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H. S. Tullos - One of the best experts on this subject based on the ideXlab platform.

  • Sciatic Neuropathy Secondary to Intrapelvic Migration of an Acetabular Cup
    2016
    Co-Authors: Case A Report, H. S. Tullos
    Abstract:

    Symptomatic or clinically detectable peripheral neu-ropathy after a total hip arthroplasty is rare, with a prevalence of 0.3 to 1.0 per cent according to one re-port; however, the total number of hip replacements grated superiorly has not been reported previously. We report the case of a patient who had Sciatic Neuropathy caused by intrapelvic migration of the ac-etabular cup, and we describe the clinical importance Radiograph of the failed left acetabular component, showing marked proximal and medial migration of the component, wire mesh, and bone cement. performed during the period of the study was not pro-vided9. Injury to the obturator, Sciatic, or femoral nerve can occur during or after the procedure. In a prospec-tive study of thirty hip arthroplasties in twenty-eight patients, some degree of nerve damage was detectable electromyographically in twenty-one patients (75 per cent)10. The principal risk factors for neural injury include revision total hip arthroplasty, limb-lengthening, antico-agulation, female gender, and vascular insufficiency410. Delayed palsies of the Sciatic nerve are usually due to protruded cement or fragments of broken wire1-3-5. How-ever, to our knowledge, delayed Sciatica secondary to protrusion of a cemented acetabular cup that had mi-*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study

  • Sciatic Neuropathy secondary to intrapelvic migration of an acetabular cup a case report
    Journal of Bone and Joint Surgery American Volume, 1997
    Co-Authors: Z U Isiklar, Ronald W Lindsey, H. S. Tullos
    Abstract:

    Symptomatic or clinically detectable peripheral Neuropathy after a total hip arthroplasty is rare, with a prevalence of 0.3 to 1.0 per cent according to one report; however, the total number of hip replacements performed during the period of the study was not provided9. Injury to the obturator, Sciatic, or femoral nerve can occur during or after the procedure. In a prospective study of thirty hip arthroplasties in twenty-eight patients, some degree of nerve damage was detectable electromyographically in twenty-one patients (75 per cent)10. The principal risk factors for neural injury include revision total hip arthroplasty, limb-lengthening, anticoagulation, female gender, and vascular insufficiency4,10. Delayed palsies of the Sciatic nerve are usually due to protruded cement or fragments of broken wire1,3,5. However, to our knowledge, delayed Sciatica secondary to protrusion of a cemented acetabular cup that had migrated superiorly has not been reported previously. We report the case of a patient who had Sciatic Neuropathy caused by intrapelvic migration of the acetabular cup, and we describe the clinical importance of differentiating this condition from coexisting conditions of the lumbar spine. A sixty-nine-year-old woman sustained a fracture of the left femoral neck in 1979. Treatment with open reduction and internal fixation was complicated by aseptic failure of fixation and avascular necrosis. A left total hip arthroplasty, also performed in 1979, failed without infection as well. In 1990, a revision was done with insertion of a cup with cement and titanium wire mesh. After the revision the pain in the hip persisted, and at twelve months the patient began to have …

Carl Y. Saab - One of the best experts on this subject based on the ideXlab platform.

  • Minocycline injection in the ventral posterolateral thalamus reverses microglial reactivity and thermal hyperalgesia secondary to Sciatic Neuropathy.
    Neuroscience letters, 2011
    Co-Authors: Brian W. Leblanc, Michele L. Zerah, Laith M. Kadasi, Noori Chai, Carl Y. Saab
    Abstract:

    We hypothesized that microglia in the ventral posterolateral (VPL) nucleus of the thalamus are reactive following peripheral nerve injury, and that inhibition of microglia by minocycline injection in the VPL attenuates thermal hyperalgesia. Our results show increased expression of OX-42 co-localized with phosphorylated p38MAPK (P-p38) in the VPL seven days after chronic constriction injury (CCI) of the Sciatic nerve. However, astrocytic GFAP expression in the VPL is unchanged 7 and 14 days after CCI. Microinjection of minocycline into the VPL contralateral to CCI reverses thermal hyperalgesia, whereas vehicle injection has no effect on paw withdrawal latency. Minocycline abrogates the increased expression of OX-42 in the VPL after CCI. Therefore, peripheral nerve injury favors a hyperactive microglial phenotype in the VPL, suggesting remote neuroimmune signaling from the damaged nerve to the brain, concomitant with neuropathic behavior that is reversed by local intervention in the VPL to inhibit microglia.

