Nerve relationships to the sacrospinous ligament: application to suspension procedures and transgluteal approaches for nerve repair and tumor removal with three case illustrations
Background Transvaginal suspension procedures often use the sacrospinous ligament (SSL), which attaches onto the ischial spine (IS). However, nerve-related sequelae (e.g., sciatic nerve injury) following such procedures have been reported. Therefore, the current anatomical study was performed to bet...
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| Veröffentlicht in: | Surgical and radiologic anatomy (English ed.) 2023-06, Vol.45 (6), p.693-698 |
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| creator | Seltzer, Laurel A. Ibrahim, Naser Olewnik, Łukasz Iwanaga, Joe Dumont, Aaron S. Amrami, Kimberly K. Spinner, Robert J. Tubbs, R. Shane |
| description | Background
Transvaginal suspension procedures often use the sacrospinous ligament (SSL), which attaches onto the ischial spine (IS). However, nerve-related sequelae (e.g., sciatic nerve injury) following such procedures have been reported. Therefore, the current anatomical study was performed to better understand these relationships. Additionally, three case illustrations of patients with injury to the sciatic nerve following sacrospinous ligament suspension procedures are included to exemplify the significance of a thorough knowledge of this anatomy.
Methods
In 20 human adult cadavers (40 sides), a gluteal dissection was performed to expose the IS and SSL and regional nerves near the greater sciatic foramen. Measurements between the IS and SSL were made between these structures and surrounding nerves.
Results
The average distance between the IS and sciatic nerve was 1.4 cm. From this bony part, the average distance to the S1 and S2 ventral rami was 3.1 cm and 1.9 cm, respectively. From the IS to the lumbosacral trunk, pudendal nerve, nerve to obturator internus, and superior gluteal nerve, the mean distance was 4 cm, 0.5 cm, 0.7 cm, and 4.5 cm, respectively. From the SSL to the lumbosacral trunk, S1 ventral ramus, and S2 ventral ramus, there was an average distance of 4.2 cm, 1.6 cm, and 0.8 cm, respectively. Statistically, in females, the distances from the IS and SSL to the sciatic nerve, lumbosacral trunk, superior gluteal nerve, and S1 and S2 ventral rami were shorter when compared to males.
Conclusion
An improved understanding of the relationship between the SSL and IS and nerves near the greater sciatic foramen can lead to fewer intraoperative complications during approaches to various peripheral nerves in this region. Lastly, these relationships might help better understand the nerve injuries following pelvic suspension procedures that use the SSL. |
| doi_str_mv | 10.1007/s00276-023-03142-7 |
| format | Article |
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Transvaginal suspension procedures often use the sacrospinous ligament (SSL), which attaches onto the ischial spine (IS). However, nerve-related sequelae (e.g., sciatic nerve injury) following such procedures have been reported. Therefore, the current anatomical study was performed to better understand these relationships. Additionally, three case illustrations of patients with injury to the sciatic nerve following sacrospinous ligament suspension procedures are included to exemplify the significance of a thorough knowledge of this anatomy.
Methods
In 20 human adult cadavers (40 sides), a gluteal dissection was performed to expose the IS and SSL and regional nerves near the greater sciatic foramen. Measurements between the IS and SSL were made between these structures and surrounding nerves.
Results
The average distance between the IS and sciatic nerve was 1.4 cm. From this bony part, the average distance to the S1 and S2 ventral rami was 3.1 cm and 1.9 cm, respectively. From the IS to the lumbosacral trunk, pudendal nerve, nerve to obturator internus, and superior gluteal nerve, the mean distance was 4 cm, 0.5 cm, 0.7 cm, and 4.5 cm, respectively. From the SSL to the lumbosacral trunk, S1 ventral ramus, and S2 ventral ramus, there was an average distance of 4.2 cm, 1.6 cm, and 0.8 cm, respectively. Statistically, in females, the distances from the IS and SSL to the sciatic nerve, lumbosacral trunk, superior gluteal nerve, and S1 and S2 ventral rami were shorter when compared to males.
