Accessory right spermatic ganglion: possible embryological basis and clinical significance.

The spermatic ganglia are collections of sympathetic neuron cell bodies located within the cords of the infrarenal aortic plexus, positioned at the origin of the testicular arteries in males. During routine dissection of the aortic plexus at our institution, one specimen exhibited a second (accessory) testicular artery on the right side that coursed retrocaval. Histology was used to confirm the presence of an accessory right spermatic ganglion at the base of the accessory retrocaval testicular artery. Interestingly, the accessory spermatic ganglion was also supplied by its own right lumbar splanchnic nerve. This is the first case to describe the anatomy of an accessory spermatic ganglion in a specimen that exhibits an accessory testicular artery on the right side. This neurovascular variation is of interest to surgeons who aim to perform nerve-sparing retroperitoneal lymph node dissections for malignancy.

Intraoperative conjoined lumbosacral nerve roots associated with spondylolisthesis.

Lumbosacral nerve roots anomalies may produce low back pain. These anomalies are reported to be a cause for failed back surgery. They are usually left undiagnosed, especially in endoscopic discectomy techniques. Any surgery for entrapment disorders, performed on a patient with undiagnosed lumbosacral nerve roots anomaly, may lead to serious neural injuries because of an improper surgical technique or decompression. In this report, we describe our experience with a case of L5-S1 spondylolisthesis and associated congenital lumbosacral nerve root anomalies discovered during the surgical intervention, and the difficulties raised by such a discovery. Careful examination of coronal and axial views obtained through high-quality Magnetic Resonance Imaging may lead to a proper diagnosis of this condition leading to an adequate surgical planning, minimizing the intraoperatory complications.

The usefulness of lumbosacral magnetic resonance imaging in the management of isolated dysfunctional elimination.

PURPOSE: Magnetic resonance imaging is sometimes used to rule out spinal pathology in patients with dysfunctional elimination, although its usefulness in this setting is unclear. We determined the usefulness of magnetic resonance imaging in children with isolated dysfunctional elimination, and normal cutaneous, neurological and orthopedic examinations. MATERIALS AND METHODS: We reviewed the records of children with dysfunctional elimination who underwent lumbosacral magnetic resonance imaging and identified those who were neurologically normal and who had normal cutaneous back examinations. Our primary goal was to determine the rate at which magnetic resonance imaging identified a spinal abnormality in this population. Univariate analysis was performed to assess the association of several clinical variables with a radiographic abnormality on magnetic resonance imaging. RESULTS: Between 2000 and 2009 a total of 49 lumbosacral magnetic resonance imaging studies were performed in 29 females and 18 males with a mean age of 8.5 years (range 2.1 to 17). Four of the 49 imaging studies (8%) revealed a radiographic abnormality but in only 1 (2%) was clinically significant spinal pathology identified, that is filum lipoma causing cord tethering. Findings on the 3 remaining abnormal imaging studies were considered unrelated to bladder dysfunction. No clinical, demographic or videourodynamic findings were associated with a radiographic abnormality on magnetic resonance imaging. CONCLUSIONS: In children with isolated dysfunctional elimination complaints, and normal neurological, orthopedic and back examinations the diagnostic yield of lumbosacral magnetic resonance imaging is low but not zero. We suggest that spinal magnetic resonance imaging be used judiciously and as a test of last resort in these children.

Deep infiltrating endometriosis with sacral plexus involvement: Improving knowledge through human cadaver dissection.

INTRODUCTION: The aim of this study was to assess a human cadaver model of sacral plexus dissection for learning about deep innervation in the female pelvis, and the latter's relationship with deep infiltrating endometriosis. METHODS: This was a prospective, observational study. Eight residents in obstetrics and gynecology were tested before and after a lecture on innervation of the female pelvis and a cadaver dissection class. Standardized cadaver dissection was used to identify the sacral nerve roots S2 to S4, superior and inferior hypogastric plexuses, hypogastric nerve, and splanchnic nerves. RESULTS: The residents' level of knowledge improved significantly after a one-hour lecture (p = 0.9.10-5) and after a cadaver dissection class (p = 0.6.10-6). The improvement was significantly greater for the dissection class (p = 0.0003). All the pelvic nerve structures were identified in all but one of the cadavers and had similar measurements. A vascular anatomical variant was observed in one case. CONCLUSION: A human cadaver model is of value for learning about deep pelvic innervation and the latter's relationship with deep infiltrating endometriosis. The reproducibility and safety of cadaver dissection might improve surgical skills.

Congenital absence of lumbosacral articular facet joint associated with conjoined nerve root: a case report.

