Sciatic Nerve Injury Related to Hip Replacement Surgery: Imaging Detection by MR Neurography Despite Susceptibility Artifacts

Abstract

Sciatic nerve palsy related to hip replacement surgery (HRS) is among the most common causes of sciatic neuropathies. The sciatic nerve may be injured by various different periprocedural mechanisms. The precise localization and extension of the nerve lesion, the determination of nerve continuity, lesion severity, and fascicular lesion distribution are essential for assessing the potential of spontaneous recovery and thereby avoiding delayed or inappropriate therapy. Adequate therapy is in many cases limited to conservative management, but in certain cases early surgical exploration and release of the nerve is indicated. Nerve-conduction-studies and electromyography are essential in the diagnosis of nerve injuries. In postsurgical nerve injuries, additional diagnostic imaging is important as well, in particular to detect or rule out direct mechanical compromise. Especially in the presence of metallic implants, commonly applied diagnostic imaging tests generally fail to adequately visualize nervous tissue. MRI has been deemed problematic due to implant-related artifacts after HRS. In this study, we describe for the first time the spectrum of imaging findings of Magnetic Resonance neurography (MRN) employing pulse sequences relatively insensitive to susceptibility artifacts (susceptibility insensitive MRN, siMRN) in a series of 9 patients with HRS procedure related sciatic nerve palsy. We were able to determine the localization and fascicular distribution of the sciatic nerve lesion in all 9 patients, which clearly showed on imaging predominant involvement of the peroneal more than the tibial division of the sciatic nerve. In 2 patients siMRN revealed direct mechanical compromise of the nerve by surgical material, and in one of these cases indication for surgical release of the sciatic nerve was based on siMRN. Thus, in selected cases of HRS related neuropathies, especially when surgical exploration of the nerve is considered, siMRN, with its potential to largely overcome implant related artifacts, is a useful diagnostic addition to nerve-conduction-studies and electromyography.

Simultaneous bilateral total hip arthroplasty dislocation with unilateral foot drop following closed reduction

“…Our case is the first description of a sciatic nerve palsy following closed hip reduction caused by compressive injury secondary to a haematoma, although this is a recognised cause of injury following primary and revision hip replacement 13. Given the causes of post reduction sciatic nerve palsy documented being entwinement of the sciatic nerve around the femoral neck, and our case of a direct pressure from a haematoma, we would recommend early surgical exploration, even in cases of painless neuropraxia.…”

T2 mapping of the distal sciatic nerve in healthy subjects and patients suffering from lumbar disc herniation with nerve compression

“…In the right column, the nerve signal decay is shown for the three sequences with the corresponding T2 fit incorporating all available TEs (black dotted line) or matched TEs (green dashed line). When the TEs are matched, a good agreement between magnetic resonance spectroscopy (MRS) and the 3D T2-prepared TSE sequence can be seen, whereas the T2 in the 2D MESE sequence is elevated regardless of TE selection or iatrogenic injury and tumors such as perineuriomas [5][6][7][8], Fabry disease [9][10][11], CMTD [12], or diabetic and other neuropathies [13,14]. Importantly, (semi-)quantitative MRN might be more objective and potentially more robust and reproducible when compared to mere qualitative MRN, with DTI, for instance, being capable of contributing with quantitatively assessable changes by means of diffusion parameters that have already been evaluated among patients with muscular disorders such as myotonic dystrophy [15], radiculopathy [16], CIDP [17], CMTD [18], or different Fig.…”

“…Using qualitative MRN and structural evaluations, the sciatic nerve has shown to be affected in various pathologies, such as hamstring injury due to different causes [5], injection injury after iatrogenic intramuscular infiltrations [6], injury related to hip replacement surgeries [7], perineuriomas [8], Fabry disease [9][10][11], hereditary motor and sensory neuropathies such as Charcot-Marie-Tooth disease (CMTD) [12], or diabetic and other neuropathies [13,14]. These studies conducted primarily visual inspections of the sciatic nerves to detect changes in signal intensities, discontinuities, or lesion loads, often together with evaluations of morphological nerve sizes and volumes [5][6][7][8][9][10][11][12][13][14].…”

MR Neurography: Diagnostic Imaging in the PNS

“…Furthermore, it has to be mentioned that MRN, although a very promising method, holds some limitations such as metal artifacts after iatrogenic nerve injury, due to metal implants placed in direct proximity to the area that has to be examined or due to osteosynthesis after traumatic injury. However, nerve lesion contrast still may be utilized despite implant-related artifacts by employing measures of artifact reduction [22]. It is also noteworthy that high-resolution nerve ultrasound may visualize nerve compromise related to motion with less effort than MRN.…”