Relationship of inferior gluteal nerves and vessels: target for application of stimulation devices for the prevention of pressure ulcers in spinal cord injury

Abstract

A study was carried out to determine whether the location of the inferior gluteal nerve could be reliably predicted using external anatomy or vascular imaging. This study was motivated by our group's development of an electrical stimulation system to provide direct gluteal stimulation in paralyzed individuals, in particular those with spinal cord injury (SCI). Pressure ulcers are a common complication for many individuals with reduced mobility. Numerous approaches have been employed to treat and prevent pressure ulcers; however no procedure or nursing care regimen has been successful in eradicating them completely. Our group seeks to prevent skin breakdown in susceptible patients by direct electrical stimulation of the paralyzed gluteal muscle, leading to improved circulation and increased muscle mass (hypertrophy) in the treated area. Currently, percutaneous electrodes are placed through an extensive probing process to select the motor point of the target muscle. We examined 15 cadaver gluteal regions to identify the relationship between the internal anatomy of the inferior gluteal artery and nerve as well as the relationship to external anatomic landmarks. The cadavers displayed variability with regard to the morphology of the branches of both nerve and artery. Furthermore, there did not appear to be any relationship between the relative positions of the nerve and artery. However, the potential target area of the proximal origin of the inferior gluteal nerve could reliably be predicted from the external bony anatomy of the lower pelvis.

Effects of Long-Term Paired Associative Stimulation on Strength of Leg Muscles and Walking in Chronic Tetraplegia: A Proof-of-Concept Pilot Study

“…During PAS, 100-Hz PNS trains (1-ms square pulses, 6 pulses per train, train duration 100 ms) (15) were delivered using the Keypoint device and surface electrodes. For the gluteal nerve stimulation, the electrode placement was determined by an anatomical landmark centered at the ischial tuberosity (26). To ensure appropriate gluteal nerve stimulation, a tape roll (45 × 25 mm) was attached on top of the electrodes and the patient sat on it pressing the electrodes toward the nerve.…”

Variations in the Course of the Inferior Gluteal Nerve and Artery: A Case Report and Literature Review

“…However, cases of IGN variation have been reported [4,5]. Recently, the nerve and artery were investigated for clinical treatments, such as skin flap surgery, IGN, aneurysms, and imaging diagnosis [6][7][8][9][10]. Therefore, it is useful to examine the basic clinical data of the IGN and IGA that exit the pelvis from the upper edge of the piriformis (suprapiriformis foramen [SPF]).…”