The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
David L. Helfet - One of the best experts on this subject based on the ideXlab platform.
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Sciatic Nerve Injury Associated with Acetabular Fractures
HSS Journal, 2009Co-Authors: Paul S. Issack, David L. HelfetAbstract:Sciatic Nerve injuries associated with acetabular fractures may be a result of the initial trauma or injury at the time of surgical reconstruction. Patients may present with a broad range of symptoms ranging from radiculopathy to foot drop. There are several posttraumatic, perioperative, and postoperative causes for Sciatic Nerve palsy including fracture–dislocation of the hip joint, excessive tension or inappropriate placement of retractors, instrument- or implant-related complications, heterotopic ossification, hematoma, and scarring. Natural history studies suggest that Nerve recovery depends on several factors. Prevention requires attention to intraoperative limb positioning, retractor placement, and instrumentation. Somatosensory evoked potentials and spontaneous electromyography may help minimize iatrogenic Nerve injury. Heterotopic ossification prophylaxis can help reduce delayed Sciatic Nerve entrapment. Reports on Sciatic Nerve decompression are not uniformly consistent but appear to have better outcomes for sensory than motor neuropathy.
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Sciatic Nerve release following fracture or reconstructive surgery of the acetabulum
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Paul S. Issack, Jennifer Kreshak, Craig E Klinger, Jose B Toro, Robert L Buly, David L. HelfetAbstract:BACKGROUND: Sciatic neuropathy associated with acetabular fractures can result in disabling long-term symptoms. The purpose of this retrospective study was to evaluate the effect of Sciatic Nerve release on Sciatic neuropathy associated with acetabular fractures and reconstructive acetabular surgery. METHODS: Between 2000 and 2004, ten patients with Sciatic neuropathy associated with an acetabular fracture were treated with release of the Sciatic Nerve from scar tissue and heterotopic bone. Additional surgical procedures included open reduction and internal fixation of the acetabulum (five patients), removal of hardware and total hip arthroplasty (three patients), and removal of hardware alone (one patient). The average age of the patients was forty-three years. All patients were followed with serial examinations and assessments for a minimum of one year (average, twenty-six months). RESULTS: All patients had partial to complete relief of radicular pain, of diminished sensation, and of paresthesias after the Nerve release. Four of seven patients with motor loss and two of five patients with a footdrop demonstrated improvement in function after the Nerve release. No patient had evidence of worsening on neurologic examination after the release. CONCLUSIONS: Sciatic Nerve release during reconstructive acetabular surgery can decrease the sensory symptoms of preoperative Sciatic neuropathy associated with a previous acetabular fracture. Motor symptoms, however, are less likely to resolve following Nerve release. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum” (2007;89:[1432-7][1], July 2007 [1]: /lookup/volpage/89/1432
Paul S. Issack - One of the best experts on this subject based on the ideXlab platform.
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Sciatic Nerve Injury Associated with Acetabular Fractures
HSS Journal, 2009Co-Authors: Paul S. Issack, David L. HelfetAbstract:Sciatic Nerve injuries associated with acetabular fractures may be a result of the initial trauma or injury at the time of surgical reconstruction. Patients may present with a broad range of symptoms ranging from radiculopathy to foot drop. There are several posttraumatic, perioperative, and postoperative causes for Sciatic Nerve palsy including fracture–dislocation of the hip joint, excessive tension or inappropriate placement of retractors, instrument- or implant-related complications, heterotopic ossification, hematoma, and scarring. Natural history studies suggest that Nerve recovery depends on several factors. Prevention requires attention to intraoperative limb positioning, retractor placement, and instrumentation. Somatosensory evoked potentials and spontaneous electromyography may help minimize iatrogenic Nerve injury. Heterotopic ossification prophylaxis can help reduce delayed Sciatic Nerve entrapment. Reports on Sciatic Nerve decompression are not uniformly consistent but appear to have better outcomes for sensory than motor neuropathy.
