OBJECTIVE: Retrograde ejaculation (RE) is a known complication of anterior lumbar interbody fusion (ALIF) and results from injury to the superior hypogastric plexus (SHP) during intervertebral disc exposure. Yet, there has been no recommendation for SHP mobilization. Thus, the aim of this study was to describe the anatomy of the SHP and vessels at the L5-S1 level, and to evaluate the possibility of SHP mobilization and its retraction to the side. METHODS: Twelve formaldehyde-embalmed cadavers (6 female and 6 male; mean age 65.5 years [range 60-77 years]) were dissected. Distances from the SHP and middle sacral vessels to the midline were measured at the L5-S1 level. The relationship of the great vessel bifurcations and common iliac vessels to the SHP were noted. The extent of lateral retraction of the SHP following mobilization was measured in relation to the midline. Moreover, the positions of the SHP and middle sacral vessels relative to the midline at the L5-S1 level were determined. RESULTS: The SHP formed below the aortic bifurcation and was present at the L5-S1 level in all cases. The SHP overlaid the midline with a left-sided shift. There were 4 cases (33.3%) in which lateral retraction was not achievable because the plexus divided into hypogastric nerves at the L5-S1 level or was too wide for safe mobilization. In the remaining cases, retraction on the left side was achievable up to 15.3 mm from the midline, while retraction to the right side was limited to 5.3 mm from the midline. The types of SHP morphological arrangement included single cord (41.7%), plexiform (41.7%), and fiber (16.6%). CONCLUSIONS: Based on the more extensive left-sided shift of the SHP at the L5-S1 level and frequent presence of the third left splanchnic lumbar nerve, attempting retraction to the left side is recommended. If it is not feasible, the SHP should be split at the midline, with both components mobilized laterally.

• Klíčová slova
• ALIF, anatomy, anterior lumbar interbody fusion, retrograde ejaculation, sexual dysfunction, spinal fusion, superior hypogastric plexus,
• Publikační typ
• časopisecké články MeSH

The sural nerve is commonly used as an autologous nerve graft. Its harvest results in a sensory deficit in the corresponding distribution area. End-to-side neurorrhaphy of the distal sural nerve stump to the superficial fibular nerve could address the problem of sensory loss in the dorsolateral foot without altering the donor nerve. The purpose of our study is to elaborate on a technique for sural nerve-to-superficial fibular nerve end-to-side neurorrhaphy. Fourteen legs from seven formaldehyde-preserved cadavers were dissected. The sural nerve was transected two centimeters above the distal tip of the lateral malleolus (LM) and mobilised to reach the intermediate dorsal cutaneous nerve (IDCN) and the medial dorsal cutaneous nerve (MDCN). The measurements were taken to localise the coaptation points with the nerves. The distal stump of the sural nerve had to be mobilised 18.0 (8.6-24.9) mm distally in relation to the distal tip of LM in order to reach the IDCN. The coaptation point with the IDCN was 18.9 (15.3-22.8) mm above the distal tip of the LM on the anterior margin of the LM. Mobilisation of 33.7 (25.5-38.8) mm was required for reaching the MDCN. The coaptation point with the MDCN was 19.9 (15.8-27.0) mm above the distal tip of the LM, overlaying the lateral margin of the extensor digitorum longus muscle. The end-to-side neurorrhaphy of the sural nerve to the superficial fibular nerve is anatomically feasible and can be performed on both IDCN and MDCN. We recommend using the MDCN due to its larger diameter.

• Klíčová slova
• End-to-side neurorrhaphy, Superficial fibular nerve, Sural nerve, Sural nerve graft,
• Publikační typ
• časopisecké články MeSH

This study aimed to delineate the macroscopic and microscopic topography of muscles surrounding the anterior aspect of the hip joint and the underlaying joint capsule. Seven fresh-frozen cadavers were bilaterally dissected as per study protocol. Eleven hip joints were evaluated macroscopically, while three hip joints underwent histological analysis. Additionally, twenty hip bones and femurs were examined for the osseous morphology near the anterior portion of the articulating surfaces. Macroscopically, the rectus femoris muscle contributed to the articular capsule exclusively through its reflected head. The iliocapsularis and iliopsoas muscles were in direct contact with the articular capsule. Although the iliocapsularis muscle was adherent to the capsule throughout its whole course, the iliopsoas muscle was connected to the capsule through the iliopectineal bursa. Microscopically, different spatial thickness of the capsule was observed, with the thicker regions corresponding to the capsular ligaments. Osseous landmarks, relevant to the course of the iliopsoas muscle, included the iliopsoas notch and a groove for the psoas major muscle. Furthermore, split of the anterior inferior iliac spine and the "subspine" were constant findings corresponding to the origin of the direct head of the rectus femoris and the iliocapsularis muscles, and attachment of the medial band of the iliofemoral ligament, respectively. On the head of the femur, the Poirier's facet (35.0%), the Allen's fossa (60.0%), and the so-called plaque (50.0%) were observed. Conclusively, we introduce the concept of a four-layered anterior musculocapsular complex of the hip, aiming to aid the orthopaedic surgeon in both hip replacement and preservation procedures.

