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lumbar plexopathy

Michael R Riley, Adam T Doan, Richard W Vogel, Alexander O Aguirre, Kayla S Pieri, Edward H Scheid
BACKGROUND CONTEXT: Intraoperative neurophysiological monitoring (IONM) has gained rather widespread acceptance as a method to mitigate risk to the lumbar plexus during lateral lumbar interbody fusion (LLIF) surgery. The most common approach to IONM involves using only electromyography (EMG) monitoring, and the rate of postoperative deficit remains unacceptably high. Other test modalities, such as transcranial electric motor-evoked potentials (tcMEPs) and somatosensory-evoked potentials, may be more suitable for monitoring neural integrity, but they have not been widely adopted during LLIF...
April 3, 2018: Spine Journal: Official Journal of the North American Spine Society
Isabel Tulloch, Riaz Ali, Marios C Papadopoulos
We describe the unique case of a 51-year-old lady who developed a contralateral lumbosacral plexopathy two days after a lumbar microdiscectomy. This is the first report to date of this complication occurring following this procedure. We review the literature regarding lumbosacral plexopathy and discuss the evidence base behind investigating and managing this condition and the potential pathophysiological mechanisms which underlie its development. We draw comparisons with the more widely recognised post-operative brachial neuritis, characterised by delayed onset brachial plexopathy developing after cervical decompression, and propose an immune-mediated inflammatory mechanism linking the two conditions...
January 26, 2018: British Journal of Neurosurgery
Naomi A Abel, Jacob Januszewski, Andrew C Vivas, Juan S Uribe
Injury to the lumbosacral (LS) plexus is a well-described complication after lateral retroperitoneal transpsoas approaches to the spine. The prognosis for functional recovery after lumbosacral plexopathy or femoral/obturator neuropathy is unclear. We designed a retrospective case-control study with patients undergoing one-level lateral retroperitoneal transpsoas lumbar interbody fusion (LLIF) between January 2011 and June 2016 to correlate electrodiagnostic assessments (EDX) to physiologic concepts of nerve injury and reinnervation, and attempt to build a timeline for patient evaluation and recovery...
May 30, 2017: Neurosurgical Review
Julie Bykowski, Joseph M Aulino, Kevin L Berger, R Carter Cassidy, Asim F Choudhri, A Tuba Kendi, Claudia F E Kirsch, Michael D Luttrull, Aseem Sharma, Vilaas S Shetty, Khoi Than, Christopher J Winfree, Rebecca S Cornelius
MRI without and with contrast is the most accurate imaging method to determine whether a process is intrinsic or extrinsic to a nerve of the brachial or lumbosacral plexus. However, there are no Current Procedural Terminology codes to correspond to imaging studies of the brachial or lumbar plexus discretely. This assessment uses "MRI of the brachial plexus" or "MRI of the lumbosacral plexus" as independent entities given that imaging acquisition for the respective plexus differs in sequences and planes compared with those of a routine neck, chest, spine, or pelvic MRI, yet acknowledges the potential variability of ordering practices across institutions...
May 2017: Journal of the American College of Radiology: JACR
Atsushi Mizuma, Chikage Kijima, Eiichiro Nagata, Shunya Takizawa
Metastasis of breast cancer is often detected through a long-term course and difficult to diagnose. We report a case of brachial plexopathy suspected to be the initial lesion of breast cancer metastasis, which was only detected by magnetic resonance (MR) neurography. A 61-year-old woman was admitted to our hospital within 2 years after operation for breast cancer because of progressive dysesthesia and motor weakness initially in the upper limb on the affected side and subsequently on the contralateral side...
May 2016: Case Reports in Oncology
Erlick A C Pereira, Mohammad Farwana, Khai S Lam
Spinal stenosis and low-grade spondylolisthesis produce symptoms of neural compression that can be treated with extreme lateral lumbar interbody fusion (XLIF) via indirect decompression. This study aimed to investigate whether the restoration of disc dimensions would relieve symptoms of radiculopathy, claudication and back pain. In this retrospective study, patients undergoing XLIF surgery for relief of radicular symptoms or degenerative disc disease were included. Radiologically proven changes were used to assess the modes of degeneration...
January 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Bhavi Patel, Patrick Dolan, Getahun Kifle
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Simant Singh Thapa, Nirmal J Kaur, Susan V George
No abstract text is available yet for this article.
December 2016: American Journal of Medicine
Jin-Sung Kim, Won Suh Choi, Ji Hoon Sung
INTRODUCTION: Minimally invasive oblique lateral interbody fusion (OLIF) has steadily gained popularity as the fusion method of choice in patients with spondylolisthesis or foraminal stenosis. However, the complication rates reported in the literature vary greatly between authors. In this research, the authors report the clinical outcomes and perioperative complications of OLIF at L4-5. METHODS: The authors retrospectively reviewed prospectively acquired records of patients with L4-5 spondylolisthesis or foraminal stenosis who had undergone OLIF between 2013 and 2015...
August 2016: Neurosurgery
Nancy E Epstein
BACKGROUND: In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis. METHODS: Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0...
2016: Surgical Neurology International
Grégoire Boulouis, Eimad Shotar, Volodia Dangouloff-Ros, Pierre-Henri Janklevicz, Nathalie Boddaert, Olivier Naggara, Francis Brunelle
Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma...
