The Experts below are selected from a list of 294 Experts worldwide ranked by ideXlab platform
Darryl B. Sneag - One of the best experts on this subject based on the ideXlab platform.
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Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging
HSS Journal ®, 2020Co-Authors: Christian Geannette, Darryl B. SneagAbstract:Background Sacral insufficiency fracture (SIF) can cause Lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock pain that is exacerbated by physical activity and alleviated with rest. The frequency of LSRP secondary to SIF has not been reported. Questions/Purposes We aimed to determine the frequency of LSRP associated with SIF using magnetic resonance imaging (MRI) of the lumbar spine. Methods We searched a radiology database at our institution using the keywords “sacral insufficiency fracture” and “lumbar spine MRI” for patient records from January 2014 through December 2017. We assessed for the presence of LSRP, reflected by elevated T2-weighted or short tau inversion recovery (STIR) signal intensity and enlargement of the nerve on noncontrast lumbar spine MRI. An incompletely healed vertically oriented SIF was confirmed if there was a persistent bone marrow edema pattern adjacent to the fracture site; we did not include purely transverse SIFs. The final cohort comprised 57 patients (48 female; age range, 14 to 89 years). Results Abnormalities of the extraforaminal L5 nerve root or the combined L4 and L5 nerve roots (the Lumbosacral Trunk) were identified in 19 (33%) of 57 patients, with a total of 23 sites (bilateral involvement in four cases). Of the 23 abnormal nerves, 19 (82.6%) had corresponding, clinically documented radicular symptoms and 16 (69.6%) had no other explanation on MRI for their radicular symptoms other than SIF. Conclusions LSRP caused by SIF is an entity all radiologists should be cognizant of, especially in cases of otherwise unexplained radicular symptoms. The diagnosis of SIF can be helpful in cases involving concomitant multilevel lumbar spondylosis and neural foraminal stenosis.
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Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging
HSS Journal, 2020Co-Authors: Christian Geannette, Darryl B. SneagAbstract:Sacral insufficiency fracture (SIF) can cause Lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock pain that is exacerbated by physical activity and alleviated with rest. The frequency of LSRP secondary to SIF has not been reported. We aimed to determine the frequency of LSRP associated with SIF using magnetic resonance imaging (MRI) of the lumbar spine. We searched a radiology database at our institution using the keywords “sacral insufficiency fracture” and “lumbar spine MRI” for patient records from January 2014 through December 2017. We assessed for the presence of LSRP, reflected by elevated T2-weighted or short tau inversion recovery (STIR) signal intensity and enlargement of the nerve on noncontrast lumbar spine MRI. An incompletely healed vertically oriented SIF was confirmed if there was a persistent bone marrow edema pattern adjacent to the fracture site; we did not include purely transverse SIFs. The final cohort comprised 57 patients (48 female; age range, 14 to 89 years). Abnormalities of the extraforaminal L5 nerve root or the combined L4 and L5 nerve roots (the Lumbosacral Trunk) were identified in 19 (33%) of 57 patients, with a total of 23 sites (bilateral involvement in four cases). Of the 23 abnormal nerves, 19 (82.6%) had corresponding, clinically documented radicular symptoms and 16 (69.6%) had no other explanation on MRI for their radicular symptoms other than SIF. LSRP caused by SIF is an entity all radiologists should be cognizant of, especially in cases of otherwise unexplained radicular symptoms. The diagnosis of SIF can be helpful in cases involving concomitant multilevel lumbar spondylosis and neural foraminal stenosis.
Jérôme Rigaud - One of the best experts on this subject based on the ideXlab platform.
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Pelvic schwannoma: robotic laparoscopic resection.
Neurosurgery, 2020Co-Authors: Constance Deboudt, Jean-jacques Labat, Thibault Riant, Olivier Bouchot, Roger Robert, Jérôme RigaudAbstract:Schwannoma is a rare benign tumor of peripheral nerves arising from Schwann cells of the ubiquitous nerve sheath. To describe the operative steps and technical aspects of robotic laparoscopic resection of pelvic schwannoma. We describe 2 patients with pelvic schwannoma: a 34-year-old woman with schwannoma of the right Lumbosacral Trunk and a 58-year-old woman with schwannoma of a left S1 nerve. Pain was the main symptom in both patients. The diagnosis was confirmed by magnetic resonance imaging and nerve biopsies. Both patients were operated on by robotic laparoscopy. Lesions were totally enucleated after incising the epineurium. After dissection of the schwannoma, the vascular pedicle and nerve fascicles involved were identified, coagulated, and then sectioned. The remaining fascicles of the nerve were preserved. The postoperative course was uneventful in both patients. With follow-up of 9 and 13 months, both patients obtained complete pain relief with no neurological sequelae. Robotic laparoscopic resection of pelvic nerve tumors such as schwannomas is technically feasible.