We report a rare case of congenital absence of the L5-S1 facet joint, which was associated with a conjoined nerve root. Combination of these two anomalies has been quite rarely reported in the literature. A 39-year-old man presented with acute low back pain and right leg radiating pain. Muscle weakness and sensory disturbance of the right leg were also apparent in the region innervated by L5 and S1 nerve roots. Preoperative multidetector three-dimensional computed tomography (3D-CT) showed complete absence of the right S1 superior articular process. Magnetic resonance (MR) images showed lumbar disc herniation at right L5-S1 level that migrated cranially. Intraoperative findings revealed that the right L5 nerve root and S1 nerve root were conjoined, and the conjoined nerve root was compressed by L5-S1 disc herniation, which led to impairment of the conjoined nerve root by a single-level lumbar disc herniation. After removal of the disc herniation, his right leg pain immediately subsided, however muscle weakness and sensory disturbance persisted. Surgeons should be aware of this nerve root anomaly when examining a patient who shows an unusual clinical presentation and/or congenital osseous anomaly.

Conjoined lumbosacral nerve roots: analysis of cases diagnosed intraoperatively.

STUDY DESIGN: Retrospective cross-sectional study of cases with conjoined lumbar nerve root anomalies. OBJECTIVE: To provide a description of presenting symptoms and clinical signs of conjoined nerve roots. SUMMARY OF BACKGROUND DATA: Nerve root anomalies are frequently underrecognized on advanced imaging studies and are also underappreciated and underreported when encountered surgically. METHODS: In this retrospective cross-sectional study, we report the intraoperative identification of 22 cases of conjoined nerve root anomaly, encountered within a period of 11 years. All cases underwent hemilaminectomy in addition to medial facetectomy and pediculectomy. All patients were followed for a mean duration of 53+/-8.2 months (range, 2 to 108 mo). RESULTS: Twenty-two patients had conjoined nerve root anomaly (mean age at diagnosis=47.7+/-5.1). They included 11 cases of L5-S1, 10 cases of L4-L5, and 1 of S1-S2. Twelve patients (54.5%) had symptoms in 2 territories. Straight leg raising sign and crossed straight leg raising were positive in 14 (63.6%) and 7 (31.8%) patients, respectively. All patients returned to work within 2 months after surgery. The signs and symptoms in only 7 cases (31.8%) could be explained by the underlying pathology (disc herniation) alone. In the remaining 68%, the conjoined roots have probably contributed to the incompatible signs and symptoms. CONCLUSIONS: Twin dermatomal involvements, in addition to a negative Lasègue sign, are clues to the diagnosis of a probable conjoined nerve root anomaly. Extension of routine hemilaminectomy to a facetectomy and partial pediculectomy leads to a favorable outcome.

Conjoined lumbosacral nerve roots. Diagnosis with metrizamide myelography.

The most common anomaly of the lumbosacral nerve roots consists of a composite root sleeve containing the roots for two spinal nerves. Before the advent of water-soluble myelography, this anomaly was rarely diagnosed except at operation. Metrizamide myelography readily demonstrates the anomaly because of improved filling of the root sleeves and greater definition of the nerve roots within the subarachnoid space. However, an underlying disk herniation may not be evident on the myelogram because of the unique anatomic configuration.

Unusual branching in lumbar plexus. Case report.

This article describes a complex bilateral variation in the formation of lumbar plexus in a 32 year old male cadaver. On the left side the plexus was postifixed and located posterior to the psoas major muscle. The femoral nerve was formed by the union of anterior rami of the second, third, fourth and fifth lumbar spinal nerves. On the right side, the lumbar plexus was prefixed. The lateral cutaneous nerve of the thigh was formed. By the union of the anterior rami of the first and second lumbar spinal nerves. The femoral nerve formed by branches from the first, second, third and fifth lumbar spinal nerves while the obturator nerve was formed by the union of the first, second and third lumbar spinal nerves. The right lumbar plexus was located in the substance of the psoas major muscle. In the present case, the formation of branches of the lumbar plexus were different from the previous data present in the literature.

[Caudal regression syndrome. Lumbo-sacral agenesis]. / Síndrome de regressão caudal agenesia lombo-sagrada.

Retrospective analysis of six cases of caudal regression syndrome, classified in accordance with vertebral envolvement. The degree of vertebral agenesis, morphology and topography of the conus medularis, neurologic implications (motor, sensitive and autonomous) and associated malformations, of particular importance in some situations of little significant vertebral agenesis are analyzed. Associations with eventual predisponent factors are sought.

Perosomus elumbis in a Holstein calf infected with bovine viral diarrhea virus.

The detection of bovine viral diarrhea virus (BVDV) in a female Holstein calf presented with perosomus elumbis, a congenital anomaly, is reported here. A cow with dystocia was evaluated and an abnormal dead calf was detected during vaginal examination. The calf was retrieved via caesarean section and exhibited abnormalities characteristic of PE, such as vertebral and pelvic malformations. These abnormalities were further confirmed using radiographic and necropsy examinations. At necropsy cerebellar hypoplasia was an additional finding, which is a typical lesion associated with bovine virus diarrhea (BVD). Several tissue samples from the calf were tested for the presence of antigens of BVDV and bovine herpesvirus-1 (BHV-1) by ELISA. In addition, sera samples from the dam and calf were tested for the presence of antibodies against BVDV, BHV-1, and bluetongue disease virus (BTV) using a virus neutralization assay. Results indicated that the calf was congenitally infected with BVDV, whereas there was no evidence for the presence of BHV-1 and BTV. In the dam's serum no antibodies against BVDV, BHV-1, and BTV were detected. Even though the etiology of perosomus elumbis is unknown, BVDV, which causes fetal anomalies at early gestation in cows, may have been a contributing factor in this case.

