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LumbosacralPlexus Surgery Hector Giocoli, MD Buenos Aires - Argentina
Characteristics Low incidence: Rarely reported lesions, witch, if posttraumatic, may remain undiagnosed because of the variable destination of the patients in emergency Difficult level diagnosis: Patients witch different parenchimal or visceral lesions, with different problems witch hinder motility (And frequently affected by severe pain) Difficult surgical treatment: Analogous lesions in the brachial plexus are normally treated, and results are quite well known. In this anatomical district surgical approach is not so comfortable and familiar www.hgiocoli.com
EtiologyTraumatic Events • Herniorrhaphy Obstetrical trauma • Appendectomy • Hysterectomy Surgery • Lumbar sympatectomy • Lateral approach to the Abdominal surgery spine Gynecological procedures Tumors Intrapelvic Terminal branches www.hgiocoli.com
Anatomy Lumbar Plexus Spinal roots L2, L3, and L4 (L1 and L5) Located in the corner between vertebral bodies and lateral apophisis Covered by Ascending iliac and cava veins, and by psoas muscle By aorta and common iliac arteries on the right side By iliac arterial and venous plexuses on the leftwww.hgiocoli.com
Anatomy Sacral Plexus Spinal roots L5, S1, and L2 (L4) Lies on the sacro iliac junction Medial to psoas muscle between it and the column Hypogastric artery intermigles the nerve trunks and asending veins cover the plexus The lumbosacral trunk is given by components from L4 and from L5 www.hgiocoli.com
Surgical Techniques Anterior: extraperitoneal Lateral: extraperitoneal Anterior: transperitoneal Posterior: sacrectomyIn some cases is impossible to access to themore proximal sciatic nerve, the bony andligamentous rim of the greater sciatic notch canbe nibbled or drilled away to gain access www.hgiocoli.com