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1.
Pan Afr Med J ; 33: 242, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692794

RESUMO

The sciatic nerve is the terminal branch of the sacral plexus. Sciatalgia is a nerve root pain. In most cases, sciatica originates from degenerative disc disease. Tumor involving the sciatic nerve is extremely rare. We here report the case of a 33-year old patient with nerve tumor detected on MRI performed for drug-resistant sciatica. Tumor involving the sciatic nerve is rare and diagnosis is difficult. MRI data are crucial for establishing an effective surgical approach.


Assuntos
Imagem por Ressonância Magnética/métodos , Neurilemoma/diagnóstico por imagem , Neurofibroma/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Nervo Isquiático/patologia , Ciática/diagnóstico
2.
J Comput Assist Tomogr ; 43(6): 976-980, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31688247

RESUMO

Endometriosis (EN) is a common gynecological condition characterized by the presence of functional endometrium located outside the uterine cavity. Sciatic nerve (SN) is rarely affected by EN. Magnetic resonance imaging allows a direct visualization of the spinal and SN, and it is the modality of choice for the study of SN involvement in extrapelvic EN. We report a case of an endometrioma located in the right SN with a systematic review of the literature.


Assuntos
Endometriose/diagnóstico por imagem , Nervo Isquiático/patologia , Ciática/diagnóstico por imagem , Adulto , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia , Imagem por Ressonância Magnética/métodos , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/cirurgia , Ciática/etiologia , Ciática/cirurgia , Resultado do Tratamento
3.
J Comput Assist Tomogr ; 43(6): 953-957, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738201

RESUMO

PURPOSE: Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-like symptoms. There are 6 predominant types of sciatic nerve variations with type 1 being the most common (84.2%), followed by type 2 (13.9%). However, there is scarce literature on the prevalence of sciatic nerve variation in those diagnosed with sciatica. MATERIALS AND METHODS: The charts of 95 patients clinically diagnosed with sciatica who had a magnetic resonance imaging of the pelvis/hip were retrospectively studied. All patients had T1-weighted axial, coronal, and sagittal images. Magnetic resonance imagings were interpreted separately by 2 board-certified fellowship-trained musculoskeletal radiologists to identify the sciatic nerve variant. RESULTS: Seven cases were excluded because of inadequate imaging. Of the remaining 88 patients, 5 had bilateral sciatica resulting in a sample size of 93 limbs. Fifty-two (55.9%) had type 1 sciatic nerve anatomy, 39 (41.9%) had type 2, and 2 (2.2%) had type 3. The proportions of type 1 and 2 variations were significantly different from the normal distribution (P < 0.001), whereas type 3, 4, 5, and 6 variants were not (P = 1.00). CONCLUSIONS: There is strong statistical significance regarding the relationship between sciatic nerve variation and the clinical diagnosis of sciatica. Preoperative magnetic resonance imaging can be considered in sciatica patients to prevent iatrogenic injury in pelvic surgery.


Assuntos
Síndrome do Músculo Piriforme/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Nervo Isquiático/patologia , Tíbia/diagnóstico por imagem , Tíbia/inervação
4.
BMC Musculoskelet Disord ; 20(1): 438, 2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31564252

RESUMO

BACKGROUND: The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. METHODS: For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). RESULTS: The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). CONCLUSION: According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ciática/etiologia , Ciática/terapia , Resultado do Tratamento
5.
Pathologica ; 111(2): 67-69, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31388198

RESUMO

Peripheral nerve mucoid degeneration (PNMD) is a rare non-neoplastic degenerative condition characterized by endoneural deposit of mucoid matrix. Herein, we report a case of PNMD involving the sciatic nerve with preoperative features, surgical treatment and pathological findings.


Assuntos
Degeneração Neural/diagnóstico por imagem , Degeneração Neural/cirurgia , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/cirurgia , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Isquiático/patologia
6.
World Neurosurg ; 129: e761-e766, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203072

