DOCSLIB.ORG

Localisation of Hypogastric Nerves and Pelvic Plexus in Relation to Rectal Cancer Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Localisation of Hypogastric Nerves and Pelvic Plexus in Relation to Rectal Cancer Surgery Revista Anatomy ok 28/9/07 11:04 Página 111 Eur J Anat, 11 (2): 111-118 (2007) Localisation of hypogastric nerves and pelvic plexus in relation to rectal cancer surgery I. Bissett1, A. Zarkovic2, P. Hamilton2 and S. Al-Ali2 1- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand 2- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auc- kland, New Zealand SUMMARY mm below a line joining the upper surfaces of two acetabula. This study shows that extrafas- Urinary, bowel, and sexual dysfunction caused cial excision does not damage the hypogastric by iatrogenic lesions of the pelvic plexus nerves or the pelvic plexuses and provides a remain a common complication of radical way to radiologically assess the proximity of a pelvic surgery. Preservation of these nerves tumour to the pelvic plexus. Such knowledge during surgery is hampered by their poor aids in preoperative planning to reduce the visualisation within the pelvic cavity and their incidence of post-operative pelvic autonomic small size. Recently, increased awareness of dysfunction. the high incidence of post-operative autonom- ic dysfunction has led to the development of nerve-sparing surgical techniques. This study Key words: Anatomy – Pelvic plexus – Col- aims to expand our knowledge of the anatomy orectal surgery – Rectal neoplasms of the pelvic plexus, to contribute to further enhancement of nerve sparing surgical tech- INTRODUCTION niques. Dissections of the hypogastric nerves and pelvic plexuses were performed on 10 The importance of the hypogastric nerves cadavers. We showed that nerves from the and the pelvic plexuses has only become clear pelvic plexus that supply the rectum can be over the last few years, during which time mobilised to a length of 10-15 mm and thus many authors have reported a high incidence can be identified and safely divided, leaving of urinary and sexual dysfunction following the pelvic plexus intact following the extrafas- rectal excision (Balslev and Harling, 1983; cial excision of the rectum. Likewise, the Gerstenberg et al., 1980; Hjortrup et al., hypogastric nerves, which are enveloped in a 1984; Hojo et al., 1989; Kinn and Ohman, layer of parietal fascia, also remain intact. The 1986; La Monica et al., 1985; Neal et al., fascia containing the hypogastric nerves was 1981; Santangelo et al., 1987; Williams and separated from the fascia propria by a loose Slack, 1980). Lepor et al. (1985) identified the areolar layer. Pelvic plexuses measured about nerves responsible for potency and described 30 by 30 mm in size. Radiological images their course in the pelvis based on serial giant showed the plexuses to be positioned about 5 sections of the pelvis of a cadaver. Other stud- Correspondence to: Mr. Ian Bissett. Department of Surgery, University of Auckland, Level 12, Room 12.087, Auckland City Hospital Support Building, Park Road, Grafton, Auckland, New Submitted: February 23, 2007 Zealand. Phone: +64 9 373 7599 ext 89820; Fax: +64 9 377 9656. E-mail: i.bis- Accepted: July 5, 2007 [email protected] 111 Revista Anatomy ok 28/9/07 11:04 Página 112 I. Bissett, A. Zarkovic, P. Hamilton and S. Al-Ali ies of the pelvic nerves followed, leading to The study included 10 adult, unembalmed the development of several descriptions of sur- cadavers (9 male and 1 female) aged 52-85 gical techniques aimed at preserving the years who required a post-mortem. Patients nerves (Havenga et al., 1996; Heald, 1997; who had previously undergone pelvic surgery Maas et al., 1998; Moriya et al., 1995). Some or who had been dead for more than 36 hours studies involved microscopic dissection of were excluded. The post-mortem was initially foetal tissue where the nerves are thicker and performed by the pathologist leaving the are surrounded by a small amount of connec- pelvic organs intact. Dissection of the pelvis tive tissue (Fritsch, 1989). Baader and Her- was performed immediately following the rmann (2003) investigated the pelvic pathologist’s post-mortem examination. In autonomic nerves in adults and their implica- addition, gross and microdissection using a tions in pelvic surgery. Despite advances in surgical stereomicroscope was carried out on a nerve-sparing surgery, the pelvic plexus further two formalin-preserved sagittally sec- remains liable to iatrogenic injury due to the tioned hemi- and whole male pelvises. small size of the individual nerve fibers, the