Sciatic-to-Femoral Nerve End-to-End Coaptation for Proximal Lower Extremity Function in Patients With Acute Flaccid Myelitis: Technical Note and Review of the Literature

Abstract BACKGROUND Acute flaccid myelitis (AFM) is an acute-onset anterior horn disease resulting in flaccid paralysis of extremities, trunk, facial, and cervical musculature in children following upper respiratory or gastrointestinal viral illness. Nerve transfer procedures have been shown to restore function. OBJECTIVE To present a technical description of sciatic-to-femoral nerve transfers in 4 children with AFM. METHODS Retrospective review of relevant cases was performed. RESULTS A total of 4 cases are presented of young children with persistent quadriparesis in the setting of AFM, presenting between 4 and 15 mo following initial diagnosis. Electromyography showed denervation of muscles innervated by the femoral nerve, with sparing of the sciatic distribution. The obturator nerve was also denervated in all patients. We therefore elected to pursue sciatic-to-femoral transfers to restore active knee extension. These transfers involved end-to-end coaptation of a sciatic nerve fascicle to the femoral nerve motor branches supplying quadriceps muscles. CONCLUSION We present technical descriptions of bilateral sciatic-to-femoral nerve neurotization for the restoration of quadriceps function in 4 patients with AFM. The sciatic nerve fascicles are a reasonable alternative donor nerve for patients with proximal muscle paralysis and limited donor options in the lower extremity.

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Nerve transfers for femoral nerve palsy: an updated approach and surgical technique

Journal of Neurosurgery ◽

10.3171/2021.2.jns203463 ◽

2021 ◽

pp. 1-11

Author(s):

Blair R. Peters ◽

Austin Y. Ha ◽

Amy M. Moore ◽

Thomas H. Tung

Keyword(s):

Pain Score ◽

Nerve Palsy ◽

Femoral Nerve ◽

Surgical Techniques ◽

Nerve Transfer ◽

Knee Extension ◽

Lower Extremity Function ◽

Nerve Decompression ◽

Nerve Transfers ◽

Femoral Nerve Palsy

OBJECTIVE Femoral nerve palsy results in significant impairment of lower extremity function due to the loss of quadriceps muscle function. The authors have previously described their techniques utilizing the anterior obturator and sartorius nerves for transfer in cases of femoral nerve palsy presenting within 1 year of injury. In the current study, the authors discuss their updated techniques, results, and approach to partial and complete femoral nerve palsies using femoral nerve decompression and nerve transfers. METHODS They conducted a retrospective review of patients with femoral nerve palsies treated with their technique at the Washington University School of Medicine in 2008–2019. Primary outcomes were active knee extension Medical Research Council (MRC) grades and visual analog scale (VAS) pain scores. RESULTS Fourteen patients with femoral nerve palsy were treated with femoral nerve decompression and nerve transfer: 4 with end-to-end (ETE) nerve transfers, 6 with supercharged end-to-side (SETS) transfers, and 4 with ETE and SETS transfers, using the anterior branch of the obturator nerve, the sartorius branches, or a combination of both. The median preoperative knee extension MRC grade was 2 (range 0–3). The average preoperative VAS pain score was 5.2 (range 1–9). Postoperatively, all patients attained an MRC grade 4 or greater and subjectively noted improved strength and muscle bulk and more natural gait. The average postoperative pain score was 2.3 (range 0–6), a statistically significant improvement (p = 0.001). CONCLUSIONS Until recently, few treatments were available for high femoral nerve palsy. A treatment strategy involving femoral nerve decompression and nerve transfers allows for meaningful functional recovery and pain relief in cases of partial and total femoral nerve palsy. An algorithm for the management of partial and complete femoral nerve palsies and a detailed description of surgical techniques are presented.

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Contralateral Obturator Nerve to Femoral Nerve Transfer for Restoration of Knee Extension After Acute Flaccid Myelitis

JBJS Case Connector ◽

10.2106/jbjs.cc.19.00073 ◽

2019 ◽

Vol 9 (4) ◽

pp. e0073-e0073 ◽

Cited By ~ 2

Author(s):

Kazuteru Doi ◽

Sei Haw Sem ◽

Yasunori Hattori ◽

Sotetsu Sakamoto ◽

Kota Hayashi ◽

...

