Tables in Original article by JEAN-PIERRE SPINOSA (1, 2) - ERIC DE BISSCHOP (3) - JONATHAN LAURENÇON (1) - GAËL KUHN (1) - BEAT M. RIEDEDERER (1)
Differential staged sacral reflexes allow a localization of pudendal neuralgia
(1) Department of Cellular Biology and Morphology, University of Lausanne, Lausanne, Switzerland
(2) Private practice, Lausanne, Switzerland
(3) Private practice, Aubagne, France
Fig 1. – (A) The technique of pudendal nerve terminal motor latency measurements. (B) Electrophysiological Anatomy. S: indicates the stimulus at the level of the clitoris. Records are made at the level of the anterior and posterior anal sphincter quadrants. LAN: levator ani nerve. PNA: pudendal nerve afferents. PNE: pudendal nerve efferents. MT: medullar transfer. SC: spinal cord. |
Fig 2. – (A) The internal face of the left half pelvis. The red needle indicates the position of the ischial spine: the levator ani nerve passage through the sacrospinal ligament is clearly visible. (B) The passage of the levator ani nerve above the sacrospinal ligament is easily distinguishable. (C) The pudendal canal has been opened and the internal obturator fascia removed. The nerve that passes above the blue needle is the dorsal nerve of the clitoris, the one above the yellow needle is the main branch of the pudendal nerve, i.e. the perineal nerve. The ramifications of the inferior rectal nerve are seen underneath the red needle. (D) Ischiorectal fossa in the right half pelvis. The inferior rectal nerve that innervates the posterior anal hemisphere originates in a much higher zone and does not traverse the pudendal canal as classically described in the literature. In addition to other functions, perineal nerves act as motor nerves for the anterior anal hemisphere. |
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Fig 3. – The concept of staged scared reflexes and its electrical impulse circuits. Image (A) represents the recording made from the anterior or ventral quadrant of the external anal sphincter. Image (B) represents the recording made from the posterior or caudal quadrant; and image (C) represents the recording from the levator ani (pubococcygeus) muscle. To establish normal latency of staged reflexes, the healthy side of patients with uni-lateral neuralgia were measured (n = 59), black numbers. Staged reflexes were measured in the painful side of 76 patients with uni- or bi-lateral neuralgia (numbers in red). Note the highly significant difference (t-test p < 0.1) of latencies of the anterior quadrant when compared with the healthy side, suggesting a compression of the pudendal nerve in the pudendal canal. |