Relationship of segmental variations in the human lumbar plexus to the length of the 12th rib

Tokita, Kounosuke; Anetai, Hidaka; Kojima, Ryuhei; Banneheka, Shyama; Aizawa, Yukio; Naito, Makoto; Nakano, Takashi; Kageyama, Ikuo; Kumaki, Katsuji

doi:10.1016/j.aanat.2020.151592

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…This is also seen after spinal surgery and will usually heal within 2–4 months [ 18 ]. Because there is an anatomic variability of the 12th rib length and course between patients, this could influence the course and branching pattern of the subcostal nerve as well, since the 12th rib length is associated with variations to the lumbar plexus [ 19 ]. In three patients, there was a rudimentary 12th rib and trocar placement was done more lateral from the rib tip.…”

Section: Discussionmentioning

confidence: 99%

A prospective case series to evaluate subcostal nerve injury with high-resolution ultrasound in posterior retroperitoneoscopic adrenalectomy

van Uitert,

Chaman-Baz,

van der Wal

et al. 2024

Surg Endosc

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Background Posterior retroperitoneoscopic adrenalectomy has several advantages over transabdominal laparoscopic adrenalectomy regarding operating time, blood loss, postoperative pain, and recovery. However, postoperatively several patients report chronic pain or hypoesthesia. We hypothesized that these symptoms may be the result of damage to the subcostal nerve, because it passes the surgical area. Methods A prospective single-center case series was performed in adult patients without preoperative pain or numbness of the abdominal wall who underwent unilateral posterior retroperitoneoscopic adrenalectomy. Patients received pre- and postoperative questionnaires and a high-resolution ultrasound scan of the subcostal nerve and abdominal wall muscles was performed before and directly after surgery. Clinical evaluation at 6 weeks was performed with repeat questionnaires, physical examination, and high-resolution ultrasound. Long-term recovery was evaluated with questionnaires, and photographs from the patients were examined for abdominal wall asymmetry. Results A total of 25 patients were included in the study. There were no surgical complications. Preoperative visualization of the subcostal nerve was possible in all patients. At 6 weeks, ultrasound showed nerve damage in 15 patients, with no significant association between nerve damage and postsurgical pain. However, there was a significant association between nerve damage and hypoesthesia (p = 0.01), sensory (p < 0.001), and motor (p < 0.001) dysfunction on physical examination. After a median follow-up of 18 months, 5 patients still experienced either numbness or muscle weakness, and one patient experienced chronic postsurgical pain. Conclusion In this exporatory case series the incidence of postoperative damage to the subcostal nerve, both clinically and radiologically, was 60% after posterior retroperitoneoscopic adrenalectomy. There was no association with pain, and the spontaneous recovery rate was high. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

A prospective case series to evaluate subcostal nerve injury with high-resolution ultrasound in posterior retroperitoneoscopic adrenalectomy

van Uitert,

Chaman-Baz,

van der Wal

et al. 2024

Surg Endosc

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“…We found three innervation patterns in the 5VP specimens: in 5VPa, L2 formed three nerves (ilioinguinal -with L1-, genitofemoral and caudal femoral cutaneous -only L2-); while in 5VPb and 5VPc, L2 also included the femoral and obturator nerves (with L3). Regarding the origin of the lumbosacral sacral trunk, we can define the 6VP as the common conformation due to its higher frequency, so the 5VP specimens showed a cranial shift in the lumbosacral plexus [ 19 ]. The variation in the number of the lumbar vertebrae has been associated with a caudal or a cranial deviation in the lumbar plexus, as we found here in the common opossum.…”

Section: Discussionmentioning

confidence: 99%

“…The variation in the number of the lumbar vertebrae has been associated with a caudal or a cranial deviation in the lumbar plexus, as we found here in the common opossum. This segmental variation could have clinical implications like lumbar radiculopathies [ 19 ]. Thus, it would be fascinating to research this variation in a more significant sample in the common opossum.…”

Section: Discussionmentioning

confidence: 99%

Lumbar vertebral pattern variation in the common opossum ( Didelphis marsupialis Linnaeus, 1758): implication on lumbar nerve distribution

Sepúlveda-Vásquez

Tamayo-Arango

2023

International Journal of Veterinary Science and Medicine

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The lumbar nerve distribution can differ depending on vertebral count variations among individuals of the same species. The variation in the lumbar vertebra formula and the lumbar nerve distribution in twenty adult common opossums (eight female and twelve males) was studied. Radiographs were taken to confirm vertebral identification and count. Two vertebral patterns were recognized: three specimens presented five lumbar vertebrae (5VP) and seventeen individuals presented six lumbar vertebrae (6VP). All the 6VP specimens had the same innervation pattern; however, the 5PV had three different innervation patterns (5PVa, 5VPB, and 5PVc). 5VPa and 6VP differed only in the origin of the lateral femoral cutaneous nerve (L2-L3 and L3, respectively). The differences among 5PVa, 5PVb, and 5VPc were seen in the iliohypogastric nerve, which was formed by L1 in 5VPa and 5VPb, and T13 in 5VPc. The ilioinguinal nerve was formed by L1-L2 in 5VPa and 5VPb, while it was formed by T13-L1 in 5VPc. The genitofemoral nerve was formed by L2-L3 in 5VPa, L2 in 5VPb, and L1-L2 in 5VPc. The cutaneous femoris lateralis was formed by L2-L3 in 5VPa and 5VPc, while it is formed only by L2 in 5VPb. The femoral and obturator nerves were formed by L3-L4 in 5VPa, and L2-L3 in 5VPb and 5VPc. The lumbosacral trunk originated from L4-L5-S1 in 5VP and L5-L6-S1 in 6VP. The data provided in this study may help understand the relationship between the spine and lumbosacral plexus variations and may find application in veterinary spine surgery.

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Prominent caudal shift of the lumbar plexus roots in spines with 18 thoracolumbar vertebrae

Kawashima

Sato

2023

Surg Radiol Anat

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Relationship of segmental variations in the human lumbar plexus to the length of the 12th rib

Cited by 4 publications

References 27 publications

A prospective case series to evaluate subcostal nerve injury with high-resolution ultrasound in posterior retroperitoneoscopic adrenalectomy

A prospective case series to evaluate subcostal nerve injury with high-resolution ultrasound in posterior retroperitoneoscopic adrenalectomy

Lumbar vertebral pattern variation in the common opossum ( Didelphis marsupialis Linnaeus, 1758): implication on lumbar nerve distribution

Prominent caudal shift of the lumbar plexus roots in spines with 18 thoracolumbar vertebrae

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