First, extrafascial dissection of the rectum depth and narrowness of the pelvis, which can was performed on all specimens. The dissec- hinder precise surgical access, and confusion tion involved operating through the midline relating to the anatomical description and sur- incision that had already been performed for gical nomenclature of these structures. In the post-mortem. The dissection began at the addition, authors have often described the aortic bifurcation and continued directly on pelvic autonomic nerves as web-like in struc- the rectal fascia propria. The extrafascial dis- ture and as lying in different fascial planes. In section was continued up to the “lateral liga- particular, the relationship of the nerves to the ments” of the rectum. In this study, the fascia propria has profound implications in “lateral ligaments” refer to the condensation of surgery for rectal cancer. Radiological identifi- endopelvic connective tissue encountered on cation of the position of the pelvic plexus the anterolateral aspect of the dissection in the would also allow preoperative assessment of extrafascial plane below the peritoneal reflec- tumour proximity to the plexuses, facilitating tion. They contain the autonomic nerves pass- decision making and the planning of surgery. ing to the rectum from the pelvic plexuses The aims of this study are: (Rutegard et al., 1997). To confirm the integrity of the pelvic Mobilization of the rectum anterior to plexuses and hypogastric nerves after extrafas- these attachments was then carried out. The cial excision (EFE) in rectal surgery length of the nerves from their exit from the To identify the length and position of the pelvic plexus on the parietal fascia to the point nerves passing from the pelvic plexuses to the of their entry into the fascia propria after rectum during EFE mobilization of the rectum was measured in To identify the position of the pelvic millimeters using a calliper. The position of plexuses in relation to a known radiological the uppermost nerve fibres in the “lateral lig- landmark ament” was then determined in relation to the To clarify the site of the hypogastric nerves lateral peritoneal reflection, and a plane in the retrorectal fascial planes. through the tip of the greater trochanter. The distance from the most superior nerve to the peritoneum on the lateral side of the rectum MATERIALS AND METHODS was measured in millimeters. The greater trochanter was then palpated through the skin Ethical approval for this study was granted on each side and a Kirschner wire inserted by the Auckland Ethics Committee. The transversely immediately above it until the cadavers used in this study were bequeathed to point was visible in the pelvic cavity. The dis- the Department of Anatomy with Radiology tance in millimeters from the tip of the wire under the terms of the New Zealand Human to the uppermost nerve of the “lateral liga- Tissue Act (1964) for teaching and research. ment” was measured on each side. Consent was obtained from the immediate rel- Next, the pelvic plexuses were identified atives of the deceased. The present work con- on the pelvic sidewall after extrafascial exci- forms to the provision of the Declaration of sion of the rectum. The vertical and horizon- Helsinki in 1995, as revised in Edinburgh tal dimensions of the plexuses were measured 2000. in millimeters with a calliper and recorded. 112 Revista Anatomy ok 28/9/07 11:04 Página 113 Localisation of hypogastric nerves and pelvic plexus in relation to rectal cancer surgery Radio-opaque skin staples were attached to Dissection of the formalin-preserved male the upper, lower, anterior and posterior bor- hemi-pelvis was commenced at the bifurcation ders of the pelvic plexuses. An AP X-ray of the of the common iliac vessels, where the hypogas- pelvis was performed to demonstrate the posi- tric nerve was located descending in the tion of the pelvic plexuses in the bony skele- retroperitoneal fascia. It was followed to its ter- ton. The midpoints of the pelvic plexuses were mination at the postero-superior surface of the plotted on the X-rays by finding the point of pelvic plexus. A second contribution to the transection of lines drawn through the skin pelvic plexus was identified as pelvic splanch- staples. A line was then drawn joining the nic nerves contributing to the postero-inferior upper surface of the acetabulum on both sides. plexus. Further dissection of the formalin-pre- The distance from the midpoint of the pelvic served whole male pelvis involved cutting the plexus to the upper acetabular line was then pubic bones medial to the acetabula and remov- measured for each side on the X-ray films. ing the anterior border of the pelvic bowl. Fol- After removal of the rectum and measure- lowing identification and gross dissection of ment of the pelvic plexuses, the parietal fascia the hypogastric nerves, the pelvic peritoneum enveloping the superior hypogastric plexus was removed and the pelvic plexus microscopi- immediately anterior to the aortic bifurcation cally dissected within