Perosomus elumbis in a black and white German Holstein calf.

Perosomus elumbis is a rare congenital anomaly of unknown aetiology characterized by the aplasia of the lumbosacral spinal cord and vertebrae, mostly associated with multiple other malformations of the hind limbs and the urogenital and intestinal tract. This report describes a stillborn female German Holstein calf showing a complete aplasia of the lumbosacrococcygeal portion of the spinal cord and vertebral column. In addition, both hind-limbs exhibited arthrogryposis and the musculature was completely replaced by adipose tissue. Furthermore, atresia ani and recti, agenesis of one kidney, one adrenal gland, and a hypoplastic and atretic female genital tract were detected. The aplasia of the lumbosacrococcygeal spinal cord and vertebral column and the other associated malformations in the presented case of perosomus elumbis may be the consequence of a combined developmental disturbance of the caudal neural tube, notochord and paraxial and intermediary mesoderm. However, it remains unclear whether the underlying cause is due to an inherited defect or due to an unknown exogenous factor disturbing embryogenesis in a critical developmental period.

Anomalias dos nervos lombossacrais em natimortos a termo. Estudo anatômico / Anomalies of the lumbosacral nerve roots in stillborns. An anatomical study

Contexto: Existe controvérsia entre autores quanto à incidência de variações anatômicas dos nervos espinhais lombossacros. A incidência dessas anomalias nervosas varia de 0% a 30% como verificado em estudos anatômicos em cadáveres adultos de diferentes nacionalidades, de 2,0% a 4,0% em estudos de imagem diagnóstica e de 0,34% a 10% em séries cirúrgicas. Objetivo: Determinar a incidência de anomalias anatômicas nos nervos espinhais lombossacros em 40 natimortos a termo de nacionalidade brasileira. Métodos: O segmento lombossacro da coluna vertebral de 40 natimortos, provenientes do laboratório de patologia clínica do Hospital Universitário da Universidade Federal de Sergipe (UFS), foi estudado no Laboratório de Neuroanatomia do Departamento de Morfologia da UFS. Foram excluídos aqueles casos que possuíam síndromes ou qualquer defeito orgânico associado. Os espécimes anatômicos foram fixados com solução de formaldeído a 10%, infundida por meio da veia umbilical. As peças foram preparadas com a ressecção em bloco das partes moles dorsais, processos espinhosos e lâminas da décima vértebra torácica até o sacro. Resultado: Neste estudo, foram encontradas seis variações anatômicas dos nervos espinhais lombossacros, em seis diferentes espécimes, de quatro tipos, totalizando 15% das peças. As variações anatômicas dos nervos espinhais lombossacros foram classificadas em oito tipos, sendo a anastomose intradural a mais presente. O quinto nervo lombar foi o mais frequentemente comprometido Não foi observada diferença significativa quanto ao sexo e lado envolvido. Conclusão: O presente estudo enfatiza a importância do conhecimento dessas anomalias anatômicas durante os procedimentos cirúrgicos na região lombossacral, pois não se trata de evento muito raro.

Context: There is such controversy among authors about the real incidence of lumbosacral nerve roots anomalies. The incidence ranges from 0% to 30% in anatomic studies in different populations, from 2% to 4% in diagnostic image studies and 0.34% to 10% in surgical series. Objective: To determine the incidence of anatomical abnormalities of the lumbossacral spinal nerves in 40 Brazilian stillborns. Methods: The segment of the lumbosacral spine of 40 stillborns, from the clinical pathology laboratory at the University Hospital of Federal University of Sergipe (UFS) was studied in the Laboratory of Neuroanatomy, Department of Morphology of the UFS. We excluded those cases that had any defects or syndromes associated. The anatomical specimens were fixed with formaldehyde solution 10%, infused through the umbilical vein. The specimens were prepared with en bloc resection of the soft dorsal spinous processes and laminae from the tenth thoracic vertebra to the sacrum. Results: In this study, were found four types of anatomical variations of lumbosacral spinal nerves in six different specimens, accounting for 15% of the specimens. The fifth lumbar nerve was the most frequently involved (66%).The anatomical variations of lumbosacral spinal nerves were classified into eight types, and the intradural anastomosis was the most frequent. There was no significant difference regarding gender and side involved. Conclusion: Our study emphasizes the importance of knowledge of these anatomical anomalies during surgical procedures in the lumbosacral region because they are not too rare.