Introduction: Isolated musculocutaneous nerve injuries occur rarely due to their anatomical location. We present our patient with a musculocutaneous nerve injury in a motorcyclist. Case: The patient was initially treated for a motorcycle accident. Further examination of the patient revealed impaired elbow flexion and numbness of the lateral forearm. Electromyography confirmed impaired function of the musculocutaneous nerve. After 3 months, the patient‘s condition did not show any improvement, neither electromyography confirmed recovery of the nerve activity, so surgical treatment was planned. In the surgical revision, neuroma-in-continuity was discovered and resected. The resulting nerve defect was 6 cm long. We provided nerve grafting using sural nerve from the right lower limb. After surgery, the patient began physical therapy and electrical stimulation. Two years later, the patient reached complete recovery of muscle strength. Conclusion: Due to the lack of improvement after a 3-month period, we proceeded with a surgical revision, which demonstrated a complete lesion of the nerve that could not heal spontaneously. Therefore, we opted for the nerve graft method and the patient regained full function of elbow flexors.

• MeSH
• dopravní nehody MeSH
• dospělí MeSH
• lidé MeSH
• motocykly MeSH
• nervový přenos MeSH
• nervus musculocutaneus * chirurgie   zranění   MeSH
• nervus suralis transplantace   MeSH
• poranění periferního nervu * chirurgie   etiologie   klasifikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach. METHODS: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated. RESULTS: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively. CONCLUSION: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine.

• MeSH
• bederní obratle * chirurgie   anatomie a histologie   MeSH
• bederní svaly * anatomie a histologie   chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mrtvola * MeSH
• nervus femoralis anatomie a histologie   chirurgie   MeSH
• nervus obturatorius anatomie a histologie   chirurgie   MeSH
• plexus lumbosacralis * anatomie a histologie   chirurgie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Chronic low back pain, affecting up to 58% of the population, often stems from intervertebral disc degeneration. Although magnetic resonance imaging (MRI) is commonly used for diagnostics, challenges arise in pinpointing pain sources due to frequent asymptomatic findings. Single-photon emission tomography (SPECT) integrated with computed tomography (CT) offers a promising approach, enhancing sensitivity and specificity. METHODS: In this retrospective study, spanning 2016 to 2022, SPECT/CT imaging was performed on 193 patients meeting specific criteria. We correlated SPECT/CT findings with lumbar MRI results, utilizing Pfirrmann and Rajasekaran classifications for disc degeneration and endplate damage assessment. Logistic regression analysis adjusted for age and sex evaluated associations. RESULTS: Of 965 spinal levels assessed, SPECT/CT positivity strongly correlated with higher Pfirrmann grades and Rajasekaran endplate classifications. Notably, Modic changes (MCs) on MRI displayed a nonsignificant relationship with SPECT/CT positivity. Significant associations were observed in older patients with positive MCs, Pfirrmann grades, and Rajasekaran classifications. CONCLUSIONS: This comprehensive study, the largest of its kind, establishes a significant link between SPECT/CT positivity and advanced lumbar degenerative changes. Higher Pfirrmann grades and increased Rajasekaran endplate damage demonstrated substantial correlations with SPECT/CT positivity. Notably, MCs did not exhibit such association. Our findings underscore the potential of SPECT/CT in identifying pain generators in degenerative spinal conditions, offering valuable insights for future interventions.

• MeSH
• bederní obratle diagnostické zobrazování   MeSH
• chronická bolest diagnostické zobrazování   etiologie   MeSH
• degenerace meziobratlové ploténky * diagnostické zobrazování   komplikace   MeSH
• dospělí MeSH
• jednofotonová emisní výpočetní tomografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lumbalgie * diagnostické zobrazování   etiologie   MeSH
• magnetická rezonanční tomografie * metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• SPECT/CT metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• lidé MeSH
• nervus radialis * diagnostické zobrazování   MeSH
• neurilemom * diagnostické zobrazování   chirurgie   MeSH
• reflex fyziologie   MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Awareness of unique path of the superficial branch of the radial nerve and its unusual sensory distribution can help avoid potential diagnostic confusion. We present a unique case encountered during a routine dissection of a Central European male cadaver. An unusual course of the superficial branch of the radial nerve was found in the right forearm, where the superficial branch of the radial nerve originated from the radial nerve distally, within the supinator canal, emerged between the extensor digitorum and abductor pollicis longus muscles and supplied the second and a radial half of the third digit, featuring communications with the lateral antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve. Due to dorsal emerging of the superficial branch of the radial nerve the dorsal aspect of the thumb was innervated by the lateral antebrachial cutaneous nerve. To our best knowledge such variation of the superficial branch of the radial nerve has never been reported before. This variation dramatically changes aetiology and manifestation of possible entrapment syndromes which clinicians should be aware of.