Load more

Recommended publications
  • Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions
    Hindawi International Journal of Rheumatology Volume 2020, Article ID 2919625, 13 pages https://doi.org/10.1155/2020/2919625 Review Article Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions Worku Abie Liyew Biomedical Science Department, School of Medicine, Debre Markos University, Debre Markos, Ethiopia Correspondence should be addressed to Worku Abie Liyew; [email protected] Received 25 April 2020; Revised 26 June 2020; Accepted 13 July 2020; Published 29 August 2020 Academic Editor: Bruce M. Rothschild Copyright © 2020 Worku Abie Liyew. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lumbar disc degeneration is defined as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced flexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on
    [Show full text]
  • Spinal Nerves, Ganglia, and Nerve Plexus Spinal Nerves
    Chapter 13 Spinal Nerves, Ganglia, and Nerve Plexus Spinal Nerves Posterior Spinous process of vertebra Posterior root Deep muscles of back Posterior ramus Spinal cord Transverse process of vertebra Posterior root ganglion Spinal nerve Anterior ramus Meningeal branch Communicating rami Anterior root Vertebral body Sympathetic ganglion Anterior General Anatomy of Nerves and Ganglia • Spinal cord communicates with the rest of the body by way of spinal nerves • nerve = a cordlike organ composed of numerous nerve fibers (axons) bound together by connective tissue – mixed nerves contain both afferent (sensory) and efferent (motor) fibers – composed of thousands of fibers carrying currents in opposite directions Anatomy of a Nerve Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Epineurium Perineurium Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Endoneurium Nerve Rootlets fiber Posterior root Fascicle Posterior root ganglion Anterior Blood root vessels Spinal nerve (b) Copyright by R.G. Kessel and R.H. Kardon, Tissues and Organs: A Text-Atlas of Scanning Electron Microscopy, 1979, W.H. Freeman, All rights reserved Blood vessels Fascicle Epineurium Perineurium Unmyelinated nerve fibers Myelinated nerve fibers (a) Endoneurium Myelin General Anatomy of Nerves and Ganglia • nerves of peripheral nervous system are ensheathed in Schwann cells – forms neurilemma and often a myelin sheath around the axon – external to neurilemma, each fiber is surrounded by
    [Show full text]
  • A Step Towards Stereotactic Navigation During Pelvic Surgery: 3D Nerve Topography
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Erasmus University Digital Repository Surgical Endoscopy and Other Interventional Techniques https://doi.org/10.1007/s00464-018-6086-3 A step towards stereotactic navigation during pelvic surgery: 3D nerve topography A. R. Wijsmuller1,2 · C. Giraudeau3 · J. Leroy4 · G. J. Kleinrensink5 · E. Rociu6 · L. G. Romagnolo7 · A. G. F. Melani7,8,9 · V. Agnus2 · M. Diana3 · L. Soler3 · B. Dallemagne2 · J. Marescaux2 · D. Mutter2 Received: 10 May 2017 / Accepted: 1 February 2018 © The Author(s) 2018. This article is an open access publication Abstract Background Long-term morbidity after multimodal treatment for rectal cancer is suggested to be mainly made up by nerve- injury-related dysfunctions. Stereotactic navigation for rectal surgery was shown to be feasible and will be facilitated by highlighting structures at risk of iatrogenic damage. The aim of this study was to investigate the ability to make a 3D map of the pelvic nerves with magnetic resonance imaging (MRI). Methods A systematic review was performed to identify a main positional reference for each pelvic nerve and plexus. The nerves were manually delineated in 20 volunteers who were scanned with a 3-T MRI. The nerve identifiability rate and the likelihood of nerve identification correctness were determined. Results The analysis included 61 studies on pelvic nerve anatomy. A main positional reference was defined for each nerve. On MRI, the sacral nerves, the lumbosacral plexus, and the obturator nerve could be identified bilaterally in all volunteers. The sympathetic trunk could be identified in 19 of 20 volunteers bilaterally (95%).
