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Nerve relationships to the sacrospinous ligament: application to suspension procedures and transgluteal approaches for nerve repair and tumor removal with three case illustrations

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Abstract

Background

Transvaginal suspension procedures often use the sacrospinous ligament (SSL), which attaches onto the ischial spine (IS). However, nerve-related sequelae (e.g., sciatic nerve injury) following such procedures have been reported. Therefore, the current anatomical study was performed to better understand these relationships. Additionally, three case illustrations of patients with injury to the sciatic nerve following sacrospinous ligament suspension procedures are included to exemplify the significance of a thorough knowledge of this anatomy.

Methods

In 20 human adult cadavers (40 sides), a gluteal dissection was performed to expose the IS and SSL and regional nerves near the greater sciatic foramen. Measurements between the IS and SSL were made between these structures and surrounding nerves.

Results

The average distance between the IS and sciatic nerve was 1.4 cm. From this bony part, the average distance to the S1 and S2 ventral rami was 3.1 cm and 1.9 cm, respectively. From the IS to the lumbosacral trunk, pudendal nerve, nerve to obturator internus, and superior gluteal nerve, the mean distance was 4 cm, 0.5 cm, 0.7 cm, and 4.5 cm, respectively. From the SSL to the lumbosacral trunk, S1 ventral ramus, and S2 ventral ramus, there was an average distance of 4.2 cm, 1.6 cm, and 0.8 cm, respectively. Statistically, in females, the distances from the IS and SSL to the sciatic nerve, lumbosacral trunk, superior gluteal nerve, and S1 and S2 ventral rami were shorter when compared to males.

Conclusion

An improved understanding of the relationship between the SSL and IS and nerves near the greater sciatic foramen can lead to fewer intraoperative complications during approaches to various peripheral nerves in this region. Lastly, these relationships might help better understand the nerve injuries following pelvic suspension procedures that use the SSL.

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Data Availability

Data used in this study are not available.

References

  1. Estrade JP, Agostini A, Roger V, Dallay D, Blanc B, Cravello L (2004) Sacrospinous colpopexy complications. Gynecologie, Obstetrique Fertilite 32:850–854

    Article  PubMed  Google Scholar 

  2. Ferrando CA, Walters MD (2018) A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy. Am J Obstet Gynecol 218:599.e1-599.e8. https://doi.org/10.1016/j.ajog.2018.03.033

    Article  PubMed  Google Scholar 

  3. Florian-Rodriguez ME, Hare A, Chin K, Phelan JN, Rippenda CM, Corton MM (2016) Inferior gluteal and other nerves associated with sacrospinous ligament: a cadaver study. Am J Obstet Gynecol 215:646e1–6.

  4. Iwanaga J, Puffer RC, Watanabe K, Spinner RJ, Tubbs RS (2019) Division of Sacrospinous and Sacrotuberous Ligaments Expands Access Through Greater Sciatic Foramen: Anatomic Study with Application to Resection of Greater Sciatic Foramen Tumors. World Neurosurg 128:e970–e974. https://doi.org/10.1016/j.wneu.2019.05.045

    Article  PubMed  Google Scholar 

  5. Iwanaga J, Singh V, Takeda S et al (2022) Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief. Clin Anat 35:526–528. https://doi.org/10.1002/ca.23849

    Article  PubMed  Google Scholar 

  6. Jelovesk JE, Barber MD, Brubaker L et al (2018) Effect of uterosacral ligament suspension vs. sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA 319:1554–1565

    Article  Google Scholar 

  7. Katrikh AZ, Ettarh R, Kahn MA (2017) Cadaveric nerve and artery proximity to sacrospinous ligament fixation sutures placed by a suture-capturing device. Obstet Gynecol 130:1033–1038

    Article  PubMed  Google Scholar 

  8. Lee TG, Unlu BS (2020) Sacrospinous ligament suspension and uterosacral ligament suspension in the treatment of apical prolapse. Gynecol Pelvic Med 3:39

    Article  Google Scholar 

  9. Netter, FH, Hansen JT, Lambert DR. Netter's Clinical Anatomy. Carlstadt, N.J: Icon Learning Systems, 2005.

  10. Rane A, Frazer M, Jain A, Kannan K, Iyer J (2011) The sacrospinous ligament: conveniently effective or effectively convenient? J Obstet Gynaecol 31:366–370. https://doi.org/10.3109/01443615.2011.578225

    Article  CAS  PubMed  Google Scholar 

  11. Sagsoz N, Ersoy M, Kamaci M, Tekdemir I (2022) Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse. Eur J Obstet Gynecol Reprod Biol 101:74–78. https://doi.org/10.1016/s0301-2115(01)00507-3

    Article  Google Scholar 

  12. Siddiqui N, Edenfield AL (2014) Clinical challenges in the management of vaginal prolapse. Int J Women’s Health 6:83–94

    Article  Google Scholar 

Download references

Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude. The authors state that every effort was made to follow all local and international ethical guidelines and laws that pertain to the use of human cadaveric donors in anatomical research [5] .

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Authors and Affiliations

  1. Tulane University School of Medicine, New Orleans, LA, USA

    Laurel A. Seltzer

  2. Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA

    Naser Ibrahim, Joe Iwanaga, Aaron S. Dumont & R. Shane Tubbs

  3. Department of Anatomical Dissection and Donation, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland

    Łukasz Olewnik

  4. Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  5. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    R. Shane Tubbs

  6. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Kimberly K. Amrami

  7. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Robert J. Spinner

  8. Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  9. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  10. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA

    R. Shane Tubbs

  11. University of Queensland, Brisbane, Australia

    R. Shane Tubbs

Authors
  1. Laurel A. Seltzer
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  2. Naser Ibrahim
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  3. Łukasz Olewnik
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  4. Joe Iwanaga
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  5. Aaron S. Dumont
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  6. Kimberly K. Amrami
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  7. Robert J. Spinner
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  8. R. Shane Tubbs
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Contributions

LAS: writing—original draft, formal analysis, NI: writing—original draft, ŁO: investigation, writing—review and editing, JI: investigation, writing—review and editing, ASD: writing—review and editing, KKA: resources, methodology, investigation, writing—review and editing, RJS: resources, conceptualization, methodology, investigation, writing—review and editing, RST: resources, conceptualization, methodology, investigation, writing—review and editing.

Corresponding author

Correspondence to Joe Iwanaga.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The protocol of the study did not require approval by the ethical committees or informed consent. The study followed the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013).

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Seltzer, L.A., Ibrahim, N., Olewnik, Ł. et al. Nerve relationships to the sacrospinous ligament: application to suspension procedures and transgluteal approaches for nerve repair and tumor removal with three case illustrations. Surg Radiol Anat 45, 693–698 (2023). https://doi.org/10.1007/s00276-023-03142-7

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  • DOI: https://doi.org/10.1007/s00276-023-03142-7

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