RESUMO

INTRODUCTION: The natural history of growth and radiologic progression of neuromuscular choristomas (NMCs) remain unknown. The purpose of this study was to describe the radiologic growth pattern of NMCs and to determine how the pattern of growth relates to clinical progression. METHODS: A retrospective review was performed for patients with a confirmed diagnosis of NMC and at least 2 years of radiologic (magnetic resonance imaging [MRI]) follow-up. Medical records, including physical examinations and radiologic studies, were reviewed in detail. The NMC length and transverse dimensions were compared between serial MRI examinations. RESULTS: Eleven patients with a mean radiologic follow-up time of 5.6 years (range 2-19 years) were identified. Motor deficits occurred in 10 patients (90%), sensory deficits in 5 patients (45%), and neuropathic pain in 4 (36%) patients. Eight patients (73%) presented with manifestations of limb undergrowth, 2 (18%) with congenital hip dysplasia, and 1 with a cavus foot deformity. Progression of motor and sensory deficits was observed in 5 (45%) and 1 (9%) patients, respectively. The maximal length and height of the NMC was significantly (P < 0.05) longer (initial 218 ± 118 mm vs. follow-up 270 ± 135 mm) and larger (20 ± 10 mm vs. 24 ± 14 mm) on the follow-up scan. MRI demonstrated abnormalities that were in continuity along the longitudinal extent of the NMC. CONCLUSIONS: According to this small but relatively long-term follow-up cohort, the growth pattern of this lesion is slow but progressive. We found a longitudinal continuity pattern of growth in all MRI scans, often spanning a great distance.


Assuntos
Plexo Braquial/diagnóstico por imagem , Coristoma/diagnóstico por imagem , Músculo Esquelético , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
Clin Anat ; 32(6): 836-850, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31125132

RESUMO

In pediatric patients, peripheral anesthetic blockade of the sciatic nerve is useful for postoperative pain relief after orthopedic procedures of the lower limb. The identification of the sciatic and its branches relative to the surrounding anatomical structures of the knee significantly contribute to the successful nerve blockade. However, reports have demonstrated complications arising from the inadequate and inconsistent understanding of the anatomy of the nerves in the knee region. In addition, the paucity of information regarding the location of the nerves of the knee throughout the pediatric development needs to be addressed in order for peripheral nerve blockades to become more readily used among the pediatric population. This clinical imaging study therefore aimed to document and analyze the relative morphometric relationship of the nerves in the knee region throughout the different stages of pediatric development. The locations of the sciatic, tibial, and common fibular nerves were measured in relation to relevant anatomical structures in 142 pediatric magnetic resonance imaging and computed tomography. A strong correlation was found between age and the distance from the common fibular nerve to the semitendinosus muscle, and thus can be used to predict stature. Significant differences were found between males and females, specifically after puberty, suggesting that sexual dimorphism emerges more distinctively at puberty. In order to predict the location of the nerves at the popliteal fossa, a regression formula using the patient's age and bicondylar width was created. These finding may have significant implications for popliteal approach of the sciatic nerve blockade in pediatric patients. Clin. Anat. 32:836-850, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Articulação do Joelho/anatomia & histologia , Joelho/anatomia & histologia , Nervo Isquiático/anatomia & histologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Nervo Isquiático/diagnóstico por imagem , Fatores Sexuais , Tomografia Computadorizada por Raios X
8.
World Neurosurg ; 128: e970-e974, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100516

RESUMO

OBJECTIVE: Tumors of the greater sciatic foramen remain difficult to treat. They often have both intrapelvic and extrapelvic components that may limit visualization and make safe resection of the tumor difficult. Therefore the goal of the present anatomic study was to quantitate how much additional surgical working space could be gained by transection of the sacrospinous and sacrotuberous ligaments. METHODS: Sixteen sides from 9 fresh-frozen Caucasian cadaveric torsos underwent transgluteal dissection and exposure of the greater sciatic foramen and associated liagments. With the piriformis in place, the vertical and horizontal diameters of the greater sciatic foramen were measured. Next, the sacrotuberous and sacrospinous ligaments were cut at their ischial attachments. The vertical diameter of the now confluent greater and lesser sciatic foramina (V2) was measured. RESULTS: The mean vertical diameter of the greater sciatic foramen (V1) was 54.8 ± 9.7 mm. The horizontal diameter of the greater sciatic foramen had a mean of 44.3 ± 6.1 mm with a range of 30-52 mm. After transection of the sacrotuberous and sacrospinous ligaments, the vertical distance of the greater and lesser sciatic foramina (V2) had a mean of 74.8 ± 6.8 mm with a range of 60.1-90 mm. The mean ratio of V2 to V1 was 1.40. CONCLUSIONS: The vertical length of the greater sciatic foramen increased, on average, 40% after resection of the sacrotuberous and sacrospinous ligaments. The results of this study support an alternative technique for resecting large intrapelvic tumors via a transgluteal approach.