• MeSH
• anatomická variace * MeSH
• disekce MeSH
• kosterní svaly * inervace   abnormality   MeSH
• lidé MeSH
• mrtvola * MeSH
• nervus radialis * anatomie a histologie   abnormality   MeSH
• předloktí * inervace   abnormality   MeSH
• prsty ruky * inervace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Many surgical strategies aim to treat the symptomatic neuroma of the superficial branch of the radial nerve (SBRN). It is still difficult to treat despite many attempts to reveal a reason for surgical treatment failure. The lateral antebrachial cutaneous nerve (LACN) is known to overlap and communicate with SBRN. Our study aims to determine the frequency of spreading of LACN fibers into SBRN branches through a microscopic dissection to predict where and how often LACN fibers may be involved in SBRN neuroma. METHODS: Eighty-seven cadaveric forearms were thoroughly dissected. The path of LACN fibers through the SBRN branching was ascertained using microscopic dissection. Distances between the interstyloid line and entry of LACN fibers into the SBRN and emerging and bifurcation points of the SBRN were measured. RESULTS: The LACN fibers joined the SBRN at a mean distance of 1.7 ± 2.5 cm proximal to the interstyloid line. The SBRN contained fibers from the LACN in 62% of cases. Most commonly, there were LACN fibers within the SBRN's third branch (59%), but they were also observed within the first branch, the second branch, and their common trunk (21%, 9.2%, and 22%, respectively). The lowest rate of the LACN fibers was found within the SBRN trunk (6.9%). CONCLUSION: The SBRN contains LACN fibers in almost 2/3 of the cases, therefore, the denervation of both nerves might be required to treat the neuroma. However, the method must be considered based on the particular clinical situation.

• MeSH
• disekce metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrtvola * MeSH
• nádory periferního nervového systému chirurgie   MeSH
• nervová vlákna MeSH
• nervus radialis * anatomie a histologie   chirurgie   MeSH
• neurom * chirurgie   MeSH
• předloktí inervace   chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The sural nerve is a somatosensory nerve that provides sensation to the posterolateral aspect of the lower leg and the lateral part of the ankle and foot. Due to its location and anatomical properties, it is often used as an autologous nerve graft. However, the nerve harvest can be complicated by the presence of side branches. The objective of this study was to investigate the anatomy of the sural nerve and to map its side branches. This information can be used to predict the localization of separate incisions during the stair-step incisions technique for nerve harvest, thereby reducing the risk of complications. METHODS: The study involved the dissection of 50 adult cadaveric legs (25 left and 25 right) obtained from 27 Central European cadavers. The focus of the dissection was to identify the sural nerve, small saphenous vein, and surrounding anatomical structures. Detailed measurements were taken on the side branches of the sural nerve, tributaries of the small saphenous vein, and their interrelationship. RESULTS: The average number of sural nerve side branches in a single leg was 4.2±1.9. These side branches were categorized into six groups based on their location and course: mediodistal, medioproximal, lateroproximal, laterodistal, medial perpendicular, and lateral perpendicular. Specific patterns of combination of these side branches were also identified and described. The branching point of the sural nerve was found to be 5.8±2.7 cm proximal to the lateral malleolus, whereas the small saphenous vein branching point was located more distally, 4.5 ± 2.8 cm proximal to the lateral malleolus. The highest density of sural nerve side branches was found 2.1-6.0 cm above the lateral malleolus. CONCLUSION: This study presents valuable data about the relationship between the sural nerve and the surrounding anatomical structures in the distal part of the leg, including the identification of its side branches and their relevance during nerve harvest procedures. On the basis of the most frequent locations of side branches, a three-incision-technique for nerve harvest is proposed.

• MeSH
• bérec * inervace   anatomie a histologie   MeSH
• disekce MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrtvola * MeSH
• nervus suralis * anatomie a histologie   MeSH
• odběr tkání a orgánů metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vena saphena anatomie a histologie   inervace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The adoption of health care restrictions due to the COVID-19 pandemic led to the cancellation of elective surgical care. However, the impact on patients is unknown. OBJECTIVE: To evaluate the psychological and economic impact of the cancellation of scheduled spinal operations. METHODS: We identified 50 patients with cancelled surgeries between 16 March 2020 and 24 April 2020. Forty-nine (98%) participants were contacted, with whom the modified WES-Pi questionnaire was filled in during a telephone interview. RESULTS: Of the 49 respondents, 28 (57.2%) were aged <65 years. The most often reported problem (85.7%) was an ongoing limitation in basic daily activities. At least moderate sadness was experienced by 65.3% and disappointment by 73.5% of the patients. More than 80% reported concerns about the continuation and 73.5% about the progression of their symptoms. Out of 27 employees (55.1%), 63% could not work due to severe pain or movement limitation (p < .001). The inability to work was associated with anger (p = .037). The work-related impact of the cancellation was associated with stress (p < .0001) and concerns about continuing the symptoms (p = .004). Two-third of patients would undergo immediate surgery despite the current epidemic situation. CONCLUSIONS: The cancellations of elective spinal surgeries have a serious psychological impact on patients. This together with potential economic consequences is especially evident in employees unable to work due to pain or movement disability. The information is beneficial for health management. Every effort should be made to resume planned surgical treatment if the epidemiological situation allows it.

