Sciatic Neuropathy Induced by the Lithotomy Position

Romfh, John H.; Currier, Robert D.

doi:10.1001/archneur.1983.04050020089025

Cited by 16 publications

(5 citation statements)

References 3 publications

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“…The pathogenesis of lithotomy-related SN is poorly understood; it is hypothesized that individuals with persistent fetal sciatic artery may be predisposed to SN in this position. 9,10 Other iatrogenic causes included SN after serial casting for clubfoot (1); the mechanism of SN is unclear although some form of compression seems likely. IM injections, formerly a frequent cause of SN, are now uncommon; only one case attributable to gluteal injection was identified in this series.…”

Section: Resultsmentioning

confidence: 99%

Pediatric sciatic neuropathies

Srinivasan¹,

Ryan

Escolar³

et al. 2011

Neurology

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Objective: The incidence, cause, and prognosis of sciatic neuropathy in children is not well understood. We report our 30-year experience of 53 patients with pediatric sciatic neuropathies (SN).Methods: Prospective review of the history, physical examination, electrophysiologic findings, and clinical course of children with SN. Results:The etiology of SN injury was varied and included trauma (13), iatrogenic causes (13) (8 orthopedic surgeries and 5 miscellaneous surgeries), prolonged extrinsic compression and immobilization (6), tumors (7), vascular (5), idiopathic and progressive (4), infantile and nonprogressive (2), and unknown, presumed postviral (3). Electrophysiologic studies demonstrated abnormalities in motor conduction studies of the peroneal nerve in 44/53 (83%) or tibial nerve in 35/51 (67%). Sensory conduction studies were abnormal in sural nerve in 34 of 43 cases (79%), and superficial peroneal nerves in 15/25 (60%). Needle EMG was abnormal in peroneal innervated muscles in all subjects, in tibial nerve innervated muscles in 43/51 (84%), and in the hamstrings in 18/29 (62%). Prognosis for recovery was variable and depended on the etiology and the severity of the nerve injury. Mononeuropathies are uncommon in children; however, in our experience, pediatric sciatic neuropathy (SN) represents approximately one-fourth of all mononeuropathies. Conclusions:1 SN lesions may be underappreciated in childhood. We describe the clinical features of children who presented with SN over a 30-year period. Clinical assessment. Staff neurologists, neurosurgeons, or orthopedic surgeons evaluated all children in the study before EMG evaluation. A staff electromyographer reviewed the history and neurologic examination at the time of the EMG with the patient and parents/ guardians. Follow-up data were obtained by clinical examination, review of charts, telephone conversations, and occasionally a repeat EMG. Electrophysiologic evaluation.Nerve conduction studies (NCS) and needle EMG were performed in children using Dantec Counterpoint (Dantec Electronic, Tonsbakken, Skovlunde, Denmark), TECS TE42 machine (Teca Corporation, Pleasantville, NY) or the Teca TM Synergy N-EM-EMG monitoring systems (Oxford Instruments, Oxford, UK); standard filter settings were utilized. Electrophysiologic studies were performed without sedation in the majority; in rare instances, sedation was used. In each child with a suspected SN, motor NCS included responses from the extensor digitorum brevis, abductor hallucis brevis, and in some instances tibialis anterior. Sensory NCS included sural nerve and in some instances superficial peroneal nerve responses. Plantar sensory responses were studied in preference to the technically difficult sural response in infants. Contralateral limbs were studied if there was possibility of a systemic process or multiple limb involvement. Normative data were as previously published. 1 H-reflex studies and F-wave studies were performed infrequently. Muscles

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Section: Resultsmentioning

confidence: 99%

Pediatric sciatic neuropathies

Srinivasan¹,

Ryan

Escolar³

et al. 2011

Neurology

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“…In a study by Singhal et al, (5) which investigated the predisposing risk factors for PN following liver transplantation, the following characteristics were found to be associated with PN: tall and slender body shape (BMI < 20 kg/m 2 ), a history of severe and rapid weight loss (> 15 kg in six months), and poor nutritional status (35 mg/dL < serum cholesterol < 56 mg/dL). Other studies have identified a number of other features as potential risk factors for lower extremity neuropathies in the perioperative period, and this includes thin body shape, (5) a history of smoking, (17) a history of alcohol use, (18) presence of diabetes mellitus, (19) anatomic anomalies, (20) prolonged duration in lithotomy, (5) and positioning beyond the comfortable range of motion. (19) Patients who develop PN after liver transplantation are usually treated conservatively using physical therapy, with gradual improvement over time.…”

Section: Discussionmentioning

confidence: 99%

Association between the use of gel pads under patients’ knees and the incidence of peroneal neuropathy following liver transplantation

Kim¹,

Yoon

Kee³

et al. 2014

smedj

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“…21 Both these procedures rely on the hip flexed position, which tensions the sciatic nerve as it courses around the sciatic notch and increases the risk for nerve stretch, compression, and/or ischemia. [22][23][24][25] The clinical picture for spontaneous recovery has recently been described for patients with closed, high sciatic nerve injury. In a cohort of 18 patients, 94% spontaneously regained knee flexion to Medical Research Council (MRC) ≥ 3 and 61% recovered plantar flexion to MRC ≥ 3.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Sciatic Nerve Etiology For Foot Dropmentioning

confidence: 99%

Differential Diagnosis of “Foot Drop”: Implications for Peripheral Nerve Surgery

Seruya

2024

J Reconstr Microsurg

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At least 128,000 patients in the United States each year suffer from foot drop. This is a debilitating condition, marked by the inability to dorsiflex and/or evert the affected ankle. Such patients are rendered to a lifetime of relying on an ankle-foot orthosis (AFO) for walking and nighttime to prevent an equinovarus contracture. Contrary to popular belief, foot drop can be caused by more than just insult to the common peroneal nerve at the fibular head (fibular tunnel). It is a common endpoint for a diverse spectrum of nerve injuries, which may explain its relatively high prevalence. From proximal to distal, these conditions include lumbar spine nerve root damage, sciatic nerve palsy at the sciatic notch, and common peroneal nerve injury at the fibular head. Each nerve condition is marked by a unique clinical presentation, frequency, likelihood for spontaneous recovery, and cadre of peripheral nerve techniques. The ideal surgical technique other than neurolysis for compression remains elusive, with traditional peripheral nerve procedures marred by a wide spectrum of functional results. Based on a careful understanding of why past techniques have achieved limited success, we can formulate a working set of principles to help guide surgical innovation moving forward, such as fascicular nerve transfer.

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Sciatic Neuropathy Induced by the Lithotomy Position

Cited by 16 publications

References 3 publications

Pediatric sciatic neuropathies

Pediatric sciatic neuropathies

Association between the use of gel pads under patients’ knees and the incidence of peroneal neuropathy following liver transplantation

Differential Diagnosis of “Foot Drop”: Implications for Peripheral Nerve Surgery

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