Keyword(s):

Femoral Nerve ◽

Nerve Transfer ◽

Knee Extension ◽

Obturator Nerve ◽

Acute Flaccid Myelitis

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Functional Improvement of Upper and Lower Extremity After Decompression and Neurolysis and Nerve Transfer in a Pediatric Patient with Acute Flaccid Myelitis

American Journal of Case Reports ◽

10.12659/ajcr.915235 ◽

2019 ◽

Vol 20 ◽

pp. 668-673 ◽

Cited By ~ 2

Author(s):

Rahul Kumar Nath ◽

Chandra Somasundaram

Keyword(s):

Lower Extremity ◽

Pediatric Patient ◽

Nerve Transfer ◽

Functional Improvement ◽

Acute Flaccid Myelitis

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Retroperitoneal approach for the treatment of diaphragmatic crus syndrome: technical note

Journal of Neurosurgery Spine ◽

10.3171/2020.1.spine191455 ◽

2020 ◽

Vol 33 (1) ◽

pp. 114-119

Author(s):

Zach Pennington ◽

Bowen Jiang ◽

Erick M. Westbroek ◽

Ethan Cottrill ◽

Benjamin Greenberg ◽

...

Keyword(s):

Blood Flow ◽

Lower Extremity ◽

Complete Resolution ◽

Vascular Malformations ◽

Acute Onset ◽

Technical Note ◽

Symptom Improvement ◽

Artery Of Adamkiewicz ◽

Full Neurological Recovery ◽

Flow Through

OBJECTIVEMyelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery.METHODSAll patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients’ symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia.RESULTSAll patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge.CONCLUSIONSDiaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.

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Knee extension rate of torque development and peak torque: associations with lower extremity function

Journal of Cachexia Sarcopenia and Muscle ◽

10.1002/jcsm.12285 ◽

2018 ◽

Vol 9 (3) ◽

pp. 530-539 ◽

Cited By ~ 7

Author(s):

Yusuke Osawa ◽

Stephanie A. Studenski ◽

Luigi Ferrucci

Keyword(s):

Lower Extremity ◽

Peak Torque ◽

Knee Extension ◽

Extension Rate ◽

Lower Extremity Function ◽

Rate Of Torque Development ◽

Extremity Function ◽

Torque Development

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Validation of Smartphone Accelerometry for the Evaluation of Sit-To-Stand Performance and Lower-Extremity Function in Older Adults

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0428 ◽

2021 ◽

pp. 1-9

Author(s):

Yuwei Song ◽

Momotaz Begum ◽

Sajay Arthanat ◽

Dain P. LaRoche

Keyword(s):

Older Adults ◽

Lower Extremity ◽

Force Plate ◽

Knee Extension ◽

Whole Body ◽

Lower Extremity Function ◽

Fast Speed ◽

Motion System ◽

Sit To Stand ◽

Extremity Function

This study tested the concurrent and construct validity of smartphone accelerometry measurement of sit-to-stand (STS) performance in individuals aged 65–89 years. Normal and fast STS times were recorded by smartphone accelerometer, force plate, and video motion systems concurrently, and isokinetic knee extension power and STS whole-body power were obtained. Normal and fast speed STS times from a smartphone accelerometer agreed closely with force plate and motion system methods (mean difference = 0.04 s). Normal and fast STS times were inversely related to isokinetic knee extension power (r = −.93, p < .001 and r = −.82, p < .001, respectively) and STS whole-body power (r = −.76, p < .001 and r = −.70, p < .001, respectively). The STS time obtained from a smartphone accelerometer was equivalent to the established, precise measures of STS time and was related to lower-extremity power, making it a potentially useful metric of lower-extremity function.

