Traumatic lumbar nerve root meningocele

McLennan, James E.; McLaughlin, William T.; Skillicorn, Stanley A.

doi:10.3171/jns.1973.39.4.0528

Cited by 21 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally we would like to remark that in agreement with the literature [3][4][5][6]15,17,18], in our series spontaneous recovery occurred in high percentage of cases. A lower incidence of avulsions in comparison to the brachial counterpart (where avulsions can be found in up to 70% of cases) has been found in our series (23%) and in the literature [5,12,19] but it does not seem to be the only explanation.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Untitled

2014

J Brachial Plex Peripher Nerve Inj

View full text Add to dashboard Cite

Background: Post-traumatic lumbosacral plexus injuries seem to be rare events, spontaneously recovering in high percentage: as surgery is often challenging and results in poor outcome, many Authors have advocated conservative treatment only. Nevertheless surgery should not be ruled out: in invalidating injuries, it can restore basic function in the lower extremities. Therefore, it might be necessary to establish guidelines for the management and the indication to surgery in such cases. This study aims to identify indicators predicting spontaneous recovery or the need for surgery. Method:The clinical and radiological data of 72 patients with a post-traumatic lumbosacral plexus injury were reviewed. A follow up equal or superior to 3 years is available in 42 cases.Results: Lumbosacral plexus injuries mostly occurred during road accidents. The incidence of associated lesions was relevant: bone injuries were found in 85% of patients, internal lesions in 30% and vascular injuries in 8%. Lumbosacral trunk and sacral plexus palsies were the most frequent injury patterns. Root avulsions were revealed in 23% of cases and only in sacral plexus and complete lumbosacral plexus injuries: L5 and S1 were the roots more prone to avulsions. About 70% of cases recovered spontaneously, mostly in 18 months. Spontaneous recovery was the rule in lumbar plexus and lumbosacral trunk injuries (where root avulsions never occurred) or in sacral and complete lumbosacral plexus palsies due to compression injuries. The causative mechanism correlated with the injury pattern, the associated bone injury being often predictive of the severity of the nerve injury. Lumbosacral plexus injuries occurred in car crashes were generally associated with fractures causing compression on the nerves, thus resulting in injuries often amenable of spontaneous recovery. Motorcycle accidents implied high kinetic energy traumas where traction played an important role, as the high percentage of sacroiliac joint separations demonstrated (found in more than 50% of cases and always associated to root avulsions). Loss of sphincteral control and excruciating leg pain were also invariably associated with avulsions.Conclusions: Clinical and radiological data can help to predict the occurrence of spontaneous recovery or the need for surgery in post-traumatic lumbosacral plexus injuries.

show abstract

Section: Discussionsupporting

confidence: 93%

“…Lumbosacral plexus (LSP) injuries are considered rare events and their spontaneous recovery occurs in high percentage [3][4][5][6]: on the other hand, surgery is often demanding and implies multidisciplinary cooperation, whereas outcome is frequently poor. Therefore, some Authors advocate only conservative treatment [5].…”

Section: Introductionmentioning

confidence: 99%

Untitled

2014

J Brachial Plex Peripher Nerve Inj

View full text Add to dashboard Cite

show abstract

“…Essas lesões representam 1% de todas as lesões traumáticas da pélvis. É decorrente de uma tração abrupta das raízes nervosas 1,2,4 . Os mecanismos que provocam a lesão são variados e de determinação difícil em pacientes politraumatizados.…”

Section: Discussionunclassified

“…Os mecanismos que provocam a lesão são variados e de determinação difícil em pacientes politraumatizados. O mecanismo pode ser tanto pela hiperextensão coxofemoral com rotação lateral, ou então pela hiperflexão com abdução dessa articulação, com ou sem flexão do joelho, em ambos criando um vetor resultante sobre as raízes desse plexo, estirado de forma violenta e súbita [1][2][3] .…”

Section: Discussionunclassified

Avulsão traumática de raízes do plexo lombossacro: Relato de caso

Pinheiro¹,

Andrade²,

Ribeiro³

2005

Arq Bras Neurocir

View full text Add to dashboard Cite

RESUMORelata-se um caso de avulsão traumática de raízes do plexo lombossacro. A ressonância magnética da coluna lombossacra evidenciou imagem sugestiva de pseudomeningocele na saída do forame intervertebral L5-S1 direito. A mielografia lombar confirmou a lesão. O diagnóstico foi realizado após dois meses de tratamento de contusão cerebral e múltiplas fraturas de extremidades e bacia. Nenhum tratamento cirúrgico foi oferecido. PALAVRAS-CHAVEPseudomeningocele. Avulsão de raiz. Plexo lombossacro. ABSTRACTTraumatic avulsion of the lumbosacral plexus. Case report A case of a traumatic avulsion of the lumbosacral plexus is reported in a patient which had suffered multiple injuries (brain, hip and limbs). The diagnosis was made by magnetic resonance imaging which showed an image suggestive of pseudomeningocele localized at right L5-S1 intervetebral foramen. The lumbar myelography confirmed the lesion. The diagnosis was concluded after two months of the injury because the patient was comatose during this period. No surgical treatment was proposed. IntroduçãoDiferentemente das lesões traumáticas do plexo braquial, a avulsão do plexo lombossacro é rara. Desde a primeira descrição em 1955, somente 34 casos foram publicados na literatura. Esse tipo de lesão está geralmente associado a traumas múltiplos ou fraturas da cintura pélvica, dificultando o seu diagnóstico. O desenvolvimento da ressonância magnética (RM) atualmente nos possibilita um diagnóstico precoce. Relato do casoJCS, sexo masculino, 27 anos, natural de Angra dos Reis, RJ, pescador, vítima de colisão de lancha contra o bote em que se encontrava, quando exercia a sua profissão. Apresentou contusão cerebral frontal direita, luxação coxofemoral direita com fratura cominutiva do fêmur direito. Após dois meses em coma e em tratamento ortopédico, o exame neurológico evidenciou paralisia dos músculos tibial anterior, fibulares e extensor longo do hálux, à direita. A RM evidenciou, no corte axial em T2, imagem arredondada próxima ao forame intervertebral L5-S1 direito, sugerindo pseudomeningocele (Figura 1). No corte sagital em T1 e T2 constatou-se dilatação fusiforme com sinal isointenso ao líquor, na saída do forame intervertebral L5-S1 direito (Figura 2). Foi realizada mielografia, que confirmou a localização da lesão em L5-S1 (Figuras 3A e 3B). Não foi oferecido tratamento cirúrgico de qualquer espécie.

show abstract

“…Only eight well-documented cases of lumbosacral nerve root trauma with the myelographic findings have been reported (Finney and Wulfman, 1960 (one); Goodell, 1966 (two);Alker et al, 1967 (two); Payne and Thomson, 1969 (one); Carlson and Hoffman, 1971 (one);McLennan et al, 1973 (one)). …”

Section: Case Reportmentioning

confidence: 99%