RESUMEN
BACKGROUND AND OBJECTIVES: Lumbosacral plexus schwannomas (LSPSs) are benign, slow-growing tumors that arise from the myelin sheath of the lumbar or sacral plexus nerves. Surgery is the treatment of choice for symptomatic LSPSs. Conventional retroperitoneal or transabdominal approaches provide wide exposure of the lesion but are often associated with complications in the abdominal wall, lumbar or sacral plexus, ureter, and intraperitoneal organs. Advances in technology and minimally invasive (MIS) techniques have provided alternative approaches with reliable efficacy compared with traditional open surgery. We describe 3 MIS approaches using tubular retractor systems according to the lesion level. METHODS: This was a multicenter, retrospective observational cohort study to evaluate the use of MIS tubular approaches for surgical resection of LSPSs. We included 23 lumbar and upper sacral plexus schwannomas. Clinical presentation, spinal level, surgical duration, degree of resection, days of hospitalization, pathological anatomy of the tumor, approach-related surgical difficulties, and outcomes were collected. RESULTS: The posterior oblique approach was used in 43.5% of the cases, the transpsoas approach in 39.1%, and the transiliac in 17.4%. The mean operative time was 3.3 hours, and the mean hospitalization was 2.5 days. All tumors were WHO grade 1 schwannoma. Postoperative MRI confirms gross total resection in 91.3% of the patients. No patient requires instrumentation. The pros and cons of each approach were summarized. CONCLUSION: The MIS approaches adapted to the lumbar level may improve surgeons' comfort allowing a safe resection of retroperitoneal LSPS.
Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos , Neurilemoma , Humanos , Estudios Retrospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Vértebras Lumbares/cirugía , Plexo Lumbosacro/cirugía , Plexo Lumbosacro/patología , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Neurilemoma/patologíaAsunto(s)
Neuropatías del Plexo Braquial/diagnóstico por imagen , Plexo Lumbosacro/diagnóstico por imagen , Neurolinfomatosis/diagnóstico por imagen , Neuropatías del Plexo Braquial/patología , Humanos , Plexo Lumbosacro/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen/métodos , Neurolinfomatosis/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , RecurrenciaAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Neuropatías del Plexo Braquial/diagnóstico por imagen , Neurolinfomatosis/diagnóstico por imagen , Plexo Lumbosacro/diagnóstico por imagen , Recurrencia , Imagen por Resonancia Magnética , Neuropatías del Plexo Braquial/patología , Neuroimagen/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neurolinfomatosis/patología , Plexo Lumbosacro/patologíaRESUMEN
Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.
Asunto(s)
Plexo Lumbosacro/diagnóstico por imagen , Plexo Lumbosacro/patología , Imagen por Resonancia Magnética , Humanos , Desnervación MuscularRESUMEN
Se realizó un ensayo clinicoterapéutico de fase II en 100 pacientes con sacrolumbalgia aguda, que acudieron al Servicio de Medicina Natural y Tradicional del Centro Médico Psicopedagógico América Labadí Arce de Santiago de Cuba, desde julio del 2009 hasta igual mes del 2010, a fin de evaluar la eficacia del tratamiento acupuntural en ellos, para lo cual fueron conformados 2 grupos de estudio (A y B) de 50 integrantes cada uno: los primeros recibieron los efectos de la medicina natural y los segundos de la convencional. Se obtuvo que los tratados con acupuntura mejoraron en menor tiempo y con menos reacciones adversas en comparación con los consumidores de fármacos, de donde se infiere que la técnica milenaria china resultó eficaz para aliviar el dolor lumbar en quienes se aplicó.
A phase II clinical therapeutical trial on 100 patients with acute lower back pain who attended the Natural and Traditional Medicine Service at América Labadí Psychopedagogical Medical Center from Santiago de Cuba was carried out from July, 2009 to July, 2010 in order to assess the efficacy of the acupunctural treatment on them. To achieve this goal, two study groups (A and B) composed of 50 members each were created: the first ones received the natural medicine effects and the second ones received the conventional medicine effects. The results were as follows: those treated with acupuncture improved their physical condition in a short period of time and had less side effects compared to the patients who used drugs, in which case it can be inferred that Chinese millenary technique was effective to relieve lumbar pain on whom it was applied.