Assuntos
Ligamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Isquiático/anatomia & histologia , Nervo Isquiático/cirurgia , Neuropatia Ciática/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Lipossarcoma Mixoide/diagnóstico por imagem , Lipossarcoma Mixoide/patologia , Lipossarcoma Mixoide/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Neuropatia Ciática/diagnóstico por imagem , Resultado do Tratamento
9.
J Neurol ; 266(6): 1332-1339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30830284

RESUMO

PURPOSE: To examine dorsal root ganglia and proximal nerve segments in patients carrying the Fabry-related GLA-gene variant p.D313Y in comparison to patients with classical Fabry mutations and healthy controls by morphometric and functional magnetic resonance neurography. METHODS: This prospective multicenter study examines the lumbosacral dorsal root ganglia and sciatic nerve in 11 female p.D313Y patients by a standardized magnetic resonance neurography protocol at 3 T. Volumes of dorsal root ganglia L3 to S2, permeability of dorsal root ganglia L5 and S1, and spinal nerve L5 as well as cross-sectional area of the sciatic nerve were assessed and compared to 10 females carrying a classical Fabry mutation and 16 healthy female controls. RESULTS: Compared to healthy controls, dorsal root ganglia volumes of p.D313Y females were enlarged by 53% (L3), 48% (L4), 43% (L5), 57% (S1) (p < 0.001), and 55% (S2) (p < 0.05), but less pronounced compared to females carrying a classical Fabry mutation. Compared to healthy controls, p.D313Y patients showed no changes of dorsal root ganglia vascular permeability, while patients with a classical Fabry mutation showed a distinct decrease (p < 0.05). Sciatic nerve cross-sectional area was mildly increased by 6% in p.D313Y as well as in classical Fabry patients (p < 0.05). CONCLUSIONS: Patients carrying the GLA-gene variant p.D313Y show distinctly enlarged dorsal root ganglia, while vascular permeability remains within normal limits. Overall, these alterations partially share characteristics commonly seen in patients with a mutation causing classical FD. This suggests that p.D313Y causes a potentially treatable condition resembling an early stage of Fabry disease.


Assuntos
Gânglios Espinais/patologia , Doenças do Sistema Nervoso Periférico , Nervo Isquiático/patologia , alfa-Galactosidase/genética , Adulto , Idoso , Permeabilidade Capilar/fisiologia , Doença de Fabry/genética , Feminino , Gânglios Espinais/diagnóstico por imagem , Gânglios Espinais/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Mutação , Doenças do Sistema Nervoso Periférico/genética , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Estudos Prospectivos , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/fisiopatologia , Adulto Jovem
10.
Eur Radiol ; 29(6): 3241-3252, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30635758

RESUMO

OBJECTIVES: This study aimed to evaluate whether diffusion tensor imaging (DTI) parameters and cross-sectional area (CSA) can differentiate between the sciatic nerve of Charcot-Marie-Tooth (CMT) disease type I (demyelinating form) patients and that of controls. METHODS: This prospective comparison study included 18 CMT type I patients and 18 age/sex-matched volunteers. Magnetic resonance imaging including DTI and axial T2-weighted Dixon sequence was performed for each subject. Region of interest analysis was independently performed by two radiologists on each side of the sciatic nerve at four levels: hamstring tendon origin (level 1), lesser trochanter of the femur (level 2), gluteus maximus tendon insertion (level 3), and mid-femur (level 4). Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated. The CSA of the sciatic nerve bundle was measured using axial water-only image at each level. Comparisons of DTI parameters between the two groups were performed using the two-sample t test and Mann-Whitney U test. Interobserver agreement analysis was also conducted. RESULTS: Interobserver agreement was excellent for all DTI parameter analyses. FA was significantly lower at all four levels in CMT patients than controls. RD, MD, and CSA were significantly higher at all four levels in CMT patients. AD was significantly higher at level 2 in CMT patients. CONCLUSION: DTI assessment of the sciatic nerve is reproducible and can discriminate the demyelinating nerve pathology of CMT type I patients from normal nerves. The CSA of the sciatic nerve is also a potential parameter for diagnosing nerve abnormality in CMT type I patients. KEY POINTS: • Diffusion tensor imaging parameters of the sciatic nerve at proximal to mid-femur level revealed significant differences between the Charcot-Marie-Tooth disease patients and controls. • The cross-sectional area of the sciatic nerve was significantly larger in the Charcot-Marie-Tooth disease patients. • Interobserver agreement was excellent (intraclass coefficient > 0.8) for all diffusion tensor imaging parameter analyses.