  • a cyclic peptide targeted against psd 95 blocks central sensitization and attenuates thermal hyperalgesia
    Neuroscience, 2010
    Co-Authors: Brian W. Leblanc, Masashi Iwata, Andrew P Mallon, Chamila N Rupasinghe, Dennis J Goebel, John Marshall, Mark R Spaller, Carl Y. Saab
    Abstract:

    Abstract Post-synaptic density protein PSD-95 is emerging as a valid target for modulating nociception in animal studies. Based on the key role of PSD-95 in neuronal plasticity and the maintenance of pain behavior, we predicted that CN2097, a peptide-based macrocycle of nine residues that binds to the PSD-95 Discs large, Zona occludens 1 (PDZ) domains of PSD-95, would interfere with physiologic phenomena in the spinal cord related to central sensitization. Furthermore, we tested whether spinal intrathecal injection of CN2097 attenuates thermal hyperalgesia in a rat model of Sciatic Neuropathy. Results demonstrate that spinal CN2097 reverses hyperexcitability of wide dynamic range (WDR) neurons in the dorsal horn of neuropathic rats and decreases their evoked responses to peripheral stimuli (brush, low caliber von Frey and pressure), whereas CN5125 (“negative control”) has no effect. CN2097 also blocks C-fiber long-term potentiation (LTP) in the dorsal horn, which is linked to neuronal plasticity and central sensitization. At a molecular level, CN2097 attenuates the increase in phosphorylated p38 MAPK, a key intracellular signaling pathway in neuropathic pain. Moreover, spinal injection of CN2097 blocks thermal hyperalgesia in neuropathic rats. We conclude that CN2097 is a small molecule peptide with putative anti-nociceptive effects that modulates physiologic phenomena related to central sensitization under conditions of chronic pain.

Bernard A Roehr - One of the best experts on this subject based on the ideXlab platform.

  • Sciatic Neuropathy secondary to total hip arthroplasty wear debris
    Journal of Arthroplasty, 1999
    Co-Authors: Steven R Fischer, David J Christ, Bernard A Roehr
    Abstract:

    Abstract Sciatic Neuropathy after total hip arthroplasty can result from several causes. We present a case in which a large cystic mass developed around a failed total hip arthroplasty. The lesion extended through the greater Sciatic notch and into the pelvis producing Sciatic nerve compression. The diagnosis was delayed, and the patient underwent a laminectomy without relief of symptoms before an abdomino-pelvic computed tomography (CT) scan revealed the mass. After revision of the components and excision of the accessible portion of the lesion, the symptoms improved. Resolution of the intrapelvic portion of the mass was demonstrated on follow-up CT scan, suggesting that retroperitoneal resection of this type of lesion may not be required at the time of revision of the components.

Robert J Spinner - One of the best experts on this subject based on the ideXlab platform.

  • circumferential adipose lesion of the Sciatic nerve
    World Neurosurgery, 2020
    Co-Authors: Gavin A Davis, Tomas Marek, Kimberly K Amrami, Mark A Mahan, Robert J Spinner
    Abstract:

    Background Adipose lesions of nerve are generally distinguished as either extraneural or intraneural lipomas or, alternatively, lipomatosis of nerve. We present a patient with an unusual circumferential lipoma that completely encircles the right Sciatic nerve and discuss a possible pathogenesis. Case Description A 44-year-old woman presented with progressive symptoms and signs of Sciatic Neuropathy for 1 year. Magnetic resonance imaging revealed a large lipomatous mass extending from the level of the lesser trochanter to the distal third of the femur. The Sciatic nerve was completely enveloped by the lipoma in the proximal segment, partially enveloped in the mid-segment and was separate from the nerve in the distal segment. The lipoma was not covered by the epineurium. The tumor was completely resected and the patient's neurologic symptoms improved. Conclusions The pathogenetic mechanism of the reported circumferential lipoma of the Sciatic nerve is not known. Two possible mechanisms considered included 1) envelopment by an extraneural lipoma over time and 2) occurrence of a lipoma in the paraneurial compartment (and in this case, extension into an extraneural one). Based on the available literature, lipomas that circumferentially envelop the entire nerve seem to be underrecognized and poorly understood. Analogous cases of lipomas enveloping nerves or other structures than nerves have been reported in the literature. Our reported case highlights the complexity of adipose lesions affecting nerves.