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Effects of Exercise on Lower Extremity Muscle Function After Anterior Cruciate Ligament Reconstruction

Journal of Sport Rehabilitation ◽

10.1123/jsr.22.1.33 ◽

2013 ◽

Vol 22 (1) ◽

pp. 33-40 ◽

Cited By ~ 24

Author(s):

Christopher Kuenze ◽

Jay Hertel ◽

Joseph M. Hart

Keyword(s):

Anterior Cruciate Ligament ◽

Lower Extremity ◽

Muscle Function ◽

Cruciate Ligament ◽

Knee Extension ◽

Lower Extremity Function ◽

Significant Group ◽

Lower Extremity Muscle ◽

Extremity Function ◽

Anterior Cruciate

Purpose:Persistent quadriceps weakness due to arthrogenic muscle inhibition (AMI) has been reported after anterior cruciate ligament (ACL) reconstruction. Fatiguing exercise has been shown to alter lower extremity muscle function and gait mechanics, which may be related to injury risk. The effects of exercise on lower extremity function in the presence of AMI are not currently understood. The purpose of this study was to compare the effect of 30 min of exercise on quadriceps muscle function and soleus motoneuron-pool excitability in ACL-reconstructed participants and healthy controls.Methods:Twenty-six (13 women, 13 men) healthy and 26 (13 women, 13 men) ACL-reconstructed recreationally active volunteers were recruited for a case-control laboratory study. All participants completed 30 min of continuous exercise including alternating cycles of inclined-treadmill walking and bouts of squats and step-ups. Knee-extension torque, quadriceps central activation ratio (CAR), soleus H:M ratio, and soleus V:M ratio were measured before and after 30 min of exercise.Results:There was a significant group × time interaction for knee-extension torque (P = .002), quadriceps CAR (P = .03), and soleus V:M ratio (P = .03). The effect of exercise was smaller for the ACL-R group than for matched controls for knee-extension torque (ACL-R: %Δ = −4.2 [−8.7, 0.3]; healthy: %Δ = −14.2 [−18.2, −10.2]), quadriceps CAR (ACL-R: %Δ = −5.1 [−8.0, −2.1]; healthy: %Δ = −10.0 [−13.3, −6.7]), and soleus V:M ratio (ACL-R: %Δ = 37.6 [2.1, 73.0]; healthy: %Δ = −24.9 [−38.6, −11.3]).Conclusion:Declines in quadriceps and soleus volitional muscle function were of lower magnitude in ACL-R subjects than in healthy matched controls. This response suggests an adaptation experienced by patients with quadriceps AMI that may act to maintain lower extremity function during prolonged exercise.

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Mediating effects of lower extremity function on the relationship between night sleep duration and cardiovascular disease risk: a cross-sectional study in elderly Chinese without cardiovascular diseases

BMJ Open ◽

10.1136/bmjopen-2020-046015 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046015

Author(s):

Hui Zhang ◽

Xiaoyu Chen ◽

Peipei Han ◽

Weibo Ma ◽

Yuanyuan Zhang ◽

...

Keyword(s):

Lower Extremity ◽

Sleep Duration ◽

Physical Performance ◽

Indirect Effect ◽

Night Sleep ◽

Lower Extremity Function ◽

Cvd Risk ◽

Extremity Function ◽

Elderly Chinese ◽

The Relationship

ObjectiveThe purpose of this study is to investigate the mediating effect of physical performance on the relationship between night sleep duration and risk of cardiovascular disease (CVD) in elderly Chinese without CVD.Methods782 participants without CVD over 65 years (average: 70.82±3.86 years, 448 women) were included in this study. CVD risk was calculated by the Framingham Risk Score and participants were divided into four groups of night sleep duration (in hours): <7 hours, ≥7–8 hours, >8–9 hours and >9 hours. Upper extremity function was measured by grip strength and lower extremity function was measured by the Short Physical Performance Battery (SPPB), consisting of balance, 4 m walk and chair stands tests.ResultsAfter adjusting for covariates, long night sleep duration (>9 hours) and CVD risk were significantly positively associated compared with moderate night sleep duration (≥7–8 hours) (β=1.152; 95% CI 0.05 to 2.25). SPPB total score (indirect effect ab=−0.122; 95% CI −0.291 to –0.0008) rather than grip strength partially mediated the relationship between long night sleep duration and CVD risk, in which chair stands played a major mediating role (indirect effect ab=−0.171; 95% CI −0.040 to –0.0006), while balance (indirect effect ab=−0.016; 95% CI −0.100 to 0.063) and 4 m walk (indirect effect ab=0.048; 95% CI −0.066 to 0.201) did not.ConclusionsLower extremity function, especially lower limb muscle strength, partially mediates a positive association between long night sleep duration and CVD risk in the elderly without CVD. Suitable interventions for physical performance and sleep may minimise the risk of subsequent CVD.

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