Cases reported "Sciatic Neuropathy"

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1/10. Intraoperative positioning during cesarean as a cause of sciatic neuropathy.

    BACKGROUND: sciatic nerve compression has been well documented as a cause of perioperative sciatic neuropathy but rarely during cesarean. CASE: A parturient complained of left foot drop after cesarean delivery for twins performed under spinal anesthesia. Intraoperatively, her right hip was raised with padding under the right buttock to tilt the pelvis approximately 30 degrees to the left. Postoperatively, the patient had weakness, sensory changes, and diminished reflexes in the left lower extremity. Electrodiagnostic studies supported a diagnosis of neurapraxia and partial denervation in the distribution of the sciatic nerve. By postpartum week 6, she had full recovery. CONCLUSION: Elevating the right buttock during cesarean can cause compression of the underlying structures of the left buttock and result in sciatic neuropathy. Decreasing the duration of time the patient is in the left lateral position may reduce the risk of this uncommon but debilitating complication.
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2/10. sciatic nerve palsy after cementless total hip arthroplasty. Treatment by modular neck and calcar shortening: a case report.

    This is a case report of sciatic nerve palsy after total hip arthroplasty. Although the patient's symptoms became worse postoperatively, full recovery occurred after shortening of the calcar and femoral neck length. For acute sciatic nerve palsy patients with worsening of symptoms in the postoperative course in spite of hip and knee flexion, reexposure for early recognition of the sciatic nerve condition and reoperation by shortening the femoral neck may be an option.
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ranking = 0.28571428571429
keywords = operative
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3/10. hip and pelvic fractures and sciatic nerve injury.

    OBJECTIVE: To investigate the influence of hip and pelvic fracture, especially acetabular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury. methods: From January 1987 to January 2000, 17 patients (14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years. The average age was 38 years (ranging 23-56 years). The left extremities were involved in 11 patients and the right in 6. Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation. RESULTS: Preoperatively, 8 patients were treated with large doses of oral narcotics to control their severe sciatic pain. Three of the 8 patients underwent patient-controlled analgesia and epidural analgesia. After operation, excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively. Four patients still had sciatic pain and 2 patients failed to recover. sciatic nerve function improved within 3-6 months after surgery in 11 patients. CONCLUSIONS: hip and pelvic fractures can result in sciatic nerve injury, especially common peroneal nerve injury and prognosis is poor. Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.
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ranking = 0.28571428571429
keywords = operative
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4/10. Intraneural ganglion cysts: a case of sciatic nerve involvement.

    The pathogenesis of intraneural ganglion cysts is unknown. Some authors have established a connection between the cysts and the joint, while others have failed to find this communication. Most intraneural ganglion cysts occur in the proximity of a joint. We present the case of a 53-year-old Caucasian male with an intraneural cyst of the sciatic nerve located high above its bifurcation and without a connection to the joint. The lesion was microsurgically removed in toto. There was no recurrence of the cyst at follow-up 9 months postoperatively; complete resolution of the clinical symptoms occurred within 8 months of surgery. This case shows that ganglion cysts can occur in locations far from a joint, supporting the extra-articular embryonic synovial remnant theory of their genesis.
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ranking = 0.14285714285714
keywords = operative
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5/10. The risks of overly effective postoperative epidural analgesia.

    Continuous epidural analgesia is frequently used to provide supplemental postoperative pain control. Epidural analgesia has the potential to mask the early symptoms that signal impending complications after even routine surgical procedures. We report a case of sciatic nerve palsy following epidural anesthesia after an uncomplicated leg length correction. Good epidural anesthesia may remove a patient's normal protective sensation, allowing pain and other signs of nerve compression from prolonged unchanged postoperative positioning to go unnoticed. This case highlights the need for heightened awareness of potential neurologic compromise in the setting of epidural analgesia. We recommend closely monitoring the patient's neurologic condition and frequently evaluating the patient's position in bed.
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ranking = 0.85714285714286
keywords = operative
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6/10. sciatic nerve sarcoidosis: utility of magnetic resonance peripheral nerve imaging and treatment with radiation therapy.

    sarcoidosis may involve both the central and peripheral nervous system, although peripheral nerve manifestations are usually seen late in the disease. In this report, the authors describe a case of sarcoidosis in a 22-year-old woman who presented with a foot drop. Although results of conventional lumbar magnetic resonance (MR) imaging were normal, MR peripheral nerve imaging of the thigh showed a mass in the sciatic nerve indicating tumor. An intraoperative biopsy sample revealed noncaseating granulomas consistent with sarcoid. The patient was treated with steroid drugs to control the manifestations of her disease but exhibited early signs of femoral bone necrosis, which required discontinuation of the steroids. She was then treated with local radiation therapy. At her 2-year follow-up visit the patient demonstrated relief of her symptoms and improvement on MR peripheral nerve imaging. This case demonstrates that sarcoidosis may present with peripheral nerve manifestations. The appearance of a diffusely swollen nerve on MR imaging should prompt clinicians to include sarcoidosis in the differential diagnosis and plan surgery accordingly. patients who are not responsive to or who are unable to tolerate medical therapy may be treated with radiation therapy.
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ranking = 0.14285714285714
keywords = operative
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7/10. Late sciatic nerve palsy caused by hematoma after primary total hip arthroplasty.