  • vascular malformations rare causes of Sciatic Neuropathy a case series
    Neurosurgery, 2010
    Co-Authors: Jamie J Van Gompel, Kimberly K Amrami, Christoph J Griessenauer, Bernd W Scheithauer, Robert J Spinner
    Abstract:

    BACKGROUND: Sciatica is typically a clear-cut symptom complex commonly related to an impingement at the spinal nerve level. Etiologies of Sciatic Neuropathy outside the neural foramina are uncommon. OBJECTIVE: To describe 4 patients presenting with radiating leg pain due to Sciatic nerve involvement, all with a vascular etiology. METHODS: Four patients presenting with neuropathic pain were retrospectively reviewed. Preoperative 3 Tesla magnetic resonance imaging was used to identify these lesions, which most commonly showed diffuse T2 changes with nerve enhancement upon administration of contrast. RESULTS: Exploration revealed vascular lesions. All patients went on to external and limited internal neurolysis of the involved Sciatic nerve segment. Intraoperative histological study confirmed the presence of a venous angioma, an arteriovenous malformation, a venous malformation associated with Klippel-Trenaunay syndrome, and a capillary hemangioma. Follow-up demonstrated stable neurological examinations with reduction in pain at 1 year or greater. CONCLUSION: In patients with Sciatic distribution symptoms and signs, after initial negative spine imaging, high-resolution imaging of the Sciatic nerve itself should be undertaken to address rarer causes such as vascular abnormalities. In these cases, exploration and fascicular biopsy provided a diagnosis; external and limited internal neurolysis improved pain.

Anis Aribogan - One of the best experts on this subject based on the ideXlab platform.

  • a treatment option for post injection Sciatic Neuropathy transsacral block with methylprednisolone
    Pain Physician, 2010
    Co-Authors: Evren H Eker, Oya Yalcin Cok, Anis Aribogan
    Abstract:

    Background Accidental intraneural injection induced nerve injury is an iatrogenic tragedy and intramuscular injection (IM) is the most common injury mechanism affecting the Sciatic nerve. The most frequent presentation of Sciatic nerve injury includes radicular pain and paresthesia with almost immediate onset of variable motor and sensory deficit. Objectives Intraneural injection is a common injury mechanism of the Sciatic nerve and generates neuropathic pain with inflammatory neuritis. Steroids inhibit the production of inflammatory mediators and reduce ectopic discharges on damaged neural membranes. The results of transsacral steroid injection on neuropathic pain in 5 patients with accidental Sciatic nerve injury due to intraneural injection were presented in this report. Design Report of 5 cases. Description of cases Five patients, 32, 34, 45, 54 and 70 years old respectively, complaining of severe neuropathic pain, paresthesia and progressive weakness of the lower extremity with difficulty in walking secondary to gluteal injection were admitted to the clinic. The symptoms were resistant to drug therapies. Electromyography disclosed axonal damage of the Sciatic nerve. The initial examination of the patients revealed a Numeric Rating Scale (NRS) of 10, 10, 9, 9, and 10 respectively. Results Diagnostic block was performed through the unilateral S1-S2-S3 sacral foramina with 22-G spinal needle by 5 mL 1% lidocaine into each foramen. NRS scores decreased to 1, 2, 2, 2 and 1, respectively. One week later, the patients were administered 80 mg methylprednisolone with 1% lidocaine in 15 mL solution shared equally in each foramen. The patients were checked one month after therapeutic block and a full recovery was achieved in all patients. Conclusion The neuropathic pain due to accidental intraneural injection of the Sciatic nerve would be an acceptable indication for transsacral nerve block with corticosteroids in the treatment of Sciatic neuropathic pain symptoms.