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Pelvic Schwannoma: Robotic Laparoscopic Resection
Neurosurgery, 2012Co-Authors: Constance Deboudt, Jean-jacques Labat, Thibault Riant, Olivier Bouchot, Roger Robert, Jérôme RigaudAbstract:Abstract Background: Schwannoma is a rare benign tumor of peripheral nerves arising from Schwann cells of the ubiquitous nerve sheath. Objective: To describe the operative steps and technical aspects of robotic laparoscopic resection of pelvic schwannoma. Methods: We describe 2 patients with pelvic schwannoma: a 34-year-old woman with schwannoma of the right Lumbosacral Trunk and a 58-year-old woman with schwannoma of a left S1 nerve. Pain was the main symptom in both patients. The diagnosis was confirmed by magnetic resonance imaging and nerve biopsies. Both patients were operated on by robotic laparoscopy. Results: Lesions were totally enucleated after incising the epineurium. After dissection of the schwannoma, the vascular pedicle and nerve fascicles involved were identified, coagulated, and then sectioned. The remaining fascicles of the nerve were preserved. The postoperative course was uneventful in both patients. With follow-up of 9 and 13 months, both patients obtained complete pain relief with no neurological sequelae. Conclusion: Robotic laparoscopic resection of pelvic nerve tumors such as schwannomas is technically feasible.
R. Shane Tubbs - One of the best experts on this subject based on the ideXlab platform.
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Neurovascular Relationships of S2AI Screw Placement: Anatomic Study
World Neurosurgery, 2018Co-Authors: Amir Abdul-jabbar, Joe Iwanaga, Emre Yilmaz, Rod J. Oskouian, Tamir Tawfik, Thomas M O'lynnger, Thomas A. Schildhauer, Jens R. Chapman, R. Shane TubbsAbstract:Introduction The S2 alar-iliac (S2AI) screw is a modification of the traditional iliac fixation technique and has surgical and biomechanical benefits. However, there are significant regional neurovascular structures along the path of such screws. Therefore the current anatomic study was performed to better elucidate these relationships. Methods Using fluoroscopy, S2AI screws were placed in 2 adult cadavers through a standard posterior midline exposure. The screw insertion point was placed 10 mm lateral to a line bisecting the S1 and S2 foramina, adjacent to the sacroiliac joint. Using 30- to 40-degree lateral angulation from the midline and 20- to 30-degree caudal angulation, a pedicle probe was directed toward the anterior inferior iliac spine. The final trajectory was positioned to sit 1−2 cm superior to the greater sciatic foramen. Lastly, the screws and surrounding bone were drilled in order to visualize both lateral and medial neurovascular relationships. Results Removing the bone around the S2AI-screw illustrated the close relationship to the medial (internal) neurovascular structures including the obturator nerve, Lumbosacral Trunk, sacral plexus and, specifically, the S1 ventral ramus and iliac vein and artery. By removing the outer cortex of the ilium, the close relationship to the superior gluteal artery, vein, and nerve was observed. In addition, we were able to identify the proximity to the iliopsoas muscle and internal iliac vessels. Conclusions A comprehensive knowledge of the surrounding neurovascular anatomy relevant to S2AI screw placement can decrease patient morbidity and allow spine surgeons to better diagnose potential postoperative complications.
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Absence of the Lumbosacral Trunk
Cureus, 2017Co-Authors: Cameron Schmidt, Joe Iwanaga, Emre Yilmaz, Charlotte Wilson, Rod J. Oskouian, R. Shane TubbsAbstract:The Lumbosacral Trunk, typically comprised of part of the fourth lumbar ventral rami and the entirety of the fifth lumbar ventral rami, serves as a connection between the lumbar and sacral plexuses. Developmental differences underlie the variable relative contributions of L4 and L5 to the Lumbosacral Trunk. Herein, we report a rare case in which dissection of an adult male cadaver revealed no L4 contribution to the Lumbosacral plexus. We discuss the surgical and clinical implications of such an anatomic variation.