Assuntos
Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Imagem de Tensor de Difusão , Nervo Isquiático/diagnóstico por imagem , Adulto , Anisotropia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Adulto Jovem
12.
Ultrasound Q ; 35(2): 125-129, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29727344

RESUMO

Piriformis syndrome is a common cause of lumbar, gluteal, and thigh pain, frequently associated with sciatic nerve symptoms. Potential etiologies include muscle injury or chronic muscle stretching associated with gait disturbances. There is a common pathological end pathway involving hypertrophy, spasm, contracture, inflammation, and scarring of the piriformis muscle, leading to impingement of the sciatic nerve. Ultrasound-guided piriformis injections are frequently used in the treatment of these pain syndromes, with most of the published literature describing injection of the muscle. We describe a safe, effective ultrasound-guided injection technique for the treatment of piriformis syndrome using targeted sciatic perineural hydrodissection followed by therapeutic corticosteroid injection.


Assuntos
Síndrome do Músculo Piriforme/terapia , Solução Salina/administração & dosagem , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/fisiopatologia , Ultrassonografia de Intervenção/métodos , Corticosteroides/uso terapêutico , Dissecação/métodos , Humanos , Síndrome do Músculo Piriforme/diagnóstico por imagem , Síndrome do Músculo Piriforme/fisiopatologia
13.
J Ultrasound Med ; 38(1): 157-164, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29732595

RESUMO

OBJECTIVES: The purpose of this study was to determine whether sciatic nerve stiffness is altered in people with chronic low back-related leg pain by using shear wave elastography. METHODS: In this cross-sectional study, the sciatic nerve shear wave velocity (ie, an index of stiffness) was measured in both legs of 16 participants (8 with unilateral low back-related leg pain and 8 healthy controls). Sciatic stiffness was measured during a passive ankle dorsiflexion motion performed at 2°/s in an isokinetic dynamometer. The ankle range of motion and passive torque, as well as muscle activity, were also measured. RESULTS: In people with low back-related leg pain, the affected limb showed higher sciatic nerve stiffness compared to the unaffected limb (+11.3%; P = .05). However, no differences were observed between the unaffected limb of people with low back-related leg pain and the healthy controls (P = .34). CONCLUSIONS: People with chronic low back-related leg pain have interlimb differences in sciatic nerve stiffness, as measured by a safe and noninvasive method: shear wave elastography. The changes found may be related to alterations in nerve mechanical properties, which should be confirmed by future investigations.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Dor Lombar/etiologia , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/patologia , Neuropatia Ciática/diagnóstico por imagem , Neuropatia Ciática/patologia , Adolescente , Adulto , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Estudos Transversais , Eletromiografia , Feminino , Humanos , Perna (Membro)/fisiopatologia , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Mod Rheumatol ; 29(4): 693-699, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29862862

RESUMO

Objective: The aim was to compare the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the sciatic and femoral nerves in patients with unilateral osteoarthritis of the hip (OA) and osteonecrosis of the femoral head (ONFH) using diffusion tensor imaging (DTI) and to investigate the mechanism of hip pain. Methods: Forty-four patients (22 OA and 22 ONFH) underwent DTI of the sciatic and femoral nerves at the level of the hip joint and the S1 roots to visualize the tractography and quantify the FA and ADC values. Results: The tractography of the femoral and the sciatic nerves on the affected side with OA and ONFH were similar to those on the normal side. The mean FA values of the sciatic and femoral nerves, and the S1 roots were 0.542, 0.551, and 0.316 with OA, 0.568, 0.560, and 0.318 with ONFH on the affected side, and 0.559, 0.560, and 0.315 on the normal side, respectively, and did not show significant differences. The FA values of the sciatic nerve on the affected side with OA decreased with longer pain duration. Conclusion: The FA and ADC values of the sciatic and femoral nerves in patients with unilateral OA and ONFH showed no significant differences between the affected and normal sides.