• MeSH
• bolest MeSH
• COVID-19 * MeSH
• elektivní chirurgické výkony MeSH
• lidé MeSH
• operační sály MeSH
• pandemie * MeSH
• schůzky a rozvrhy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The lateral antebrachial cutaneous nerve (LACN) is a somatosensory nerve coursing in the lateral portion of the forearm. The nerve is located in a close proximity to the cephalic vein (CV) all along its course with a danger of being injured during venipuncture. The LACN also overlaps and communicates with the superficial branch of the radial nerve (SBRN) in the distal forearm and hand, making the awareness of their relationship of great importance in the treatment of neuroma. The aim of the study was to observe the relationship of the LACN to surrounding structures as well as its branching pattern and distribution. MATERIALS AND METHODS: Ninety-three cadaveric forearms embalmed in formaldehyde were dissected. The relationship of the LACN to surrounding structures was noted and photographed, and distances between the structures were measured with a digital caliper. The cross-sectional relationships of the LACN and SBRN to the CV were described using heatmaps. RESULTS: The emerging point of the LACN was found distally, proximally or at the level of the interepicondylar line (IEL). The LACN branched in 76 cases (81.7 %) into an anterior and posterior branch at mean distance of 47.8 ± 34.2 mm distal to the IEL. The sensory distribution was described according to the relationship of the LACN branches to the medial border of the brachioradialis muscle. The LACN supplying the dorsum of the hand was observed in 39.8 % of cases. The LACN and the SBRN intersected in 86 % of upper limbs with communications noticed in 71 % of forearms. The LACN was stated as the most frequent donor of the communicating branch resulting in neuroma located distal to the communication and being fed from the LACN. The relationship of the LACN and the CV showed that the IEL is the most appropriate place for the venipuncture due to maximal calibers of the CV and deep position of the LACN. The LACN was adjacent to the cubital perforating vein and the radial artery in all cases. The medial border of the brachioradialis muscle was observed less than 1.8 mm from the LACN. CONCLUSION: The study provides morphological data on the LACN distribution, branching pattern and relationship to surrounding structures in a context of clinical use in different spheres of medicine. The branching pattern of the LACN appears to be more constant compared to data provided by previous authors. We emphasized the meaning of cross-sectional relationship of the LACN to the CV to avoid venipuncture outside the cubital fossa if possible. The posterior branch of the LACN was predicted as appropriate donor of the graft for a digital nerve. The LACN appeared to be in a close proximity within the whole length of the brachioradialis muscle what the orthopedic surgeons must be concerned of. The meaning of the donor-nerve of the communicating branch in neuroma treatment was also introduced.

• MeSH
• arteria radialis MeSH
• lidé MeSH
• mrtvola MeSH
• nervus radialis anatomie a histologie   MeSH
• neurom * MeSH
• předloktí * inervace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Dual nerve transfer of the spinal accessory nerve to the suprascapular nerve (SAN-SSN) and the radial nerve to the axillary nerve is considered to be the most feasible method of restoration of shoulder abduction in brachial plexus injuries. Supraspinatus muscle plays an important role in the initiation of abduction and its functional restoration is crucial for shoulder movements. There are two possible approaches for the SAN-SSN transfer: the more conventional anterior approach and the posterior approach in the area of scapular spine, which allows more distal neurotization. Although the dual nerve transfer is a widely used method, it is unclear which approach for the SAN-SSN transfer results in better outcomes. We conducted a search of English literature from January 2001 to December 2021 using the PRISMA guidelines. Twelve studies with a total 142 patients met our inclusion criteria. Patients were divided into two groups depending on the approach used: Group A included patients who underwent the anterior approach, and Group B included patients who underwent the posterior approach. Abduction strength using the Medical Research Scale (MRC) and range of motion (ROM) were assessed. The average MRC grade was 3.57 ± 1.08 in Group A and 4.0 ± 0.65 (p = 0.65) in Group B. The average ROM was 114.6 ± 36.7 degrees in Group A and 103.4 ± 37.2 degrees in Group B (p = 0.247). In conclusion, we did not find statistically significant differences between SAN-SSN transfers performed from the anterior or posterior approach in patients undergoing dual neurotization technique for restoration of shoulder abduction.

• MeSH
• kognice MeSH
• lidé MeSH
• nervový transfer * MeSH
• nervus radialis MeSH
• rameno * chirurgie   MeSH
• regenerace nervu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH