Sciatic nerve lesions during cardiac surgery

Abstract

Sciatic nerve lesions occur only rarely in cardiac surgery patients. To evaluate potential causes for sciatic neuropathy, we reviewed the cardiac surgery performed at one institution during the last 15 years and found only six instances of sciatic neuropathy. We examined medical records for these six patients for potential etiologic factors and determined that four of the six patients had undergone prolonged periods of intra-aortic balloon pump therapy with a catheter placed through the femoral artery ipsilateral to the sciatic nerve lesion, and the other two patients had an ipsilateral femoral artery occlusion. In addition, four of the six patients had severe symptomatic peripheral vascular disease, and one of the other patients had severe and prolonged perioperative hypoxia. Although all these patients had pure sciatic neuropathy clinically, two of the four patients studied with electromyography had evidence of damage to the femoral nerve or quadriceps muscles ipsilaterally. In addition to the neurogenic changes, there were electromyographic findings suggestive of muscle ischemia. These results indicate that patients undergoing cardiac surgery may be at risk for development of a sciatic neuropathy if they have compromised blood flow through the femoral artery together with another cause for tissue hypoxia. Furthermore, asymptomatic ischemia of the femoral nerve or quadriceps muscles may occur in this clinical setting.

Pediatric sciatic neuropathies

“…SN has been described after intra-aortic balloon placement in adults. 16 In 2 children, SN was seen following prolonged spica body casting for lumbar vertebral fracture secondary to leukemia and for clubfoot; this is probably due to compression of the nerve. SN has been reported in an adult after a spica body cast.…”

Pitfalls in the electrodiagnostic studies of sacral plexopathies

“…The idiopathic cases were clinically suspected to be secondary to vasculitic, viral, and autoimmune causes and often resulted in extensive diagnostic evaluations in addition to the EDX studies. Iatrogenic causes were seen in patients who had undergone lumbar laminectomy and aortic or cardiac surgeries, with the latter two likely involving perioperative ischemia 4. Other etiologies included intrapartum maternal injuries in four patients (8%), diabetes mellitus in two (3%), and one case of herpes zoster (2%).…”

Ultrasound-guided perineural steroid injection to treat intractable pain due to sciatic nerve injury

“…Cardiac surgery has also been reported as a cause of sciatic neuropathy. 5,6 Kempster et al identified ten patients in a period of six years who underwent cardiac surgery and developed bilateral but asymmetrical sciatic neuropathy leading to prominent causalgic pain. 5 McManis et al reviewed the cardiac surgeries performed at the Mayo Clinic over 15 years and found only six instances of sciatic neuropathy.…”

“…5 McManis et al reviewed the cardiac surgeries performed at the Mayo Clinic over 15 years and found only six instances of sciatic neuropathy. 6 The precise mechanism and location of sciatic nerve injury following cardiac surgery is unknown. The site of sciatic nerve injury was thought to be at the level of the buttocks due to prolonged nerve compression under reduced arterial perfusion during cardiopulmonary bypass 5 or in the mid-thigh due to the presence of a watershed area between the superior and inferior vessels supplying the sciatic nerve in the thigh; 6 however, precise localization of the nerve lesion has not been established.…”