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Haodong Lin, Aimin Chen and Chunlin Hou

previous experiments, we have confirmed that division of the L-6 nerve root in the monkey sacral plexus, which is analogous to the S-1 root in humans, did not permanently affect limb function. 12 This paper describes a preliminary study whose aim was to investigate whether the L-6 nerve root could be used as a donor nerve to repair lumbosacral plexus root avulsion in a monkey model. Methods Animal Preparation and Surgical Procedures A total of 18 healthy rhesus monkeys of either sex, each weighing 3500 to 4500 g, were randomly divided into 3 groups. All

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David M. Benglis Jr., Steve Vanni and Allan D. Levi

T he minimally invasive lateral transpsoas approach to the lumbar spine (such as XLIF and DLIF) exists as an alternative to interbody placement at levels L1–5 in the setting of degenerative disc disease, spondylolisthesis, and scoliotic or kyphotic deformity. 1–4 , 6 , 7 , 11 Due to the location of the lumbar nerve root contributions to the lumbosacral plexus within the psoas muscle, the risk of motor and sensory nerve injury is present when traversing the lumbosacral plexus with the dilator or during retractor positioning over the disc space. 2 , 5 , 12

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Eva Maria Lang, Jörg Borges and Thomas Carlstedt

plexus injuy. A lumbosacral plexus lesion is more rare than brachial plexus injury. The first clear description of a lumbosacral plexus injury came only approximately 50 years ago. 13 Because of its protected position within the pelvis, injuries to the lumbosacral plexus occur often as a part of a massive life-threatening trauma. In severe pelvic fractures, usually with dissociation of the sacroiliac joint together with fractures of the pubic bones, there are traction lesions to the lumbosacral plexus 17, 18 or its spinal nerve roots, the cauda equina. 1, 13, 16

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Stepan Capek, Benjamin M. Howe, Kimberly K. Amrami and Robert J. Spinner

I t is predicted that 453,360 new cases of pelvic malignancy (anorectal, genital, bladder, and ureteral cancer) will be diagnosed in the US in 2015. 63 Lumbosacral plexopathy (LSP) occurs in 0.71% of all cancer patients; 30 however, in the subgroup of pelvic cancer, it will be presumably higher. Perineural spread of tumor from the organ to the lumbosacral plexus along the pelvic autonomic nerves has emerged as an alternate, logical explanation for select cases of neoplastic lumbosacral plexopathy (nLSP) in patients without extensive pelvic disease

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Ana C. Siquara de Sousa, Stepan Capek, Benjamin M. Howe, Mark E. Jentoft, Kimberly K. Amrami and Robert J. Spinner

been reported, the mechanism of nerve involvement with EM remains enigmatic. We present 2 cases of EM with sciatic neuropathy. We hypothesize that involvement of the lumbosacral plexus (LSP) in selected cases can be explained by perineural spread of EM from the uterus to the LSP along the pelvic autonomic nerves. We prove that our theory is applicable to other cases by testing this theory in a case reported in the literature. Part I: Institutional Case Reports Case1 Presentation A 49-year-old woman was referred to our institution in June 2013 with a

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Nico Sollmann, Dominik Weidlich, Barbara Cervantes, Elisabeth Klupp, Carl Ganter, Hendrik Kooijman, Claus Zimmer, Ernst J. Rummeny, Bernhard Meyer, Thomas Baum, Jan S. Kirschke and Dimitrios C. Karampinos

plexus or lumbosacral plexus (LSP), which are known to be particularly challenging for imaging. 4 , 10 , 11 , 21 , 36 However, most previous work has relied on qualitative MRN evaluations with a focus on the assessments of signal alterations on T2-weighted images, although MRN principally also offers the possibility for quantitative evaluation. 4 , 10 , 11 , 21 , 36 In this context, evaluation of nerves only based on qualitative parameters remains challenging and is regarded as subjective; in contrast, quantitative methods, such as T2 mapping, may reflect a more

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Shelly Lwu and Rajiv Midha

✓A thorough history and physical examination are fundamental to the assessment of patients with brachial and pelvic plexus tumors. Typical of most peripheral nerve tumors, the presenting symptoms and signs are few, and if present, can be subtle. Presenting complaints may include a palpable mass lesion, either symptomatic or asymptomatic; sensory alterations; pain; motor deficits; visceral symptoms; or autonomic dysfunction. Motor deficits are usually a late feature in the pathogenesis of this lesion, and a progressive course of pain and significant sensory and motor deficits suggests a malignant pathological process. A detailed family history may reveal familial syndromes and neurocutaneous disorders that predispose the patient to neoplasia, such as neurofibromatosis. The physical examination should be conducted in a systematic fashion, looking for any cutaneous features and motor and sensory deficits. The mass should also be examined for form, consistency, and mobility. An irregular, firm, and immobile mass suggests a malignant lesion. Complete and accurate clinical information must be gathered to pinpoint the anatomical localization of the lesion and formulate a differential diagnosis.

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Nerve reconstruction in lumbosacral plexopathy

Case report and review of the literature

Thomas H. Tung, D. Zachary Martin, Christine B. Novak, Carl Lauryssen and Susan E. Mackinnon

(54%) included a neurological deficit. 23 Although cases of surgical management of lumbosacral plexus injuries have been reported, 10, 19 reconstructions remain uncommon. In this report we describe the nature of lumbosacral plexus injuries, methods for diagnosis, and the successful surgical treatment of a patient. Anatomical Considerations The lumbosacral plexus is a combination of the lumbar and sacral plexi ( Fig. 1 ). The lumbar plexus consists of the first through fourth lumbar anterior rami. The sacral plexus consists of the L-4 contribution to the

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Stepan Capek, Benjamin M. Howe, Jennifer A. Tracy, Joaquín J. García, Kimberly K. Amrami and Robert J. Spinner

P rostate cancer is the most common cancer in men, accounting for 233,000 new cases and 30,000 deaths in the US yearly. The 5-year survival rate for patients with localized or regional disease is virtually 100%, but for patients with distant lesions it drops to 28%. 22 The association of neurological involvement with prostate cancer as well as other pelvic cancers has been poorly understood. Recently, perineural spread along the lumbosacral plexus has emerged as a logical, anatomical etiology for select cases. The cancer cells invade the inferior

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Robert J. Spinner, Marie-Noëlle Hébert-Blouin, Robert T. Trousdale, Rajiv Midha, Stephen M. Russell, Tatsuya Yamauchi, Syouzou Sasaki and Kimberly K. Amrami

. Identification of this joint connection is important in that failure to recognize and treat it frequently leads to intraneural recurrences. 25 To our knowledge, an intraneural cyst arising from the hip joint has not been previously reported. We hypothesized that new cases of intraneural ganglia affecting the sciatic nerve and lumbosacral plexus as well as a previously reported case of an obturator intraneural cyst 31 would arise from the hip joint. The description of these former cysts validates the term “sciatic intraneural ganglia.” Because of the variable origin of the