January 2016: European Journal of Paediatric Neurology: EJPN
Se Yeong Jo, Soo Bin Im, Je Hoon Jeong, Jang Gyu Cha
Radiculopathy triggered by degenerative spinal disease is the most common cause of spinal surgery, and the number of affected elderly patients is increasing. Radiating pain that is extraspinal in origin may distract from the surgical decision on how to treat a neurological presentation in the lower extremities. A 54-year-old man with sciatica visited our outpatient clinic. He had undergone laminectomy and discectomy to treat spinal stenosis at another hospital, but his pain remained. Finally, he was diagnosed with a plexopathy caused by late recurrence of colorectal cancer, which compressed the lumbar plexus in the presacral area...
June 2015: Korean Journal of Spine
Edvard Ehler, Oldřich Vyšata, Radek Včelák, Ladislav Pazdera
Patients frequently suffer from lumbosacral plexus disorder. When conducting a neurological examination, it is essential to assess the extent of muscle paresis, sensory disorder distribution, pain occurrence, and blocked spine. An electromyography (EMG) can confirm axonal lesions and their severity and extent, root affliction (including dorsal branches), and disorders of motor and sensory fiber conduction. Imaging examination, particularly gadolinium magnetic resonance imaging (MRI) examination, ensues. Cerebrospinal fluid examination is of diagnostic importance with radiculopathy, neuroinfections, and for evidence of immunoglobulin synthesis...
May 2015: Medicine (Baltimore)
Kevin Koo, Lo Yl, Tan Sb
Postoperative radiculopathy has previously been reported as a common complication of transforaminal lumbar interbody fusion (TLIF). However, no data has been published on lumbar plexopathy following TLIF. We present a rare case of lumbar plexopathy occurring following TLIF (L5-S1) in a patient with spondylolisthesis. Although initially a diagnostic challenge, sinister causes of neuropathy such as bleeding or neoplastic growths were excluded by imaging. A diagnosis of acute lumbar plexopathy of left L2 to L4 was eventually made after electromyographic studies was performed in consultation with a senior neurologist...
2015: Acta Orthopaedica et Traumatologica Turcica
Andrea G Lantz, R John D'A Honey
Treatment of nephrolithiasis in horseshoe kidneys can be challenging due to anomalies in renal position, collecting system anatomy and vascular supply. We report on a patient who was referred after a failed percutaneous nephrolithotomy for a left moiety staghorn calculus in a horseshoe kidney. Two punctures had been performed involving upper and middle posterior calyces. Both were very medially placed and inadvertently traversed the psoas muscle, resulting in lumbar plexopathy with permanent deficit. This complication presented postoperatively with left leg weakness, paresthesia, and pain which impaired independent ambulation...
January 2015: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Amy Freeman
We report a case of a 64-year-old man presented to A&E with a 2-week to 4-month history of right hip pain, right leg weakness and fasciculations, extensive bruising and a vesicular skin rash. He had a CT of the chest/abdomen/pelvis, which revealed multiple extensive haematomas including an iliopsoas haematoma causing a lumbar plexopathy and resulting in the right hip and leg symptoms. He had clotting studies showing a prolonged activated partial thromboplastin time. Haematology review together with mixing studies suggested a diagnosis of acquired haemophilia A...
February 17, 2015: BMJ Case Reports
Stepan Capek, Benjamin M Howe, Jennifer A Tracy, Joaquín J García, Kimberly K Amrami, Robert J Spinner
Perineural tumor spread in prostate cancer is emerging as a mechanism to explain select cases of neurological dysfunction and as a cause of morbidity and tumor recurrence. Perineural spread has been shown to extend from the prostate bed to the lumbosacral plexus and then distally to the sciatic nerve or proximally to the sacral and lumbar nerves and even intradurally. The authors present a case of a bilateral neoplastic lumbosacral plexopathy that can be explained anatomically as an extension of the same process: from one lumbosacral plexus to the contralateral one utilizing the dural sac as a bridge between the opposite sacral nerve roots...
April 2015: Journal of Neurosurgery
Pedro Berjano, Oliver P Gautschi, Frédéric Schils, Enrico Tessitore
BACKGROUND: First introduced by Pimenta et al. in 2001, the extreme lateral interbody fusion (XLIF®) approach is a safe and effective alternative to anterior or posterior approaches to lumbar fusion, avoiding the large anterior vessels and posterior structures including the paraspinous muscles, facet joint complexes and tension bands. METHOD: The authors provide a detailed description of the surgically relevant anatomy focusing on the close relationship among the lumbar plexus, psoas muscle and lateral spinal column...
March 2015: Acta Neurochirurgica
Jason Boland, Adrienne Rennick
Malignant spinal cord compression (MSCC) is an oncological emergency requiring rapid diagnosis and treatment to prevent irreversible spinal cord injury and disability. A case is described in a 45-year-old male with renal cell carcinoma in which the presentation of the MSCC was atypical with principally proximal left leg weakness with no evidence of bone metastasis. This was due to an unusual aetiology of the MSCC as the renal carcinoma had metastasised to his left psoas muscle causing a lumbosacral plexopathy and infiltrated through the intervertebral disc spaces, initially causing left lateral cauda equina and upper lumbar cord compression, before complete spinal cord compression...
June 2013: BMJ Supportive & Palliative Care
Nens van Alfen, Martijn J A Malessy
To most doctors, brachial and lumbosacral plexopathies are known as difficult disorders, because of their complicated anatomy and relatively rare occurrence. Both the brachial, lumbar, and sacral plexuses are extensive PNS structures stretching from the neck to axillary region and running in the paraspinal lumbar and pelvic region, containing 100000-200000 axons with 12-15 major terminal branches supplying almost 50 muscles in each limb. The most difficult part in diagnosing a plexopathy is probably that it requires an adequate amount of clinical suspicion combined with a thorough anatomical knowledge of the PNS and a meticulous clinical examination...
2013: Handbook of Clinical Neurology
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