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Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  e-neurosurgery.ws

Skeletonization of D7 down to the sacrum was performed. The transverse processii of L1-2-3-4 were exposed and the intertransverse ligaments were removed. The lower edge of the tranverse ligaments were drilled, including the isthmus and upper part of the lateral masses from both sides to expose the lateral edge of the whitish ligamentum flavum edge, which must be partially removed to expose the running nerve root and the ganglion and postganglionic part

Comments:

From the previous part it became evident, that only three major branches could be accessible to be used for grafting for the intended purpose. The posterior cutaneous branch of the sciatic nerve in this condition was impossible to harvest, because plastic grafting of the thighs were performed for the bed sores.

This means that such surgery could be applied to paraplegics below D10 to make the bridges to L1-S1  roots. Of course, the paraplegics below D9 can have benefit from such surgery, but with less benefit.

Notice:

The saphenous nerve as seen in the picture is accompanying the femoral artery. The sartorius muscle is a good landmark. It is preferable to localize the nerve at the midthird of the leg and working medial to the sartorius in the upper third up to the point, where all the other motor branches unite. In the lower third the dissection is done lateral to the sartorius muscle  with subsequent opening of the channel, until the nerve start to give branching, usually three subdivisions. The length of the graft is usually 33-35 cm in adult patient