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Sciatic Nerve release following fracture or reconstructive surgery of the acetabulum
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Paul S. Issack, Jennifer Kreshak, Craig E Klinger, Jose B Toro, Robert L Buly, David L. HelfetAbstract:BACKGROUND: Sciatic neuropathy associated with acetabular fractures can result in disabling long-term symptoms. The purpose of this retrospective study was to evaluate the effect of Sciatic Nerve release on Sciatic neuropathy associated with acetabular fractures and reconstructive acetabular surgery. METHODS: Between 2000 and 2004, ten patients with Sciatic neuropathy associated with an acetabular fracture were treated with release of the Sciatic Nerve from scar tissue and heterotopic bone. Additional surgical procedures included open reduction and internal fixation of the acetabulum (five patients), removal of hardware and total hip arthroplasty (three patients), and removal of hardware alone (one patient). The average age of the patients was forty-three years. All patients were followed with serial examinations and assessments for a minimum of one year (average, twenty-six months). RESULTS: All patients had partial to complete relief of radicular pain, of diminished sensation, and of paresthesias after the Nerve release. Four of seven patients with motor loss and two of five patients with a footdrop demonstrated improvement in function after the Nerve release. No patient had evidence of worsening on neurologic examination after the release. CONCLUSIONS: Sciatic Nerve release during reconstructive acetabular surgery can decrease the sensory symptoms of preoperative Sciatic neuropathy associated with a previous acetabular fracture. Motor symptoms, however, are less likely to resolve following Nerve release. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum” (2007;89:[1432-7][1], July 2007 [1]: /lookup/volpage/89/1432
S Rochkind - One of the best experts on this subject based on the ideXlab platform.
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neurolysis for the treatment of Sciatic Nerve palsy associated with total hip arthroplasty
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Gilad J Regev, Michael Drexler, Ronen Sever, Tim Dwyer, Morsi Khashan, Zvi Lidar, Khalil Salame, S RochkindAbstract:Sciatic Nerve palsy following total hip arthroplasty (THA) is a relatively rare yet potentially devastating complication. The purpose of this case series was to report the results of patients with a Sciatic Nerve palsy who presented between 2000 and 2010, following primary and revision THA and were treated with neurolysis. A retrospective review was made of 12 patients (eight women and four men), with Sciatic Nerve palsy following THA. The mean age of the patients was 62.7 years (50 to 72; standard deviation 6.9). They underwent interfascicular neurolysis for Sciatic Nerve palsy, after failing a trial of non-operative treatment for a minimum of six months. Following surgery, a statistically and clinically significant improvement in motor function was seen in all patients. The mean peroneal Nerve score function improved from 0.42 (0 to 3) to 3 (1 to 5) (p 12 months following injury.
Mirko Pham - One of the best experts on this subject based on the ideXlab platform.
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somatotopic fascicular organization of the human Sciatic Nerve demonstrated by mr neurography
Neurology, 2015Co-Authors: Philipp Baumer, Martin Bendszus, Markus Weiler, Mirko PhamAbstract:Objectives: To investigate whether the human Sciatic Nerve might have a consistent somatotopic organization according to proximal fascicle input by spinal Nerves. Methods: Twelve patients (55.3 ± 15.5 years) with confirmed lesions of either the L5 or S1 spinal Nerve root underwent magnetic resonance neurography of Sciatic Nerve fascicles including thigh and knee levels (T2-weighted sequence with fat saturation, repetition time/echo time 7,552/52 milliseconds, voxel size 0.27 × 0.27 × 3.0 mm 3 ). Twenty healthy subjects and 12 additional patients with an established diagnosis of peripheral polyneuropathy served as 2 separate age- and sex-matched control groups. Two blinded readers assessed patients and controls for presence of distinct lesion patterns. Spatial maps of normalized T2 signal were rendered after segmentation and coregistration of Sciatic Nerve voxels to detect fascicle lesion patterns. Results: A clear somatotopic distribution of Nerve fascicles was observed on cross-sections along the entire course of the Sciatic Nerve and was distinct between patients with L5 and those with S1 lesions. Fascicles emerging from L5 were ordered in anterolateral positions within Sciatic Nerve cross-sections, while fascicles emerging from S1 appeared posteromedially. Visual assessment discriminated these somatotopic lesions in all cases from both healthy and polyneuropathy controls. Conclusion: A distinct pattern of somatotopy was identified within the Sciatic Nerve according to proximal fascicle input by L5 and S1 spinal Nerves. Knowledge of human Nerve somatotopy may have clinically useful implications in imaging-aided diagnosis of neuropathies.