    [Show full text]
  • 35. Lumbar Plexus. Sacral Plexus. Coccygeal Plexus
    GUIDELINES Students’ independent work during preparation to practical lesson Academic discipline HUMAN ANATOMY Topic LUMBAR PLEXUS. SACRAL PLEXUS. COCCYGEAL PLEXUS 1. Relevance of the topic Lumbar, sacral and coccygeal plexuses innervate the skin of the abdomen, lower back and lower extremities and all the muscles of the lower limbs. Acquired knowledge is the basis for many fields of practical medicine, such as neurology, surgery and traumatology. 2. Specific objectives After the lesson the student should know and be able to: - describe the sources of the formation of the lumbar plexus; - classify the nerves of the lumbar plexus; - to be able to demonstrate and define the branches of the lumbar plexus; - describe sources of sacral plexus formation; - classify sacral plexus nerves; - be able to demonstrate and identify short and long branches of the sacral plexus; - describe the sources of formation coccygeal plexus; - classify coccygeal plexus nerves; - be able to demonstrate and identify branches of coccygeal plexus; - to explain the innervation of muscles and skin in the areas of the lower back and lower extremity. 3. Basic level of preparation For practical this lesson a student should know and be able: - to know the anatomy of the spine, pelvis, lower extremities; - to analyze and show large and small pelvis, their bones; - to analyze and demonstrate bones and joints of the lower limbs; - to demonstrate muscles of the abdomen, perineum, pelvic girdle and lower limbs; - to know the anatomy (external and internal structure) of the spinal cord; - to know the spinal nerve anatomy. 4. Tasks for independent work during preparation for the classes 4.1.
    [Show full text]
  • Management of Metastatic Tumors Invading the Peripheral Nervous System
    Neurosurg Focus 22 (6):E14, 2007 Management of metastatic tumors invading the peripheral nervous system JOHN GACHIANI, M.D.,1 DANIEL H. KIM, M.D.,3 ADRIANE NELSON, M.D.,2 AND DAVID KLINE, M.D.1 Departments of 1Neurosurgery and 2Pathology, Louisiana State University Health Sciences Center; 3Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana Object. The authors present the results of a retrospective review of 37 surgically treated metastases to nerve (malignant peripheral non–neural sheath nerve tumors). Tumor frequencies, presentations, management, and prognosis are discussed. Methods. Thirty-seven patients who were treated for metastases to nerve between 1969 and 2006 at the Louisiana State University Health Sciences Center were identified in a review of patient records. Notes regarding patient history and physical examination findings were reviewed to provide informa- tion on presenting symptoms and signs. Imaging and histopathological examination results were also reviewed. Cases were analyzed depending on the primary tumor and the location of metastasis. Results. There included 37 surgically treated lesions, 16 of which originated in the breast and 10 of which originated in the lung. In two cases melanomas had metastasized to nerve, and one tumor each had metastasized from the bladder, rectum, skin, head and neck, and thyroid, and from a primary Ewing sarcoma. There was a single lymphoma that had metastasized to the radial nerve and one chor- doma and one osteosarcoma, each of which had metastasized to the brachial plexus. Conclusions. The nervous system is involved in numerous ways by oncological process. Direct involvement of the peripheral nervous system occurs mostly from direct extension, although it occa- sionally occurs because of distant spread from the primary tumor to nerve.
