This case study involves a 16-year-old young man, who was involved in a severe motor vehicle accident.
His vehicle impacted on the driver’s side of the vehicle which he was driving. He suffered an impact which caused a closed head injury, a fracture of the face, a C7 lateral process fracture, and a complex pelvic injury. Additionally, he had intra-abdominal hematoma, apparently from the pelvic injury.
The patient underwent emergency surgery immediately following the accident and metal instrumentation was used in his face, pelvis, and spinal column to resolve the urgent injuries he sustained.
Unfortunately within a day of surgery, the patient developed left foot weakness, a condition which has persisted for the past year. In addition to weakness of the leg, the patient describes pain symptoms that seem to be a combination of orthopedic and peripheral nerve conditions.
The pain has been present throughout treatment and is not particularly responsive to Neurontin or Elavil. The pain is on the top of his foot, and affects all of his toes. There are no clear aggravating factors or diminishing factors and is essentially constant. There are few symptoms above the level of the knee.
Based on the timing of the symptoms, physical exam, and the EMG study showing the peroneal nerve loss, the patient’s orthopedic surgeon suspects that there may be an entrapment at the level of the fibular head.
Before planning surgery, the surgeon weighs imaging options so that both spine and soft tissue injury locations can be considered simultaneously. The surgeon determined that it would be difficult to have a useful EMG with regard to clarifying the conduction block location.
Ultimately, an MR Neurography study to evaluate the peroneal nerve at and below the tibial plateau is the focus for surgical treatment.
Based on these findings, two small surgeries are planned. These would be a peroneal nerve neuroplasty at the level of the fibular head, and also a sciatic neuroplasty at the level of the sciatic notch, possibly with removal and/or drilling of any protruding instrumentation which may be impacting the nerve.
The surgeon treating this patient was grateful to have the MR Neurography images for surgical planning and stated he believed more orthopedic surgeons and their patients would benefit from MR Neurography.
There are nearly 30 Nerve Scan Center locations across the United States. If you or someone you know is considering spine fusion or orthopedic surgery, please contact the Neurography Institute so that we can assist in your surgical planning.
The detailed images that can be provided through MR Neurography may mean the difference between a successful spine surgery and failed spine surgery.
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