Challenges in sciatic nerve repair: anatomical considerations

Burks, S. Shelby; Levi, D.; Hayes, Seth; Levi, Allan D.

doi:10.3171/2014.2.jns131667

Cited by 36 publications

(38 citation statements)

References 44 publications

(66 reference statements)

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“…Stab wounds, gunshot wounds, and boat propeller injuries are commonly associated with midsciatic injury. 8,22 Injury location and sciatic division have been associated with differing rates of success after nerve autograft repair. High sciatic injuries involving the peroneal component have been associated with poor outcomes, whereas midthigh injuries to the tibi-al component have had higher rates of success.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with thin sural nerves may only be able to cover a 2.5-cm gap. 8 In addition to insufficient graft material, sensory loss at the donor site and possible neuroma formation are possible morbidities associated with autologous sensory nerve graft transplants. 36 Although we do not report a control of sural graft alone in this patient series, historical data from Roganovic et al demonstrate that worse outcomes started with nerve defects > 5 cm in patients with injuries to the tibial nerve or tibial division of the sciatic nerve who were treated with sural nerve grafts or nerve grafts from other sources alone.…”

Section: Discussionmentioning

confidence: 99%

Section: Neurosurg Focus 42 (3):e2 2017mentioning

confidence: 99%

“…In the case of sciatic nerve injury, the sural nerve is 15 to 20 times smaller in cross-sectional area, and supply will be completely exhausted at 6 cm of sciatic nerve gap. 8 The concept of autografting for peripheral nerve injury dates back to the middle portion of the 20th century.36 This technique, typically thought of as the gold standard, has shortcomings; namely, lack of graft material, donor site morbidity, and the possible formation of neuroma. Given these .…”

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confidence: 99%

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First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

Gersey

Burks

Anderson

et al. 2017

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OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Neurosurg Focus 42 (3):e2 2017mentioning

confidence: 99%

mentioning

confidence: 99%

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First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

Gersey

Burks

Anderson

et al. 2017

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“…N. peroneus communis daha lateralde seyreder. Peroneal sinir, tibial sinire göre daha oblik bir seyir izler ve tibial sinirden ayrıldıktan sonra yaralanmalara daha açık olacak şekilde yüzeyel seyreder (1)(2)(3).…”

Section: Introductionunclassified

Evaluation of etiologic factors and electrophysyologic findings in sciatic nerve injury

et al. 2017

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ÖzAmaç: Elektromiyografi (EMG) laboratuvarına başvuran siyatik sinir yaralanmalı hastalarda elektrofizyolojik bulgular eşliğinde etiyolojik faktörlerin incelenmesi hedeflendi. Gereç ve Yöntem:Bu çalışmada, Ocak 2010 ile Ağustos 2013 tarihleri arasında elektromiyografi (EMG) laboratuvarında incelenen olgular retrospektif olarak incelendi. Standart yöntemlerle sinir ileti ölçümleri ve iğne elektromiyografisi yapılmış olan hastalar çalışmaya alındı. Hasta dosyalarından olgulara ait yaş, cinsiyet, etiyoloji ve öykü ile ilgili veriler elde edildi. Bulgular:Geriye dönük olarak toplam 3225 olgu tarandı. Siyatik sinir hasarı şüphesiyle EMG laboratuvarına gönderilen olgu sayısı 144'tü; 50 olguda siyatik sinir hasarı saptandı. Çalışmaya alınan hastaların yaşları 7-88 arasındaydı. Hastaların %80'i erkek, %20'si kadındı. Etiyolojik nedenler arasında %38 ile femur fraktürü ilk sırada yer alırken %20 ile im enjeksiyonlar ikinci sıradaydı. Vakaların tümünde peroneal sinir hasarı saptandı,%14'ünde tibial sinirde hasarlanma yoktu. Tibial sinir hasarı olan olguların hepsinde peroneal sinir hasarı bulunuyordu. Peroneal sinir yaralanmalarının %38'i, tibial sinir yaralanmalarının ise %18'i total tutulumluydu. En sık neden olarak saptanan kırık etiyolojisinin oranı %50 idi.Sonuç: Siyatik nöropatilerin yönetiminde, etiyolojik değerlendirme ve elektrofizyolojik inceleme erken tanı, optimal tedavi ve zamanlama açısından önemli yer tutmaktadır.

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Surgical anatomy of the sciatic nerve: A meta‐analysis

Tomaszewski

Graves

Henry

et al. 2016

Journal Orthopaedic Research

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The sciatic nerve has varying anatomy with respect to the piriformis muscle. Understanding this variant anatomy is vital to avoiding iatrogenic nerve injuries. A comprehensive electronic database search was performed to identify articles reporting the prevalence of anatomical variations or morphometric data of the sciatic nerve. The data found was extracted and pooled into a meta-analysis. A total of 45 studies (n = 7068 lower limbs) were included in the meta-analysis on the sciatic nerve variations with respect to the piriformis muscle. The normal Type A variation, where the sciatic nerve exits the pelvis as a single entity below the piriformis muscle, was most common with a pooled prevalence of 85.2% (95%CI: 78.4-87.0). This was followed by Type B with a pooled prevalence of 9.8% (95%CI: 6.5-13.2), where the sciatic nerve bifurcated in the pelvis with the exiting common peroneal nerve piercing, and the tibial nerve coursing below the piriformis muscle. In morphometric analysis, we found that the pooled mean width of the sciatic nerve at the lower margin of the piriformis muscle was 15.55 mm. The pooled mean distance of sciatic nerve bifurcation from the popliteal fossa was 65.43 mm. The sciatic nerve deviates from its normal course of pelvic exit in almost 15% of cases. As such we recommend that a thorough assessment of sciatic nerve variants needs to be considered when performing procedures in the pelvic and gluteal regions in order to reduce the risk of iatrogenic injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1820-1827, 2016.

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Challenges in sciatic nerve repair: anatomical considerations

Abstract: key WorDS • injury • nerve • repair • sciatic • sural • peripheral nerve • anatomyAbbreviations used in this paper: AGC = axon guidance channel; CSA = cross-sectional area; EHL = extensor hallucis longus.

Cited by 36 publications

References 44 publications

First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

Evaluation of etiologic factors and electrophysyologic findings in sciatic nerve injury

Surgical anatomy of the sciatic nerve: A meta‐analysis

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