    [Show full text]
  • Spinal Nerves and Reflexes
    Central Nervous System - Spinal Nerves and Reflexes Chapter 13B Spinal Nerves - Number There are 31 pairs of spinal nerves…a total of 62 nerves. Spinal cord is located in the vertebral canal. Spinal nerves exit vertebral column through intervertebral foramina. Intervertebral foramen Vertebral canal Spinal Nerves Interneuron Sensory neuron Sensory fiber Spinal nerve Motor neuron Motor fiber All spinal nerves are mixed nerves….contain sensory and motor fibers. Spinal Nerves - Supply N V C2–C3 C2 C 3 C3 C4 Spinal nerves go to skin, muscles and some T2 C4 C5 T3 T1 of the internal organs. T4 T2 T5 C5 T3 T T 6 4 T7 T5 T8 Dermatomes: areas of the skin that is T2 T6 T9 T T2 T7 10 connected to a specific spinal nerve. T11 T8 T12 T9 C L1 6 T10 L2 T T L3 1 11 L4 C Myotomes: specific muscles that are C6 L 7 T12 5 L1 supplied by a specific spinal nerve. S4S L 3 2 S2 C8 C8 T L3 L1 1 1 S5 C7 S1 L5 L4 S2 L2 KEY L5 L Spinal cord regions 3 = Cervical = Thoracic S = Lumbar 1 = Sacral L4 ANTERIOR POSTERIOR Spinal Nerves - Branches Spinal nerve Dorsal Dorsal root Dorsal root ganglion ramus Spinal nerve Ventral Dorsal horn ramus Ventral Ventral root horn Rami communicantes After exiting vertebral column, EACH spinal nerve splits into branches, called rami: 1. Dorsal ramus: contains nerves that serve the dorsal portions of the trunk- carry visceral motor, somatic motor, and sensory information to and from the skin and muscles of the back.
    [Show full text]
  • BOOK REVIEW Central Nerve Plexus Injury
    Spinal Cord (2009) 47, 271–272 & 2009 International Spinal Cord Society All rights reserved 1362-4393/09 $32.00 www.nature.com/sc BOOK REVIEW Central nerve plexus injury Carlstedt T even though the book was published in 2007, only about 10% Central Nerve Plexus Injury, London, Imperial College Press, 2007, of the references listed in this chapter were published after 192 pages, US $128.00 2000, and the most recent papers were published in 2004. ISBN-10: 1860945732; ISBN-13: 978-1860945731 In Chapter 7, the author describes his approach to managing the brachial and lumbosacral plexuses. His Spinal Cord (2009) 47, 271–272; doi:10.1038/sc.2008.111 descriptions of surgical procedures are well written. How- ever, the quality of the photographs of surgical procedures is The fact that neurons from the central nervous system can less than satisfactory in most instances. regenerate into peripheral nerves has been known for a long In Chapter 8, Dr Carlstedt describes his experiences with time.1 Now,inhisbook,DrCarlstedtappliesthisconceptto intradural root repair in a limited series of patients. He repair avulsion injuries of the brachial and lumbosacral plexus. attributes any and all recovery experienced by these patients In Chapter 1 of his book, Dr Carlstedt briefly describes the to the spinal procedure and then challenges the axiom that history of brachial plexus repair, up to his first cases of root normal function cannot be restored after any procedure in reimplantation into the spinal cord. the brachial plexus, excluding neurolysis. The fact that he In Chapter 2, he reviews the mechanisms and patterns of fails to consider other nonsurgical sources of recovery within root avulsion, reinforcing the concept that the lower roots of his small series of patients is disturbing.
