sacral rhizotomy obviated reflex activity and autonomic dysreflexia but induced detrusor hypertonicity and incontinence.
Adult↗
Bladder and urethral responses to sympathetic stimulation.
Bladder and urethral pressure responses were recorded in 47 cats subjected to electrical stimulation of sympathetic fibers isolated at the caudal mesenteric ganglion before and after complete sacral denervation. Recorded responses were complex and seemed to be at least partially dependent on afferent and efferent pelvic nerve activity. Sacral denervation alone did not influence urethral closing pressure but the combination of sacral and hypogastric denervation resulted in a marked loss of urethral sphincter function.
Animals↗