Conclusion
An improved understanding of the relationship between the SSL and IS and nerves near the greater sciatic foramen can lead to fewer intraoperative complications during approaches to various peripheral nerves in this region. Lastly, these relationships might help better understand the nerve injuries following pelvic suspension procedures that use the SSL.</description><identifier>ISSN: 1279-8517</identifier><identifier>ISSN: 0930-1038</identifier><identifier>EISSN: 1279-8517</identifier><identifier>DOI: 10.1007/s00276-023-03142-7</identifier><identifier>PMID: 37052654</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Adult ; Anatomy ; Cadaver ; Cadavers ; Complications ; Female ; Humans ; Imaging ; Ligaments ; Ligaments, Articular ; Lumbosacral Plexus - anatomy & histology ; Male ; Medicine ; Medicine & Public Health ; Neoplasms ; Original Article ; Orthopedics ; Pelvis - anatomy & histology ; Peripheral nerves ; Pudendal nerve ; Radiology ; Sciatic nerve ; Sciatic Nerve - anatomy & histology ; Surgery</subject><ispartof>Surgical and radiologic anatomy (English ed.), 2023-06, Vol.45 (6), p.693-698</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-a2023aa0db4ef0457da26b6f15b13c69752deccfe961f7854fcc9614345d2cb63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00276-023-03142-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00276-023-03142-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37052654$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Seltzer, Laurel A.</creatorcontrib><creatorcontrib>Ibrahim, Naser</creatorcontrib><creatorcontrib>Olewnik, Łukasz</creatorcontrib><creatorcontrib>Iwanaga, Joe</creatorcontrib><creatorcontrib>Dumont, Aaron S.</creatorcontrib><creatorcontrib>Amrami, Kimberly K.</creatorcontrib><creatorcontrib>Spinner, Robert J.</creatorcontrib><creatorcontrib>Tubbs, R. Shane</creatorcontrib><title>Nerve relationships to the sacrospinous ligament: application to suspension procedures and transgluteal approaches for nerve repair and tumor removal with three case illustrations</title><title>Surgical and radiologic anatomy (English ed.)</title><addtitle>Surg Radiol Anat</addtitle><addtitle>Surg Radiol Anat</addtitle><description>Background
Transvaginal suspension procedures often use the sacrospinous ligament (SSL), which attaches onto the ischial spine (IS). However, nerve-related sequelae (e.g., sciatic nerve injury) following such procedures have been reported. Therefore, the current anatomical study was performed to better understand these relationships. Additionally, three case illustrations of patients with injury to the sciatic nerve following sacrospinous ligament suspension procedures are included to exemplify the significance of a thorough knowledge of this anatomy.
Methods
In 20 human adult cadavers (40 sides), a gluteal dissection was performed to expose the IS and SSL and regional nerves near the greater sciatic foramen. Measurements between the IS and SSL were made between these structures and surrounding nerves.
Results
The average distance between the IS and sciatic nerve was 1.4 cm. From this bony part, the average distance to the S1 and S2 ventral rami was 3.1 cm and 1.9 cm, respectively. From the IS to the lumbosacral trunk, pudendal nerve, nerve to obturator internus, and superior gluteal nerve, the mean distance was 4 cm, 0.5 cm, 0.7 cm, and 4.5 cm, respectively. From the SSL to the lumbosacral trunk, S1 ventral ramus, and S2 ventral ramus, there was an average distance of 4.2 cm, 1.6 cm, and 0.8 cm, respectively. Statistically, in females, the distances from the IS and SSL to the sciatic nerve, lumbosacral trunk, superior gluteal nerve, and S1 and S2 ventral rami were shorter when compared to males.
Conclusion
An improved understanding of the relationship between the SSL and IS and nerves near the greater sciatic foramen can lead to fewer intraoperative complications during approaches to various peripheral nerves in this region. Lastly, these relationships might help better understand the nerve injuries following pelvic suspension procedures that use the SSL.</description><subject>Adult</subject><subject>Anatomy</subject><subject>Cadaver</subject><subject>Cadavers</subject><subject>Complications</subject><subject>Female</subject><subject>Humans</subject><subject>Imaging</subject><subject>Ligaments</subject><subject>Ligaments, Articular</subject><subject>Lumbosacral Plexus - anatomy & histology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasms</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Pelvis - anatomy & histology</subject><subject>Peripheral nerves</subject><subject>Pudendal nerve</subject><subject>Radiology</subject><subject>Sciatic nerve</subject><subject>Sciatic Nerve - anatomy & histology</subject><subject>Surgery</subject><issn>1279-8517</issn><issn>0930-1038</issn><issn>1279-8517</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kc1u1TAQhS0EoqXwAiyQJTZsArZjx7nsUEULUgUbWFuOM7nXlWMHT9KK5-IFcW4uP2LBymP7mzNHcwh5ztlrzph-g4wJ3VRM1BWruRSVfkDOudC7qlVcP_yrPiNPEG8ZY4rz9jE5qzVTolHynPz4BPkOaIZgZ58iHvyEdE50PgBF63LCyce0IA1-b0eI81tqpyl4d8RXEhecIOJ6m3Jy0C8ZkNrY0znbiPuwzGDD2pWTdYfyN6RM42nsZH3e4GUszxnGdFfoez8fiocMQJ1FoD6EBYve0eNT8miwAeHZ6bwgX6_ef7n8UN18vv54-e6mcrVo5sqKshlrWd9JGJhUurei6ZqBq47XrtlpJXpwboBdwwfdKjk4V0pZS9UL1zX1BXm16Rbn3xbA2YweHYRgI5SVGNEy1git5Iq-_Ae9TUuOxV2huGh1K5kulNioda-YYTBT9qPN3w1nZo3UbJGaYtwcIzVr04uT9NKN0P9u-ZVhAeoNwPIV95D_zP6P7E94I7HI</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Seltzer, Laurel A.