Assuntos
Nervo Femoral/diagnóstico por imagem , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Adulto , Idoso , Imagem de Tensor de Difusão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Ultrasound Q ; 35(2): 120-124, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30020271

RESUMO

OBJECTIVE: This study aimed to visualize sciatic nerve injury in rats using ultrasound imaging in a crushed injury model. METHODS: Adult male Sprague-Dawley rats were subjected to a left sciatic nerve crush operation. Then, high-frequency ultrasound was used to image both sciatic nerves at 2 days and at 1, 2, 3, 4, and 6 weeks after surgery. RESULTS: Normal uninjured nerves have uniform thickness, display a smooth epineurium and inner adventitia, and are oblong in transverse sections. After the crush operation, nerve thickness increased, the inner echo signal decreased, the image of the epineurium became obscured and coarse before becoming smooth again, and transverse sections of the nerve fibers changed from being semicircular to oval in shape before becoming elliptical again. These observations were consistent with pathological changes associated with nerve injury. CONCLUSIONS: High-frequency ultrasound is capable of capturing dynamic changes in rat sciatic nerves in a crushed injury model. This can be used as an auxiliary method of evaluation in traditional peripheral nerve injury experiments.


Assuntos
Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/lesões , Neuropatia Ciática/diagnóstico por imagem , Ultrassonografia/métodos , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley
16.
Skeletal Radiol ; 48(1): 129-136, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29982854

RESUMO

OBJECTIVE: The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. MATERIALS AND METHODS: The study group included patients with complaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects. Evaluations were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9 MHz multifrequency convex probe. RESULTS: There were 40 patients (20 male, 20 female) with a mean age of 43.1 ± 12.7 years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9 ± 10.7 years in the control group (p > 0.05). The sciatic nerve stiffness assessed on both the axial (12.3 ± 3.7 kPA) and longitudinal (14.3 ± 3.8 kPA) planes of the involved side was significantly higher than non-involved side (axial: 6.8 ± 2.1 and longitudinal: 8.3 ± 2.3 kPA) in the patient group (p < 0.001). CONCLUSIONS: Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. Although the findings in this preliminary study show that shear wave elastography can detect a change in sciatic nerve stiffness in patients with unilateral LDH, larger studies are required to determine the clinical utility of this technique.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Masculino , Ciática/etiologia
17.
Clin Neuroradiol ; 29(1): 19-26, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29030674

RESUMO

PURPOSE: To establish normal values and to identify demographic determinants of quantitative biomarkers in magnetic resonance neurography (MRN). METHODS: In this study 60 healthy individuals (5 men and 5 women of every decade between 20 and 80 years) were examined according to a standardized MRN protocol at 3 T, including multiecho T2 relaxometry. Nerve cross-sectional area (CSA), transverse relaxation time (T2), and proton spin density (PSD) were assessed for the sciatic, tibial, median, ulnar, and radial nerves. Correlation with demographic variables, such as height, weight, body mass index (BMI), and age was expressed by Pearson coefficients and t­tests were used to compare MRN biomarkers between men and women with and without normalization to body weight and BMI by linear regression. RESULTS: The average nerve CSA correlated moderately with height (r = 0.28, p = 0.04), weight (r = 0.40, p = 0.002), and BMI (r = 0.35, p = 0.008), but not with age (r = 0.23, p = 0.09). While T2 did not correlate with demographic parameters, PSD was strongly inversely associated with BMI (r = -0.64, p < 0.001) and weight (r = -0.557, p < 0.001). Sex-dependent differences in imaging marker values were found for CSA but became negligible after normalization to body weight. CONCLUSION: Quantitative biomarkers of MRN co-vary with demographic variables. As particularly important determinants, we identified body weight for nerve CSA and BMI for PSD. The presented normal values and demographic determinants may assist investigations into the potential of MRN biomarkers in further disease-specific studies.


Assuntos
Imagem por Ressonância Magnética/métodos , Nervos Periféricos/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Estatura , Índice de Massa Corporal , Peso Corporal , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Estudos Prospectivos , Nervo Radial/diagnóstico por imagem , Valores de Referência , Nervo Isquiático/diagnóstico por imagem , Fatores Sexuais , Nervo Tibial/diagnóstico por imagem , Nervo Ulnar/diagnóstico por imagem
18.
Vet Anaesth Analg ; 46(1): 106-115, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30502040