    [Show full text]
  • The Intrinsic Cardiac Nervous System and Its Role in Cardiac Pacemaking and Conduction
    Journal of Cardiovascular Development and Disease Review The Intrinsic Cardiac Nervous System and Its Role in Cardiac Pacemaking and Conduction Laura Fedele * and Thomas Brand * Developmental Dynamics, National Heart and Lung Institute (NHLI), Imperial College, London W12 0NN, UK * Correspondence: [email protected] (L.F.); [email protected] (T.B.); Tel.: +44-(0)-207-594-6531 (L.F.); +44-(0)-207-594-8744 (T.B.) Received: 17 August 2020; Accepted: 20 November 2020; Published: 24 November 2020 Abstract: The cardiac autonomic nervous system (CANS) plays a key role for the regulation of cardiac activity with its dysregulation being involved in various heart diseases, such as cardiac arrhythmias. The CANS comprises the extrinsic and intrinsic innervation of the heart. The intrinsic cardiac nervous system (ICNS) includes the network of the intracardiac ganglia and interconnecting neurons. The cardiac ganglia contribute to the tight modulation of cardiac electrophysiology, working as a local hub integrating the inputs of the extrinsic innervation and the ICNS. A better understanding of the role of the ICNS for the modulation of the cardiac conduction system will be crucial for targeted therapies of various arrhythmias. We describe the embryonic development, anatomy, and physiology of the ICNS. By correlating the topography of the intracardiac neurons with what is known regarding their biophysical and neurochemical properties, we outline their physiological role in the control of pacemaker activity of the sinoatrial and atrioventricular nodes. We conclude by highlighting cardiac disorders with a putative involvement of the ICNS and outline open questions that need to be addressed in order to better understand the physiology and pathophysiology of the ICNS.
    [Show full text]
  • Overview of Spinal Nerves
    Spinal Nerves Boundless Overview of Spinal Nerves Spinal nerves, a part of the PNS, generally refers to mixed nerves, with motor, sensory, and autonomic signals between the CNS and the body. 1. fig. 1 shows a spinal nerve Spinal nerves arise from a combination of nerve fibers: the dorsal and ventral roots of the spinal cord. Afferent sensory axons, bringing sensory information from the body to the spinal cord and brain, travel through the dorsal roots of the spinal cord, and efferent motor axons, bringing motor information from the brain to the body, travel through the ventral roots of the spinal cord. All spinal nerves except the first pair emerge from the spinal column through an opening between vertebrae, called an intervertebral foramen. The spinal nerves are typically labeled by their location in the body: thoracic, lumbar, or sacral. Dorsal Root: Also known as the posterior root, the afferent sensory root of a spinal nerve. Autonomic: Acting or occurring involuntarily, without conscious control. Intervertebral Foramen: The foramen allows for the passage of the spinal nerve root, dorsal root ganglion, the spinal artery of the segmental artery, communicating veins between the internal and external plexuses, recurrent meningeal (sinu- vertebral) nerves, and transforaminal ligaments. 2. Source URL: https://www.boundless.com/physiology/peripheral-nervous-system-pns/spinal-nerves/ Saylor URL: http://www.saylor.org/courses/psych402/ Attributed to: [Boundless] www.saylor.org Page 1 of 12 fig. 2 shows intervertebral foramina Intervertebral foramina are indicated by arrows. Spinal Nerves The term spinal nerve generally refers to a mixed spinal nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body.
    [Show full text]
  • The Spinal Cord and Spinal Nerves
    14 The Nervous System: The Spinal Cord and Spinal Nerves PowerPoint® Lecture Presentations prepared by Steven Bassett Southeast Community College Lincoln, Nebraska © 2012 Pearson Education, Inc. Introduction • The Central Nervous System (CNS) consists of: • The spinal cord • Integrates and processes information • Can function with the brain • Can function independently of the brain • The brain • Integrates and processes information • Can function with the spinal cord • Can function independently of the spinal cord © 2012 Pearson Education, Inc. Gross Anatomy of the Spinal Cord • Features of the Spinal Cord • 45 cm in length • Passes through the foramen magnum • Extends from the brain to L1 • Consists of: • Cervical region • Thoracic region • Lumbar region • Sacral region • Coccygeal region © 2012 Pearson Education, Inc. Gross Anatomy of the Spinal Cord • Features of the Spinal Cord • Consists of (continued): • Cervical enlargement • Lumbosacral enlargement • Conus medullaris • Cauda equina • Filum terminale: becomes a component of the coccygeal ligament • Posterior and anterior median sulci © 2012 Pearson Education, Inc. Figure 14.1a Gross Anatomy of the Spinal Cord C1 C2 Cervical spinal C3 nerves C4 C5 C 6 Cervical C 7 enlargement C8 T1 T2 T3 T4 T5 T6 T7 Thoracic T8 spinal Posterior nerves T9 median sulcus T10 Lumbosacral T11 enlargement T12 L Conus 1 medullaris L2 Lumbar L3 Inferior spinal tip of nerves spinal cord L4 Cauda equina L5 S1 Sacral spinal S nerves 2 S3 S4 S5 Coccygeal Filum terminale nerve (Co1) (in coccygeal ligament) Superficial anatomy and orientation of the adult spinal cord. The numbers to the left identify the spinal nerves and indicate where the nerve roots leave the vertebral canal.