• Klíčová slova
• Acetabulum, Hip capsule, Iliocapsularis muscle, Iliopsoas muscle, Proximal femur,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Periprosthetic infections pose a devastating complication in skeletally immature patients treated for an orthopaedic oncological condition. Reconstructive approaches to revision procedures are often limited, and many cases still require amputation. CASE PRESENTATION: In this report, we present our unique experience with the bio-expandable MUTARS® BioXpand prosthesis, utilized during the second stage of a revision surgery in an adolescent female patient. Initially, the patient underwent reconstruction using a conventional endoprosthesis following the resection of a high-grade distal femur osteosarcoma; however, she developed a deep infection six months later. During a two-stage revision procedure, the infection was successfully eradicated at the cost of loss of growth potential at also the site of proximal tibia. The initial 5 cm limb-length discrepancy was restored through the application of bioexpandable endoprosthesis, which allowed for an 8 cm gain in bone stock. At the last follow-up appointment, the patient was fully weight-bearing and demonstrated excellent clinical outcomes, with no evidence of infection or tumor recurrence. CONCLUSION: This successful limb-salvage procedure indicates that bioexpandable endoprosthesis may serve as a viable and effective reconstructive option in revision surgery for skeletally immature individuals.

• Klíčová slova
• Bioexpandable prosthesis, Knee revision, Lengthening nail, Limb-salvage surgery, MUTARS® BioXpand, Periprosthetic infection, Precise nail,
• MeSH
• femur * chirurgie   patologie   MeSH
• infekce spojené s protézou * chirurgie   etiologie   MeSH
• lidé MeSH
• mladiství MeSH
• nádory femuru * chirurgie   patologie   MeSH
• nádory kostí * chirurgie   patologie   MeSH
• osteosarkom * chirurgie   patologie   MeSH
• prognóza MeSH
• reoperace MeSH
• záchrana končetiny * metody   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The sartorius muscle is typically innervated by two branches of the femoral nerve arising from the lumbar plexus. We present an unreported variant where the sartorius muscle was innervated by an accessory branch arising from the ilioinguinal nerve in addition to the proper two branches from the femoral nerve. The iliohypogastric nerve was fused with the ilioinguinal nerve. More proximally, the lumbar plexus also showed unusual arrangement. The anterior branch of the lateral femoral cutaneous nerve arose from the femoral branch of the genitofemoral nerve while the posterior branch arose directly from the second lumbar nerve. The genital branch of the genitofemoral nerve pierced the psoas major muscle more distally than usual, and featured a close proximity with the femoral nerve. Possible variable appearance of these nerves should be kept in mind during several surgical and diagnostic procedures since their iatrogenic or traumatic damage, or their susceptibility to entrapment, pose unpredictable clinical consequences.

• Klíčová slova
• Ilioinguinal nerve, Lateral femoral cutaneous nerve, Lumbar plexus, Sartorius muscle, Variation,
• MeSH
• anatomická variace * MeSH
• kosterní svaly inervace   abnormality   MeSH
• lidé MeSH
• mrtvola MeSH
• nervus femoralis * abnormality   MeSH
• plexus lumbosacralis * abnormality   anatomie a histologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND AND OBJECTIVES: En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy. METHODS: Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy). RESULTS: The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements. CONCLUSION: The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum.