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mr neurography of Sciatic Nerve injection injury
Journal of Neurology, 2011Co-Authors: Mirko Pham, Carsten Wessig, Jorg Brinkhoff, K Reiners, Guido Stoll, Martin BendszusAbstract:We report on magnetic resonance neurography (MRN) as a supplementary diagnostic tool in Sciatic Nerve injection injury. The object of the study was to test if T2-weighted (w) contrast within the Sciatic Nerve serves as an objective criterion for Sciatic injection injury. Three patients presented with acute sensory and/or motor complaints in the distribution of the Sciatic Nerve after dorsogluteal injection and underwent MRN covering gluteal, thigh and knee levels. Native and contrast-enhanced T1-w images were employed to identify the tibial and peroneal division of the Sciatic Nerve while T2-w images with fat suppression allowed visualization of the site and extent of the Nerve lesion. MRN in the two patients with clinically severe sensory and motor impairment correctly depicted Sciatic injury: continuity of the T2-w lesion within the Nerve at the lesion site and distal to it corresponded well to severe injury confirmed by NCS/EMG as axonotmetic or neurotmetic. Topography of the T2-w lesion on cross-section corresponded to predominant peroneal involvement; moreover, associated denervation patterns of distal target muscles were revealed. One of these patients completely recovered with concomitant complete regression of MRN abnormalities on follow-up. The third patient experienced transient sensory and mild motor impairment with complete recovery after 2 weeks. In this patient, T2-w signal within the Nerve and distal target muscles remained normal indicating only mild, non-axonal Nerve affliction. Our case series shows that MRN can be very useful in precisely determining the site of Sciatic injection injury and may provide diagnostic criteria for the assessment of lesion severity and recovery.
Martin Bendszus - One of the best experts on this subject based on the ideXlab platform.
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somatotopic fascicular organization of the human Sciatic Nerve demonstrated by mr neurography
Neurology, 2015Co-Authors: Philipp Baumer, Martin Bendszus, Markus Weiler, Mirko PhamAbstract:Objectives: To investigate whether the human Sciatic Nerve might have a consistent somatotopic organization according to proximal fascicle input by spinal Nerves. Methods: Twelve patients (55.3 ± 15.5 years) with confirmed lesions of either the L5 or S1 spinal Nerve root underwent magnetic resonance neurography of Sciatic Nerve fascicles including thigh and knee levels (T2-weighted sequence with fat saturation, repetition time/echo time 7,552/52 milliseconds, voxel size 0.27 × 0.27 × 3.0 mm 3 ). Twenty healthy subjects and 12 additional patients with an established diagnosis of peripheral polyneuropathy served as 2 separate age- and sex-matched control groups. Two blinded readers assessed patients and controls for presence of distinct lesion patterns. Spatial maps of normalized T2 signal were rendered after segmentation and coregistration of Sciatic Nerve voxels to detect fascicle lesion patterns. Results: A clear somatotopic distribution of Nerve fascicles was observed on cross-sections along the entire course of the Sciatic Nerve and was distinct between patients with L5 and those with S1 lesions. Fascicles emerging from L5 were ordered in anterolateral positions within Sciatic Nerve cross-sections, while fascicles emerging from S1 appeared posteromedially. Visual assessment discriminated these somatotopic lesions in all cases from both healthy and polyneuropathy controls. Conclusion: A distinct pattern of somatotopy was identified within the Sciatic Nerve according to proximal fascicle input by L5 and S1 spinal Nerves. Knowledge of human Nerve somatotopy may have clinically useful implications in imaging-aided diagnosis of neuropathies.
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mr neurography of Sciatic Nerve injection injury
Journal of Neurology, 2011Co-Authors: Mirko Pham, Carsten Wessig, Jorg Brinkhoff, K Reiners, Guido Stoll, Martin BendszusAbstract:We report on magnetic resonance neurography (MRN) as a supplementary diagnostic tool in Sciatic Nerve injection injury. The object of the study was to test if T2-weighted (w) contrast within the Sciatic Nerve serves as an objective criterion for Sciatic injection injury. Three patients presented with acute sensory and/or motor complaints in the distribution of the Sciatic Nerve after dorsogluteal injection and underwent MRN covering gluteal, thigh and knee levels. Native and contrast-enhanced T1-w images were employed to identify the tibial and peroneal division of the Sciatic Nerve while T2-w images with fat suppression allowed visualization of the site and extent of the Nerve lesion. MRN in the two patients with clinically severe sensory and motor impairment correctly depicted Sciatic injury: continuity of the T2-w lesion within the Nerve at the lesion site and distal to it corresponded well to severe injury confirmed by NCS/EMG as axonotmetic or neurotmetic. Topography of the T2-w lesion on cross-section corresponded to predominant peroneal involvement; moreover, associated denervation patterns of distal target muscles were revealed. One of these patients completely recovered with concomitant complete regression of MRN abnormalities on follow-up. The third patient experienced transient sensory and mild motor impairment with complete recovery after 2 weeks. In this patient, T2-w signal within the Nerve and distal target muscles remained normal indicating only mild, non-axonal Nerve affliction. Our case series shows that MRN can be very useful in precisely determining the site of Sciatic injection injury and may provide diagnostic criteria for the assessment of lesion severity and recovery.