</creator><creator>Ibrahim, Naser</creator><creator>Olewnik, Łukasz</creator><creator>Iwanaga, Joe</creator><creator>Dumont, Aaron S.</creator><creator>Amrami, Kimberly K.</creator><creator>Spinner, Robert J.</creator><creator>Tubbs, R. Shane</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20230601</creationdate><title>Nerve relationships to the sacrospinous ligament: application to suspension procedures and transgluteal approaches for nerve repair and tumor removal with three case illustrations</title><author>Seltzer, Laurel A. ; Ibrahim, Naser ; Olewnik, Łukasz ; Iwanaga, Joe ; Dumont, Aaron S. ; Amrami, Kimberly K. ; Spinner, Robert J. ; Tubbs, R. Shane</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-a2023aa0db4ef0457da26b6f15b13c69752deccfe961f7854fcc9614345d2cb63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Anatomy</topic><topic>Cadaver</topic><topic>Cadavers</topic><topic>Complications</topic><topic>Female</topic><topic>Humans</topic><topic>Imaging</topic><topic>Ligaments</topic><topic>Ligaments, Articular</topic><topic>Lumbosacral Plexus - anatomy & histology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasms</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Pelvis - anatomy & histology</topic><topic>Peripheral nerves</topic><topic>Pudendal nerve</topic><topic>Radiology</topic><topic>Sciatic nerve</topic><topic>Sciatic Nerve - anatomy & histology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Seltzer, Laurel A.</creatorcontrib><creatorcontrib>Ibrahim, Naser</creatorcontrib><creatorcontrib>Olewnik, Łukasz</creatorcontrib><creatorcontrib>Iwanaga, Joe</creatorcontrib><creatorcontrib>Dumont, Aaron S.</creatorcontrib><creatorcontrib>Amrami, Kimberly K.</creatorcontrib><creatorcontrib>Spinner, Robert J.</creatorcontrib><creatorcontrib>Tubbs, R. 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Shane</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nerve relationships to the sacrospinous ligament: application to suspension procedures and transgluteal approaches for nerve repair and tumor removal with three case illustrations</atitle><jtitle>Surgical and radiologic anatomy (English ed.)</jtitle><stitle>Surg Radiol Anat</stitle><addtitle>Surg Radiol Anat</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>45</volume><issue>6</issue><spage>693</spage><epage>698</epage><pages>693-698</pages><issn>1279-8517</issn><issn>0930-1038</issn><eissn>1279-8517</eissn><abstract>Background
Transvaginal suspension procedures often use the sacrospinous ligament (SSL), which attaches onto the ischial spine (IS). However, nerve-related sequelae (e.g., sciatic nerve injury) following such procedures have been reported. Therefore, the current anatomical study was performed to better understand these relationships. Additionally, three case illustrations of patients with injury to the sciatic nerve following sacrospinous ligament suspension procedures are included to exemplify the significance of a thorough knowledge of this anatomy.
Methods
In 20 human adult cadavers (40 sides), a gluteal dissection was performed to expose the IS and SSL and regional nerves near the greater sciatic foramen. Measurements between the IS and SSL were made between these structures and surrounding nerves.
Results
The average distance between the IS and sciatic nerve was 1.4 cm. From this bony part, the average distance to the S1 and S2 ventral rami was 3.1 cm and 1.9 cm, respectively. From the IS to the lumbosacral trunk, pudendal nerve, nerve to obturator internus, and superior gluteal nerve, the mean distance was 4 cm, 0.5 cm, 0.7 cm, and 4.5 cm, respectively. From the SSL to the lumbosacral trunk, S1 ventral ramus, and S2 ventral ramus, there was an average distance of 4.2 cm, 1.6 cm, and 0.8 cm, respectively. Statistically, in females, the distances from the IS and SSL to the sciatic nerve, lumbosacral trunk, superior gluteal nerve, and S1 and S2 ventral rami were shorter when compared to males.
Conclusion
An improved understanding of the relationship between the SSL and IS and nerves near the greater sciatic foramen can lead to fewer intraoperative complications during approaches to various peripheral nerves in this region. Lastly, these relationships might help better understand the nerve injuries following pelvic suspension procedures that use the SSL.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>37052654</pmid><doi>10.1007/s00276-023-03142-7</doi><tpages>6</tpages></addata></record> |
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| ispartof | Surgical and radiologic anatomy (English ed.), 2023-06, Vol.45 (6), p.693-698 |
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| subjects | Adult Anatomy Cadaver Cadavers Complications Female Humans Imaging Ligaments Ligaments, Articular Lumbosacral Plexus - anatomy & histology Male Medicine Medicine & Public Health Neoplasms Original Article Orthopedics Pelvis - anatomy & histology Peripheral nerves Pudendal nerve Radiology Sciatic nerve Sciatic Nerve - anatomy & histology Surgery |
| title | Nerve relationships to the sacrospinous ligament: application to suspension procedures and transgluteal approaches for nerve repair and tumor removal with three case illustrations |
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