RESUMO

OBJECTIVE: To develop a modified ultrasound-guided parasacral approach to the sciatic nerve and compare the effects of a volume of 0.2 mL kg-1 of 0.5% levobupivacaine with an equivalent volume of 0.9% saline injected near the sciatic nerve. STUDY DESIGN: Cadaveric and experimental, blinded, randomized study. ANIMALS: Seven canine cadavers and seven experimental Beagle dogs. METHODS: Both sciatic nerves of seven cadavers were identified using a modified in-plane ultrasound-guided approach. Methylene blue solution (0.2 mL) was injected perineurally, and success was evaluated through dissection. The same approach was repeated in seven Beagle dogs sedated with dexmedetomidine (50 µg kg-1) injected intramuscularly (IM). After randomization, 0.2 mL kg-1 of 0.5% levobupivacaine (limb L) and 0.2 mL kg-1 of 0.9% saline (limb C) were injected perineurally on either right or left limb. Block success was determined by sensory deficits every hour for 8 hours after an atipamezole injection (0.2 mg kg-1) IM. Reaction to pinprick (binary score) over the course of the sciatic nerve (four locations) and locomotion were assessed. RESULTS: The overall sciatic nerve block success was 93% in cadavers and 86% in sedated dogs. It was impossible to localize the sciatic nerves in one obese sedated dog. Significant differences between limb L and limb C were observed for pinprick at great trochanter, caudal thigh and lateral tarsal joint (p < 0.0001). Reaction to pinprick was absent in all dogs at great trochanter and caudal thigh up to at least 3 hours on limb L. Locomotion was impaired in all but one dog for 60 (30-210) minutes (median; interquartile range). No complications were observed. CONCLUSIONS AND CLINICAL RELEVANCE: A volume of ≥0.2 mL kg-1 and a concentration of 0.5% levobupivacaine can be recommended when using a modified ultrasound-guided parasacral approach to the sciatic nerve in dogs.


Assuntos
Anestésicos Locais/farmacologia , Cães/fisiologia , Levobupivacaína/farmacologia , Bloqueio Nervoso/veterinária , Medição da Dor/veterinária , Nervo Isquiático/diagnóstico por imagem , Anestésicos Locais/administração & dosagem , Animais , Feminino , Levobupivacaína/administração & dosagem , Masculino , Medição da Dor/efeitos dos fármacos , Distribuição Aleatória , Ultrassonografia de Intervenção/veterinária
20.
Eur J Anaesthesiol ; 36(4): 255-263, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30562225

RESUMO

BACKGROUND: Local infiltration anaesthesia (LIA) was introduced as an innovative analgesic procedure for enhanced recovery after primary total knee arthroplasty (TKA). However, LIA has never been compared with analgesia based on an adductor canal catheter and a single-shot sciatic nerve block. OBJECTIVE: To evaluate two analgesic regimens for TKA comparing mobility, postoperative pain and patient satisfaction. DESIGN: Two-group randomised, controlled clinical trial. SETTING: Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Germany between April and August 2017. PATIENTS: Adults undergoing primary TKA under general anaesthesia were eligible for study participation. Exclusion criteria were heart insufficiency (New York Heart Association class >2), liver insufficiency (Child Pugh Score >B), evidence of diabetic polyneuropathy, severe obesity (BMI > 40 kg m), chronic opioid therapy for more than 3 months before scheduled surgery and allergy to local anaesthetics. INTERVENTIONS: Nerve block patients group (n=20) underwent surgery with two ultrasound-guided regional anaesthesia blocks: a single-shot sciatic nerve block with 20 ml of ropivacaine 0.75% combined with an adductor canal block with a catheter placed for less than 4 days with an infusion of ropivacaine 0.2% at a rate of 6 ml h. LIA patients (LIA group, n=20) received LIA of the knee capsule at the end of surgery with 150 ml of ropivacaine 0.2%. MAIN OUTCOME MEASURES: The primary endpoint was postoperative time to patient mobilisation (ability to walk) on the ward. RESULTS: Baseline characteristics were similar in each study group. Patients in both groups were mobilised to walk after TKA in similar time frames (LIA 24.0 h versus nerve block 27.1 h, 95% CI of difference -9.6 to 3.3 h). Maximum postoperative pain scores on exertion were higher in LIA patients with a mean 1.3 of 10 numerical rating scale points (95% CI 0.3 to 2.3, P = 0.010) as were intra-operative opioid requirements (LIA median 107 [IQR 100 to 268] mg versus nerve block median 78 [60 to 98] mg, P < 0.001). Patient satisfaction, postoperative oral morphine-equivalents and resting pain levels were comparable between groups. Anaesthesia induction time was reduced in LIA patients (LIA 10 min versus nerve block 35 min, 95% CI of difference 13 to 38 min, P < 0.001). CONCLUSION: Both analgesic regimens allow early mobilisation after TKA with high patient satisfaction. LIA shortened peri-operative time. Further research is required to optimise especially pain control during the later postoperative period with LIA. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT03114306.


Assuntos
Anestesia Local , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Satisfação do Paciente , Idoso , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
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