The lateral cutaneous branches of the dorsal rami of the thoraco-lumbar junction

Maigne, Jean-Yves; Lazareth, J. P.; Surville, H. Guérin; Maigne, Robert

doi:10.1007/bf02098698

Cited by 79 publications

(67 citation statements)

References 6 publications

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“…6,7,12 It originates from the upper 3 lumbar spinal nerves (L1-3), passes through the thoracolumbar fascia, and can be entrapped at the osteofibrous orifice where it penetrates the thoracolumbar fascia. 4,[6][7][8] The anatomic and functional bases for the development of SCN entrapment neuropathy are a rigid fascial edge and stretching of the gluteus maximus muscle and skin over a large area during flexion of the hip joint. If the nerve is chronically subjected to stretching, the resulting tissue irritation, edema, inflammatory cell infiltration, and scarring can lead to entrapment.…”

Section: Discussionmentioning

confidence: 99%

“…Anatomic studies have shown that the SCN crosses the iliac crest through the thoracolumbar fascia from a rigid osseoaponeurotic orifice located 7-8 cm from the midline. 6,8 We carefully dissected the subcutaneous soft tissue and identified the SCN by placing a nerve stimulator on the fat layer of the subcutaneous space. The nerve stimulator system consisted of an electrical stimulator (Neuropack MEB2306, Nihon Kohden), bipolar forceps, and a connective wire.…”

Section: Surgical Techniquementioning

confidence: 99%

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Surgical treatment of superior cluneal nerve entrapment neuropathy

Morimoto

Isu

Kim

et al. 2013

SPI

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Object Superior cluneal nerve (SCN) entrapment neuropathy is a poorly understood clinical entity that can produce low-back pain. The authors report a less-invasive surgical treatment for SCN entrapment neuropathy that can be performed with local anesthesia. Methods From November 2010 through November 2011, the authors performed surgery in 34 patients (age range 18–83 years; mean 64 years) with SCN entrapment neuropathy. The entrapment was unilateral in 13 patients and bilateral in 21. The mean postoperative follow-up period was 10 months (range 6–18 months). After the site was blocked with local anesthesia, the thoracolumbar fascia of the orifice was dissected with microscissors in a distal-to-rostral direction along the SCN to release the entrapped nerve. Results were evaluated according to Japanese Orthopaedic Association (JOA) and Roland-Morris Disability Questionnaire (RMDQ) scores. Results In all 34 patients, the SCN penetrated the orifice of the thoracolumbar fascia and could be released by dissection of the fascia. There were no intraoperative surgery-related complications. For all patients, surgery was effective; JOA and RMDQ scores indicated significant improvement (p < 0.05). Conclusions For patients with low-back pain, SCN entrapment neuropathy must be considered as a causative factor. Treatment by less-invasive surgery, with local anesthesia, yielded excellent clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Surgical treatment of superior cluneal nerve entrapment neuropathy

Morimoto

Isu

Kim

et al. 2013

SPI

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“…[4][5][6][7][8] In fact, 1.6% 6 to 12% 4 of all LBP is due to SCN entrapment neuropathy. Surgical release at the point where the SCN exits through the osteofibrous orifice has been reported as effective.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of ICG video angiography in the surgical treatment of superior cluneal nerve entrapment neuropathy