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Innervation of the Anterior Sacroiliac Joint
World Neurosurgery, 2017Co-Authors: Garrett Ng, Joe Iwanaga, Rod J. Oskouian, Faizullah Mashriqi, Fernando Alonso, Kevin Tubbs, Marios Loukas, R. Shane TubbsAbstract:Objective Sacroiliac joint pain can be disabling and recalcitrant to medical therapy. The innervation of this joint is poorly understood, especially its anterior aspect. Therefore, the present cadaveric study was performed to better elucidate this anatomy. Methods Twenty-four cadaveric sides underwent dissection of the anterior sacroiliac joint, with special attention given to any branches from regional nerves to this joint. Results No femoral, obturator, or Lumbosacral Trunk branches destined to the anterior sacroiliac joint were identified in the 24 sides. In 20 sides, one or two small branches (less than 0.5 mm in diameter) were found to arise from the L4 ventral ramus (10%), the L5 ventral ramus (80%), or simultaneously from both the L4 and L5 ventral rami (10%). The length of the branches ranged from 5 to 31 mm (mean, 14 mm). All these branches arose from the posterior part of the nerves and traveled to the anterior surface of the sacroiliac joint. No statistical significance was found between sides or sexes. Conclusions An improved knowledge of the innervation of the anterior sacroiliac joint might decrease suffering in patients with chronic sacroiliac joint pain.
Christian Geannette - One of the best experts on this subject based on the ideXlab platform.
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Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging
HSS Journal ®, 2020Co-Authors: Christian Geannette, Darryl B. SneagAbstract:Background Sacral insufficiency fracture (SIF) can cause Lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock pain that is exacerbated by physical activity and alleviated with rest. The frequency of LSRP secondary to SIF has not been reported. Questions/Purposes We aimed to determine the frequency of LSRP associated with SIF using magnetic resonance imaging (MRI) of the lumbar spine. Methods We searched a radiology database at our institution using the keywords “sacral insufficiency fracture” and “lumbar spine MRI” for patient records from January 2014 through December 2017. We assessed for the presence of LSRP, reflected by elevated T2-weighted or short tau inversion recovery (STIR) signal intensity and enlargement of the nerve on noncontrast lumbar spine MRI. An incompletely healed vertically oriented SIF was confirmed if there was a persistent bone marrow edema pattern adjacent to the fracture site; we did not include purely transverse SIFs. The final cohort comprised 57 patients (48 female; age range, 14 to 89 years). Results Abnormalities of the extraforaminal L5 nerve root or the combined L4 and L5 nerve roots (the Lumbosacral Trunk) were identified in 19 (33%) of 57 patients, with a total of 23 sites (bilateral involvement in four cases). Of the 23 abnormal nerves, 19 (82.6%) had corresponding, clinically documented radicular symptoms and 16 (69.6%) had no other explanation on MRI for their radicular symptoms other than SIF. Conclusions LSRP caused by SIF is an entity all radiologists should be cognizant of, especially in cases of otherwise unexplained radicular symptoms. The diagnosis of SIF can be helpful in cases involving concomitant multilevel lumbar spondylosis and neural foraminal stenosis.
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Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging
HSS Journal, 2020Co-Authors: Christian Geannette, Darryl B. SneagAbstract:Sacral insufficiency fracture (SIF) can cause Lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock pain that is exacerbated by physical activity and alleviated with rest. The frequency of LSRP secondary to SIF has not been reported. We aimed to determine the frequency of LSRP associated with SIF using magnetic resonance imaging (MRI) of the lumbar spine. We searched a radiology database at our institution using the keywords “sacral insufficiency fracture” and “lumbar spine MRI” for patient records from January 2014 through December 2017. We assessed for the presence of LSRP, reflected by elevated T2-weighted or short tau inversion recovery (STIR) signal intensity and enlargement of the nerve on noncontrast lumbar spine MRI. An incompletely healed vertically oriented SIF was confirmed if there was a persistent bone marrow edema pattern adjacent to the fracture site; we did not include purely transverse SIFs. The final cohort comprised 57 patients (48 female; age range, 14 to 89 years). Abnormalities of the extraforaminal L5 nerve root or the combined L4 and L5 nerve roots (the Lumbosacral Trunk) were identified in 19 (33%) of 57 patients, with a total of 23 sites (bilateral involvement in four cases). Of the 23 abnormal nerves, 19 (82.6%) had corresponding, clinically documented radicular symptoms and 16 (69.6%) had no other explanation on MRI for their radicular symptoms other than SIF. LSRP caused by SIF is an entity all radiologists should be cognizant of, especially in cases of otherwise unexplained radicular symptoms. The diagnosis of SIF can be helpful in cases involving concomitant multilevel lumbar spondylosis and neural foraminal stenosis.
