Sciatic nerve injection palsy in the child: Early microsurgical treatment and long‐term results

Abstract

Sciatic nerve injury caused by intramuscular injection in the gluteal region in the child seems as a sensory-motor palsy of the lower limb of variable degree. In preterm children or in children with severe perinatal distress, requiring intensive care, a drop foot is often missed or misdiagnosed as a malformative clubfoot or late diagnosed. Intramuscular drug injection (mainly antibiotics) during early infancy is another cause of injury. There are very few literature reports on postinjection trauma and on therapeutic indications in the child. The Authors report their experience in early microsurgical exploration of the sciatic nerve. From 1990 to 2004, we observed at different times from diagnosis 17 children with sciatic nerve palsy following intramuscular injection. Nine of them underwent nerve exploration surgery in the gluteal region (neurolysis in seven and nerve grafting in two). Conservative treatment was successful in only three cases showing early signs of recovery (at about 3 months of life). Complete recovery was observed only in five early treated cases, while late treated cases had only mild improvement after surgery. During surgery, anatomical variations predisposing to nerve injury were observed. The authors havingobserved better results and faster recovery in the early treated patients, stress the importance of a rapid therapeutic decision to avoid or limit foot deformities, sensory defects and lower limb length discrepancy due to paralysis during growth.

Sciatic nerve injection injury

“…Naloxone with hydroxybenzoate, vitamin K with glycocholic acid and lecithin, and glycocholic acid and lecithin used alone were the least neurotoxic, but still caused nerve injuries. 20 Gentili et al 10 reported a moderate degree of nerve-fibre damage after intrafascicular injections of chloramphenicol, gentamicin, iron dextran and cephalothin in rats, with more damage being seen in large fibres. Extrafascicular injections did not always produce nerve damage.…”

“…29 Ropivacaine administered intraneurally into the sciatic nerve of rats caused severe demyelination and Wallerian degeneration. 26 Senes et al 20 evaluated the neurotoxicity of several agents; hydroxybenzoate, alcohol and glycerol diacetate were found to be the most neurotoxic, with cefuroxime sodium and phenobarbital being moderately neurotoxic. Naloxone with hydroxybenzoate, vitamin K with glycocholic acid and lecithin, and glycocholic acid and lecithin used alone were the least neurotoxic, but still caused nerve injuries.…”

“…31 Since the peroneal division is frequently involved, paralytic foot drop is a common presentation due to a deficit of dorsiflexion and eversion. 2,6,13,20 Involvement of the tibial division may lead to loss of plantar flexion of the foot, loss of flexion of the toes and weakened inversion of the foot. Some patients may suffer a complete sciatic nerve lesion proximal to the hamstring, with a sciatic distribution of pain and paraesthesia, impaired knee flexion, a flail foot due to loss of dorsiflexion and plantar flexion, a loss of posterior tibialis foot invertors and peroneus longus and brevis foot evertors, and sensory loss to the posterior thigh, lower lateral leg and foot.…”

“…For obvious reasons, pain and neurosensory loss may be difficult to evaluate in neonates and infants, therefore, SNII diagnosis should primarily focus on motor loss in these very young patients. 20 …”

Sciatic Nerve Neuropathy Developed After Bone Marrow Aspiration in the Pediatric Patient

“…vasküler nedenler (7), gluteal bölgeye yapılan enjeksiyonlar (8) ve viral enfeksiyonlar sayılabilir (3). Kemik iliği aspirasyonu sonrası oluşan komplikasyonlar hemorajiye bağlı olup, bu durum en sık olarak miyeloproliferatif hastalık varlığında gerçekleşmektedir (5).…”