Kim

Isu²,

Chiba³

et al. 2013

SPI

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Superior cluneal nerve (SCN) entrapment neuropathy is a known cause of low back pain. Although surgical release at the entrapment point of the osteofibrous orifice is effective, intraoperative identification of the thin SCN in thick fat tissue and confirmation of sufficient decompression are difficult. Intraoperative indocyanine green video angiography (ICG-VA) is simple, clearly demonstrates the vascular flow dynamics, and provides real-time information on vascular patency and flow. The peripheral nerve is supplied from epineurial vessels around the nerve (vasa nervorum), and the authors now present the first ICG-VA documentation of the technique and usefulness of peripheral nerve neurolysis surgery to treat SCN entrapment neuropathy in 16 locally anesthetized patients. Clinical outcomes were assessed with the Roland-Morris Disability Questionnaire before surgery and at the latest follow-up after surgery. Indocyanine green video angiography was useful for identifying the SCN in fat tissue. It showed that the SCN penetrated and was entrapped by the thoracolumbar fascia through the orifice just before crossing over the iliac crest in all patients. The SCN was decompressed by dissection of the fascia from the orifice. Indocyanine green video angiography visualized the SCN and its termination at the entrapment point. After sufficient decompression, the SCN was clearly visualized on ICG-VA images. Low back pain improved significantly, from a preoperative Roland-Morris Questionnaire score of 13.8 to a postoperative score of 1.3 at the last follow-up visit (p < 0.05). The authors suggest that ICG-VA is useful for the inspection of peripheral nerves such as the SCN and helps to identify the SCN and to confirm sufficient decompression at surgery for SCN entrapment.

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“…14,16 This tendency was more marked for low thoracic and high lumbar vertebral injuries, re¯ecting the long branches of the thoracic dorsal rami, running caudally and dorsolaterally in an oblique direction. 17,18 Despite such a complicated innervation of the long spinal muscles, the multisegmental MEP exploration of the muscles showed evidence of focal conduction abnormalities in eight of 13 patients with thoracic compression myelopathy. The site of a sharply localized latency increase or, less frequently, failure of conduction across a cord segment was consistent with the compressive lesion site shown by MRI.…”

Section: Discussionmentioning

confidence: 99%

Motor evoked potentials elicited from erector spinae muscles in patients with thoracic myelopathy

et al. 2002

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Study design: A prospective study was conducted to test the utility of the motor evoked potentials (MEPs) from the erector spinae muscles as a measure to estimate the motor level of thoracic compression myelopathies in 13 consecutive patients. Objective: To con®rm whether this test is a useful addition to the neurological examination in non-invasively localizing the level responsible for the main functional change in mild to moderate thoracic myelopathy. Setting: Department of Orthopaedic Surgery, Kochi Medical School, Kochi, Japan. Methods: This electrophysiological study consisted of transcranial magnetic stimulation (TMS) of the brain and surface recording of MEPs from voluntarily contracted erector spinae muscles with the patient in the prone position. The recordings were obtained unilaterally from the same side as the lower-limb aected at 12 serial interspinous levels from T5-6 to L4-5. The results were compared to the MEP data from normal subjects and to neurological and MRI ®ndings.Results: Multisegmental MEP studies demonstrated a focal conduction block in one patient, a single site of conduction delay in seven, and normal conduction in ®ve. The conduction block was characterized by an abrupt reduction in amplitude of the MEPs. Examination of the sites conduction delay showed that the latency dierence between the two adjacent levels was longer than the corresponding normal upper limit by 1.00+0.40 ms (range, 0.62 ± 1.61 ms). The site of conduction abnormalities approximated to the compressive lesion site shown by MRI. All ®ve patients with false-negative MEP ®ndings had the lesion site at or caudal to the T10-11 vertebral level. Conclusion: This method has the advantage of instantaneously testing multisegments of the thoracic spinal cord. The technique is of particular value in estimating the motor level of the lesions rostral to T10-11 vertebral level, which can not be achieved by clinical examinations or MEP recordings from the lower limb.

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The lateral cutaneous branches of the dorsal rami of the thoraco-lumbar junction

Cited by 79 publications

References 6 publications

Surgical treatment of superior cluneal nerve entrapment neuropathy

Surgical treatment of superior cluneal nerve entrapment neuropathy

The usefulness of ICG video angiography in the surgical treatment of superior cluneal nerve entrapment neuropathy

Motor evoked potentials elicited from erector spinae muscles in patients with thoracic myelopathy

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