• MeSH
• křížová kost * chirurgie   anatomie a histologie   inervace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míšní kořeny * anatomie a histologie   chirurgie   MeSH
• mrtvola MeSH
• pudendální nerv anatomie a histologie   chirurgie   MeSH
• senioři MeSH
• splanchnické nervy anatomie a histologie   chirurgie   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: This study provides an insight on the extent of muscular variability at the suprascapular notch and elaborates on its anatomical interference in suprascapular nerve arthroscopic decompression procedures. METHODS: The suprascapular notch was dissected and its muscular topography was observed in 115 cadaveric specimens. High resolution imaging of the suprascapular notch was captured by a handheld digital microscope (Q-scope). The supraspinatus and subscapularis muscles were traced as they course at the suprascapular notch vicinity. The omohyoid muscle attachment onto the suprascapular ligament was measured. A scoping review and meta-analysis were done to investigate the observed rare muscular variants. RESULTS: In 3.48%, the suprascapular notch anterior surface was fully covered by the subscapularis muscle. The omohyoid muscle inserted onto the suprascapular ligament in 31.25% and extended up to 3/4th of the suprascapular ligament length in 2.61%. Two rare variant muscles were encountered: subclavius posticus muscle and a newly reported "coracoscapularis muscle". CONCLUSIONS: Four categories of muscles with topographical relationship to the suprascapular notch and its arthroscopic feasibility have been classified: (1) constant muscles not intervening with the suprascapular notch space - supraspinatus muscle; (2) constant muscles with variable positions that can intervene with the suprascapular notch space - subscapularis muscle; (3) constant muscles with variable positions that can intervene with the surgical approach - omohyoid muscle; (4) variable muscles intervening with the suprascapular notch space and surgical approach - subclavius posticus and coracoscapularis muscles. This study elucidates the necessity to assess/secure the omohyoid muscle attachment onto the suprascapular ligament in suprascapular nerve decompression ligamentectomy. LEVEL OF EVIDENCE: V Basic Science Research.

• Klíčová slova
• Coracoscapularis, Omohyoid, Subclavius Posticus, Subscapularis, Suprascapular nerve entrapment, Suprascapular notch arthroscopy,
• MeSH
• anatomická variace * MeSH
• artroskopie * metody   MeSH
• chirurgická dekomprese metody   MeSH
• kosterní svaly * inervace   anatomie a histologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lopatka inervace   anatomie a histologie   MeSH
• mrtvola * MeSH
• ramenní kloub inervace   chirurgie   anatomie a histologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• studie proveditelnosti 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

Primary tumors of the calcaneus present a reconstructive challenge. Their relatively low incidence leads to limited evidence, clinical experience, and ongoing discussion regarding the optimal surgical strategy. In this report, we present a case of a 19-year-old male diagnosed with an aggressive osteoblastoma who underwent subtotal calcanectomy. A custom 3D-printed titanium endoprosthesis was designed for limb-salvage reconstruction. Trabecular porous structure and screws were used to achieve subtalar and calcaneo-cuboid fusion and to compensate for the deficient ligamentous apparatus following resection. An innovative system for reattachment of the calcaneal tuberosity with spared of the Achilles tendon was also utilized. At 3 months, the implant was completely incorporated, allowing full weight bearing. At the 18-month follow-up, the implant showed no signs of loosening, the patient had no signs of recurrence, had excellent function, and successfully returned to all his pretreatment activities, underscoring the effectiveness of this reconstructive approach in the management of calcaneal tumors.Level of Evidence: IV, Case report.

• Klíčová slova
• 3D-printed endoprosthesis, calcanectomy, calcaneus reconstruction, osteoblastoma, tumor,
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: En-bloc spondylectomy in the lumbar spine is a challenging procedure mainly due to a complex prevertebral anatomy. The aim of our study is to describe the anatomy of the diaphragmatic crura and surrounding vascular and neural structures which may be iatrogenically injured during the surgical resection. MATERIALS AND METHODS: Ten embalmed specimens were meticulously dissected. Widths of the diaphragmatic crura, abdominal aorta, cisterna chyli, thoracic duct, sympathetic trunks, and inferior vena cava as well as their distances from the midline were measured at nine levels (L1 to L4 vertebra and adjacent intervertebral discs). RESULTS: The right crus was attached to the L2-L4 vertebral bodies and L2/3 intervertebral disc, while the left crus inserted onto L1-L3 vertebrae. The thoracic duct arose commonly at the level of L2 vertebra and overlaid the right crus at the L3 vertebra and L2/3-disc levels. The cisterna chyli was present in 70% of specimens and overlapped with the left crus at the same levels. Both sympathetic trunks emerged underneath the crura at the L1/2 discs or L1 vertebra level. The aorta overlapped with the crura at all levels. CONCLUSION: The L3 level appears to be the riskiest for spondylectomy due to the overlap of both diaphragmatic crura with the thoracic duct and cisterna chyli, respectively. Spondylectomy at the L2 level also brings the risk of lymphatic structures injury while injury to the left sympathetic trunk may be the main issue at the L1 level.

• Klíčová slova
• Abdominal aorta, Cisterna chyli, Diaphragmatic crura, Sympathetic trunk, Thoracic duct, Total en bloc spondylectomy,
• Publikační typ
• časopisecké články 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.

• Klíčová slova
• Femoral nerve, Genitofemoral nerve, Iliohypogastric nerve, Ilioinguinal nerve, Lateral femoral cutaneous nerve, Lateral transpsoas approach, Lumbar plexus, Obturator nerve,
• 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