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Sciatic nerve injury related to hip replacement surgery: imaging detection by MR neurography despite susceptibility artifacts.

Wolf M, Bäumer P, Pedro M, Dombert T, Staub F, Heiland S, Bendszus M, Pham M - PLoS ONE (2014)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.

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.

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Constriction of the sciatic nerve by surgical material, and denervation of target muscles in patient 2.siMRN revealed compression of the peroneal portion of the left sciatic nerve by a small susceptibility prone foreign body (arrow in a). Besides denervation of the peroneally innervated muscles at the lower leg (c), denervation of the long head of the biceps femoris muscle (b) and slight denervation of the posterior tibialis muscle and the gastrocnemius muscle (c) indicated accompanying affection of the tibial nerve as well. Abbreviations: atm: anterior tibialis muscle; bfm: biceps femoris muscle; edlm: extensor digitorum longus muscle; gm: gastrocnemius muscle; p: peroneal portion of the sciatic nerve or peroneal nerve; plm: peroneus longus muscle; ptm: posterior tibialis muscle; sn: sciatic nerve; t: tibial portion of the sciatic nerve or tibial nerve.
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pone-0089154-g003: Constriction of the sciatic nerve by surgical material, and denervation of target muscles in patient 2.siMRN revealed compression of the peroneal portion of the left sciatic nerve by a small susceptibility prone foreign body (arrow in a). Besides denervation of the peroneally innervated muscles at the lower leg (c), denervation of the long head of the biceps femoris muscle (b) and slight denervation of the posterior tibialis muscle and the gastrocnemius muscle (c) indicated accompanying affection of the tibial nerve as well. Abbreviations: atm: anterior tibialis muscle; bfm: biceps femoris muscle; edlm: extensor digitorum longus muscle; gm: gastrocnemius muscle; p: peroneal portion of the sciatic nerve or peroneal nerve; plm: peroneus longus muscle; ptm: posterior tibialis muscle; sn: sciatic nerve; t: tibial portion of the sciatic nerve or tibial nerve.

Mentions: Patient 2: A 78 year-old male, suffered from severe paresis of the extensors of the left foot and toes (MRC muscle strength grade 1/5), immediately following an ipsilateral HRS 24 months ago (Table 1). MRN revealed compression of the peroneal portion of the left sciatic nerve by a small susceptibility prone foreign body (Figure 3a). Besides signs of denervation of the peroneally innervated muscles at the lower leg (Figure 3c), signs of denervation of the long head of the biceps femoris muscle (Figure 3b) and slightly of the tibialis posterior muscle and the gastrocnemius muscle (Figure 3c) indicated accompanying affection of the tibial division of the sciatic nerve as well. Since recovery of the sciatic nerve was unlikely to occur two years after HRS, surgery was not indicated.


Sciatic nerve injury related to hip replacement surgery: imaging detection by MR neurography despite susceptibility artifacts.

Wolf M, Bäumer P, Pedro M, Dombert T, Staub F, Heiland S, Bendszus M, Pham M - PLoS ONE (2014)

Constriction of the sciatic nerve by surgical material, and denervation of target muscles in patient 2.siMRN revealed compression of the peroneal portion of the left sciatic nerve by a small susceptibility prone foreign body (arrow in a). Besides denervation of the peroneally innervated muscles at the lower leg (c), denervation of the long head of the biceps femoris muscle (b) and slight denervation of the posterior tibialis muscle and the gastrocnemius muscle (c) indicated accompanying affection of the tibial nerve as well. Abbreviations: atm: anterior tibialis muscle; bfm: biceps femoris muscle; edlm: extensor digitorum longus muscle; gm: gastrocnemius muscle; p: peroneal portion of the sciatic nerve or peroneal nerve; plm: peroneus longus muscle; ptm: posterior tibialis muscle; sn: sciatic nerve; t: tibial portion of the sciatic nerve or tibial nerve.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC3928432&req=5

pone-0089154-g003: Constriction of the sciatic nerve by surgical material, and denervation of target muscles in patient 2.siMRN revealed compression of the peroneal portion of the left sciatic nerve by a small susceptibility prone foreign body (arrow in a). Besides denervation of the peroneally innervated muscles at the lower leg (c), denervation of the long head of the biceps femoris muscle (b) and slight denervation of the posterior tibialis muscle and the gastrocnemius muscle (c) indicated accompanying affection of the tibial nerve as well. Abbreviations: atm: anterior tibialis muscle; bfm: biceps femoris muscle; edlm: extensor digitorum longus muscle; gm: gastrocnemius muscle; p: peroneal portion of the sciatic nerve or peroneal nerve; plm: peroneus longus muscle; ptm: posterior tibialis muscle; sn: sciatic nerve; t: tibial portion of the sciatic nerve or tibial nerve.
Mentions: Patient 2: A 78 year-old male, suffered from severe paresis of the extensors of the left foot and toes (MRC muscle strength grade 1/5), immediately following an ipsilateral HRS 24 months ago (Table 1). MRN revealed compression of the peroneal portion of the left sciatic nerve by a small susceptibility prone foreign body (Figure 3a). Besides signs of denervation of the peroneally innervated muscles at the lower leg (Figure 3c), signs of denervation of the long head of the biceps femoris muscle (Figure 3b) and slightly of the tibialis posterior muscle and the gastrocnemius muscle (Figure 3c) indicated accompanying affection of the tibial division of the sciatic nerve as well. Since recovery of the sciatic nerve was unlikely to occur two years after HRS, surgery was not indicated.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.

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.

Show MeSH
Related in: MedlinePlus