Abstract - Sacral nerves that supply the levator ani

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Abstract - Sacral nerves that supply the levator ani

Postby nyt » Fri Dec 18, 2015 10:57 am

Interesting anatomical considerations for those of us with hypertonic pelvic floors.


Clin Anat. 2015 Nov 18. doi: 10.1002/ca.22668. [Epub ahead of print]

Topography and landmarks for the nerve supply to the levator ani and its relevance to pelvic floor pathologies.

Loukas M1,2, Joseph S1,3, Etienne D1,4, Linganna S1, Hallner B1, Tubbs RS1,5.

Abstract
The aim of this study was to explore the anatomical variations of the nerve to the levator ani (LA) and to relate these findings to LA dysfunction. One hundred fixed human female cadavers were dissected using transabdominal, gluteal, and perineal approaches, resulting in two hundred dissections of the sacral plexus. The pudendal nerve and the sacral nerve roots were traced from their origin at the sacral foramina to their termination. All nerves contributing to the innervation of the LA were considered to be the nerve to the LA. Based on the spinal nerve components, the nerve to the LA was classified into the following categories: 50% (n=100) originated from S4 and S5 (Type I); 19% (n=38) originated from S5 (Type II); 16% (n=32) originated from S4 (Type III); 11% (n=22) originated from S3 and S4 (Type IV); 4% (n=8) originated from S3, S4 and S5 (Type V). Two patterns of nerve termination were observed. In 42% of specimens, the nerve to the LA penetrated the coccygeus muscle and assumed an external position along the inferior surface of the LA muscle. In the remaining 58% of specimens, the nerve crossed the superior surface of the coccygeus muscle and continued along the superior surface of the iliococcygeus muscle. Damage to the nerve to LA has been associated with various pathologies. In order to minimize injuries during surgical procedures, a thorough understanding of the course and variations of the nerve to the LA is extremely important. This article is protected by copyright. All rights reserved.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
nyt
 
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