    A case of late sciatic nerve palsy caused by subfascial hematoma after uncemented right total hip arthroplasty is reported. The patient developed respiratory distress 13 days postoperatively and was admitted to another institution, where she was diagnosed with pulmonary embolism and was subsequently therapeutically anticoagulated with heparin. The patient complained of right-leg numbness and tingling 18 days' postoperatively, which progressed to complete sciatic nerve palsy over several hours.
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ranking = 0.28571428571429
keywords = operative
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8/10. Surgical exposure of the sciatic nerve in the gluteal region: anatomic and historical comparison of two approaches.

    OBJECTIVE: To increase awareness among neurosurgeons of alternative surgical approaches to lesions of the sciatic nerve in the gluteal region. methods: The dominant surgical approach to lesions of the proximal sciatic nerve involves detachment and medial reflection of the gluteus maximus through a question-mark incision. An alternative to this infragluteal exposure is a transgluteal approach, which provides access to the sciatic nerve by splitting the gluteus maximus through a curvilinear incision. We explored the anatomy and surgical history of these approaches through cadaveric study, our own case series, and a literature review. RESULTS: The infragluteal approach uses a larger incision, extensive dissection, and postoperative bracing while allowing wide exposure of the nerve inferiorly into the thigh. By contrast, the transgluteal approach minimizes dissection and spares muscle attachments but requires meticulous attention to hemostasis and provides a more focal exposure of the sciatic nerve. During the past century, the infragluteal approach has been described more frequently and has become increasingly popular among peripheral-nerve surgeons. For comparison, we present three patients in whom the transgluteal approach was used to treat substantial lesions of the proximal sciatic nerve. CONCLUSION: At the present time, the majority of peripheral nerve surgeons use an infragluteal approach to the proximal sciatic nerve. However, for select patients with well-defined and localized lesions, the transgluteal approach may provide sufficient nerve exposure with lowered operative complexity and postoperative morbidity.
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ranking = 0.42857142857143
keywords = operative
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9/10. Pitfalls in the use of acetabular reinforcement rings in total hip revision.

    INTRODUCTION: For the reconstruction of acetabular bone defects different types of acetabular reinforcement rings are being used. In clinical practice, these implants showed to some extent good long-term results. In the present work pitfalls and complications after the implantation of acetabular reinforcement rings as well as possible solutions are being discussed. MATERIAL AND methods: In the first case recurrent dislocation was caused by the malposition of the acetabular component with an impingement of the protruding bone cement and the anterior edge of the acetabular ring as well as muscle insufficiency as a result of the shortening of the leg length. The second case revealed an impingement of the iliopsoas tendon due to a protruding acetabular reinforcement ring. During revision, bone cement was used to smoothen the protruding anterior edge of the acetabular reconstruction ring in order to obtain a relieved sliding of the tendon. Furthermore, we report on the case of a delayed neuropathy of the sciatic nerve after reconstruction of the acetabulum with an acetabular reinforcement ring. RESULTS: Intraoperatively an impingement of the sciatic nerve at the protruding dorsal edge of the acetabular reinforcement ring and the surrounding scar tissue was found. In a further case an aseptic loosening of an acetabular reinforcement ring caused the formation of an excessive granuloma with a large intrapelvic portion. The granuloma led to persisting senso-motoric deficits of the femoral nerve. In summary, based on these clinical cases possible pitfalls, associated with the use of acetabular reinforcement rings, are shown. The mal-positioning and the intra-operative re-shaping of the implant by the surgeon are pointed out as the substantial factors for the occurrence of an impingement phenomenon and total hip instability. Furthermore, in case of an adequate orientation of the cemented polyethylene insert an improper position of the acetabular ring which results in protruding edges has to be considered as a cause of a prosthetic impingement. CONCLUSION: The cases presented emphasize the necessity of prevention of such pitfalls intra-operatively as well as accurate analysis of implant failures. Furthermore, they suggest explicit preoperative planning before deciding on the strategy of revision surgery of acetabular reinforcement rings.
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ranking = 0.57142857142857
keywords = operative
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10/10. A case of sciatic neuropathy after caesarean section under spinal anaesthesia.

    We present a rare case in which a healthy parturient developed a left sciatic neuropathy after spinal anaesthesia for caesarean section. Intraoperatively, a wedge was placed under her right buttock to tilt the pelvis and uterus to the left, to minimise aortocaval compression. Postoperatively, she complained of being unable to move her left foot. neurologic examination revealed a left lower leg paresis. electromyography showed denervation potentials on muscles innervated by left sciatic nerve. Seven weeks after surgery the patient had made a full recovery. We conclude that the prolonged lateral tilt position might cause compression neuropathy of the sciatic nerve. After childbirth, re-positioning the patient supine or shortening the time of lateral tilt may reduce the risk of sciatic nerve injury.
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ranking = 0.28571428571429
keywords = operative
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