    [Show full text]
  • Autonomic Nervous System
    NERVOUS SYSTEM OUTLINE 18.1 Comparison of the Somatic and Autonomic Nervous Systems 540 18.2 Overview of the Autonomic Nervous System 542 18 18.3 Parasympathetic Division 545 18.3a Cranial Nerves 545 18.3b Sacral Spinal Nerves 545 18.3c Effects and General Functions of the Parasympathetic Division 545 Autonomic 18.4 Sympathetic Division 547 18.4a Organization and Anatomy of the Sympathetic Division 547 18.4b Sympathetic Pathways 550 Nervous 18.4c Effects and General Functions of the Sympathetic Division 550 18.5 Other Features of the Autonomic Nervous System 552 System 18.5a Autonomic Plexuses 552 18.5b Neurotransmitters and Receptors 553 18.5c Dual Innervation 554 18.5d Autonomic Reflexes 555 18.6 CNS Control of Autonomic Function 556 18.7 Development of the Autonomic Nervous System 557 MODULE 7: NERVOUS SYSTEM mck78097_ch18_539-560.indd 539 2/14/11 3:46 PM 540 Chapter Eighteen Autonomic Nervous System n a twisting downhill slope, an Olympic skier is concentrat- Recall from figure 14.2 (page 417) that the somatic nervous O ing on controlling his body to negotiate the course faster than system and the autonomic nervous system are part of both the anyone else in the world. Compared to the spectators in the viewing central nervous system and the peripheral nervous system. The areas, his pupils are more dilated, and his heart is beating faster SNS operates under our conscious control, as exemplified by vol- and pumping more blood to his skeletal muscles. At the same time, untary activities such as getting out of a chair, picking up a ball, organ system functions not needed in the race are practically shut walking outside, and throwing the ball for the dog to chase.
    [Show full text]
  • Dynamic Sling to Support Upper Extremity Post Brachial Plexus Injury To
    Dynamic Sling to Support Upper Extremity Post Brachial Plexus Injury to Return to Active Lifestyle Final Report December 12th, 2012 Team Members Amy Martin (Team Leader) Lindy Couwenhoven (Communicator) Stephen Monette (BWIG) Clair Kurzynski (BSAC) Clients Karen Blaschke, OTR Margaret Overstake Advisor John Puccinelli, Ph.D. 1 Table of Contents Abstract 4 Problem Motivation 5 Client Description 6 Current Devices 6 Marketed Devices 6 Past Prototypes 8 Design Requirements 8 Design Alternatives 9 Backpack Design 9 Ring Design 10 One Strap Design 11 Design Matrix 12 Patient Comfort 13 Effectiveness 13 Ease of Use 14 Adjustability 14 Safety 14 Cost 14 Preliminary Analysis 15 Final Design 16 Fabrication 18 2 Testing 19 Usability 19 Applied Force 20 Final Budget 22 Future Work 22 Timeline 23 References 25 Appendix 26 Product Design Specifications 26 Free Body Diagram Analysis 29 Testing: Raw Data 31 Usability Testing Evaluation Form 33 Usability Testing Instructions 34 3 Abstract The brachial plexus is a network of nerves in the shoulder that can cause varying levels of sensation and motor loss if damaged [1, 2]. Karen Blaschke is an occupational therapist with UW Hospitals and Clinics, and she works with patients that have experienced brachial plexus injury including our client, Margaret Overstake. Our design team was asked to create a dynamic sling that would allow someone with a brachial plexus injury to return to an active lifestyle. The sling should be adaptable for patients at different levels of rehabilitation. The final design we chose to pursue incorporates a chest strap with components that distribute the weight of the injured arm to the opposite shoulder.
    [Show full text]