Approach-related injury to the superior hypogastric plexus in males can result in retrograde ejaculation. The plexus sits anterior to the aorta and continues over the anterior surface of L5–S1, carrying sympathetic fibers down into the pelvis. Opening the peritoneum in the midline, as in a transperitoneal approach, aggressive traction or electrocautery use can cause injury to the plexus. The result is patency of the bladder sphincter during ejaculation, which allows retrograde flow of seminal fluid from the posterior urethra into the bladder. The overall incidence of retrograde ejaculation has been reported to be about 4.2%; however, this varied from 1.7% in the retroperitoneal approach to 13.3% in the transperitoneal approach. The incidence has also been reported to climbas high as 11.6% in revision cases. In addition to injury to the superior hypogastric plexus, the lumbar sympathetic trunk is also at risk of injury asit sits on the lateral aspect of the vertebral bodies. This typically results in loss of sympathetic tone and vasodilatation on the side ipsilateral to the injury, causing patients to complain of a relative coolness in their contralateral foot. Most patients experience resolution of these symptoms after 6 months. Long-term complaints of abdominal asymmetry and pseudohernia are more commonly found in large thoracoabdominal approaches followed by thoracic approaches. Lumbar paramedian approaches had the lowest incidence of complaints related to abdominal asymmetry.
Aegis, something that protects or defends; shield. Sponsorship or guidance by an individual or organization. The original aegis was a goatskin shield or breastplate, symbolizing majesty, that was worn by Zeus and his daughter Athena in Greek mythology. Athena's aegis bore the severed head of the monstrous Medusa. Aegis came to be used for any kind of invulnerable shield. But today we almost use the word in the phrase "under the aegis of ...," which means "under the authority, sponsorship, or control of."
Neurological injury to the lumbar plexus is a complication that can occur during the lateral transpsoas approach. These approaches have a 10–19% incidence of post-operative thigh numbness with the highest incidence occurring at L4–5. The incidence of this is not decreased by use of electromyography, which only alerts surgeons to their proximity to motor nerves. The vast majority of post-operative thigh numbness tends to resolve at 3–6 month follow-up. Lumbar plexus related motor deficits have an incidence of approximately 4.9%; however, these too tend to improve in incidence and severity over time. Immediate postoperative, ipsilateral iliopsoas weakness is also common and estimated between 25% and 54.9%. This is most likely due to mechanical dissection of the muscle with the retractors and the majority of these deficits resolve by 3 months. Risk of visceral or vascular injury through lateral transpsoas approach is increased in the setting of significant rotatory scoliosis. Rotation of the vertebral column of tendisplaces intraperitoneal and retroperitoneal structures into the path of approach, especially on the concavity of the curve. In a study examining the use of lateral approaches for scoliosis, This involves more anterior dissection and placing retractors in between the great vessels and the ALL. Though complication rates with ACR tend to be lower as compared to posterior osteotomy procedures, one must keep in mind the possibility of sympathetic plexus, visceral injury, or vascular injury, which can occur with additional dissection. Lengthening of the anterior column occurs with ACR, particularly when combined with a posterior facet osteotomy (Smith-Peterson type) and compression. Such lengthening may potentially be associated with vascular complications such as thrombosis or embolism of plaques with arteries that undergo excessive stretch.
Charisma, an extraordinary gift for leadership that attracts popular support and enthusiasm; a special ability to attract or charm; magnetism. Charisma is Greek for "gift," but its traditional meaning comes from Christian belief, where it originally referred to an extraordinary power - the gift of healing, the gift of tongues, or the gift of prophecy - bestowed on an individual by the Holy Spirit. The first nonreligious ues of charisma didn't appear until the 20th century, when it was applied to thet mysterious personal magnetism that a lucky few seem to possess, especially the magnetism with which a political leader can arouse great popular enthusiasm. When John F. Kennedy was elected president in 1960, its use by journalists popularized the term in the mass media. Since then, actors, rock stars, athletes, generals, and entrepreneurs have all been said to possess charisma.