Jean-jacques Labat - One of the best experts on this subject based on the ideXlab platform.
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Pelvic schwannoma: robotic laparoscopic resection.
Neurosurgery, 2020Co-Authors: Constance Deboudt, Jean-jacques Labat, Thibault Riant, Olivier Bouchot, Roger Robert, Jérôme RigaudAbstract:Schwannoma is a rare benign tumor of peripheral nerves arising from Schwann cells of the ubiquitous nerve sheath. To describe the operative steps and technical aspects of robotic laparoscopic resection of pelvic schwannoma. We describe 2 patients with pelvic schwannoma: a 34-year-old woman with schwannoma of the right Lumbosacral Trunk and a 58-year-old woman with schwannoma of a left S1 nerve. Pain was the main symptom in both patients. The diagnosis was confirmed by magnetic resonance imaging and nerve biopsies. Both patients were operated on by robotic laparoscopy. Lesions were totally enucleated after incising the epineurium. After dissection of the schwannoma, the vascular pedicle and nerve fascicles involved were identified, coagulated, and then sectioned. The remaining fascicles of the nerve were preserved. The postoperative course was uneventful in both patients. With follow-up of 9 and 13 months, both patients obtained complete pain relief with no neurological sequelae. Robotic laparoscopic resection of pelvic nerve tumors such as schwannomas is technically feasible.
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Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain.
Joint Bone Spine, 2020Co-Authors: Jean-marie Berthelot, Jean-jacques Labat, Benoît Le Goff, Gouin F, Yves MaugarsAbstract:Abstract Mapping studies of pain elicited by injections into the sacroiliac joints (SIJs) suggest that sacroiliac joint syndrome (SIJS) may manifest as low back pain, sciatica, or trochanteric pain. Neither patient-reported symptoms nor provocative SIJ maneuvers are sensitive or specific for SIJS when SIJ block is used as the diagnostic gold standard. This has led to increasing diagnostic use of SIJ block, a procedure in which an anesthetic is injected into the joint under arthrographic guidance. However, several arguments cast doubt on the validity of SIJ block as a diagnostic gold standard. Thus, the effects of two consecutive blocks are identical in only 60% of cases, and the anesthetic diffuses out of the joint in 61% of cases, often coming into contact with the sheaths of the adjacent nerve Trunks or roots, including the Lumbosacral Trunk (which may contribute to pain in the groin or thigh) and the L5 and S1 nerve roots. These data partly explain the limited specificity of SIJ block for the diagnosis of SIJS and the discordance between the pain elicited by the arthrography injection and the response to the block. The limitations of provocative maneuvers and SIJ blocks may stem in part from a contribution of extraarticular ligaments to the genesis of pain believed to originate within the SIJs. These ligaments include the expansion of the iliolumbar ligaments, the dorsal and ventral sacroiliac ligaments, the sacrospinous ligaments, and the sacrotuberous ligaments (sacroiliac joint lato-sensu). They play a role in locking or in allowing motion of the SIJs. Glucocorticoids may diffuse better than anesthetics within these ligaments. Furthermore, joint fusion may result in ligament unloading.
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Pelvic Schwannoma: Robotic Laparoscopic Resection
Neurosurgery, 2012Co-Authors: Constance Deboudt, Jean-jacques Labat, Thibault Riant, Olivier Bouchot, Roger Robert, Jérôme RigaudAbstract:Abstract Background: Schwannoma is a rare benign tumor of peripheral nerves arising from Schwann cells of the ubiquitous nerve sheath. Objective: To describe the operative steps and technical aspects of robotic laparoscopic resection of pelvic schwannoma. Methods: We describe 2 patients with pelvic schwannoma: a 34-year-old woman with schwannoma of the right Lumbosacral Trunk and a 58-year-old woman with schwannoma of a left S1 nerve. Pain was the main symptom in both patients. The diagnosis was confirmed by magnetic resonance imaging and nerve biopsies. Both patients were operated on by robotic laparoscopy. Results: Lesions were totally enucleated after incising the epineurium. After dissection of the schwannoma, the vascular pedicle and nerve fascicles involved were identified, coagulated, and then sectioned. The remaining fascicles of the nerve were preserved. The postoperative course was uneventful in both patients. With follow-up of 9 and 13 months, both patients obtained complete pain relief with no neurological sequelae. Conclusion: Robotic laparoscopic resection of pelvic nerve tumors such as schwannomas is technically feasible.
