Hip Flexion Weakness following Transpsoas Interbody Fusion

Objective The present work evaluated the motor deficit resulting from the psoas muscle access through the extreme lateral interbody fusion (XLIF) approach. Methods This was a prospective, non-randomized, controlled, single-center study with 60 patients, with a mean age of 61.8 years old. All of the subjects underwent a lateral transpsoas retroperitoneal approach for lumbar interbody fusion with electroneuromyographic guidance and accessing 1 to 3 lumbar levels (mean level, 1.4; 63% cases in only 1 level; 68% cases included L4-L5). The isometric hip flexion strength in the sitting position was determined bilaterally with a handheld dynamometer (Lafayette Instrument, Lafayette, IN, USA). Themean value of three peak forcemeasurements (N) was calculated. Standardized isometric strength tests were performed before the procedure and at 10 days, 6 weeks, 3 months and 6 months postsurgery. Results Ipsilateral hip flexion was diminished (p < 0.001) at the early postoperative period, but reached preoperative values at 6 weeks (p > 0.12). The mean hip flexion measures before the procedure and at 10 days, 6 weeks, 3 months and 6 months after surgery were the following, respectively: 13 N; 9.7 N; 13.7 N; 14.4 N; and 16 N (ipsilateral); 13.3 N; 13.4 N; 15.3 N; 15.9 N; and 16.1 N (contralateral). Neither the level nor the number of treated levels had a clear association with thigh symptoms, but hip flexion weakness was the most common symptom. Conclusions Patients in the early postoperative period of transpsoas access presented hip flexion weakness. However, this weakness was transient, and electroneuromyography use is still imperative in transpsoas access. In addition, patients must be thoroughly educated about hip flexion weakness to prevent falls in the immediate postoperative period.

The shor-term clinical outcomes and safety of extreme lateral interbody fusion combined with percutaneous pedicle screw fixation for the treatment of degenerative lumbar disease / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early efficacy and safety of extreme lateral interbody fusion (XLIF) combined with percutaneous pedicle screw fixation for lumbar degenerative disease.</p><p><b>METHODS</b>From January 2013 to June 2014, 13 patients with degenerative lumbar disease were treated with XLIF combined with percutaneous pedicle screw fixation, including 8 cases of lumbar instability, 5 cases of mild to moderate lumbar spondylolisthesis;there were 5 males and 8 females, aged from 56 to 73 years with an average of 62.1 years. All patients were single segment fusion. Operation time, perioperative bleeding and perioperative complications were recorded. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. Interbody fusion rate was observed and the intervertebral foramen area changes were compared preoperation and postoperation by X-rays and CT scanning.</p><p><b>RESULTS</b>The mean operation time and perioperative bleeding in the patients respectively was(62.8±5.2) min and(82.5±22.6) ml. One case occurred in the numbness of femoribus internus and 1 case occurred in the muscle weakness of hip flexion after operation, both of them recovered within 2 weeks. All the patients were followed up from 12 to 19 months with an average of 15.6 months. VAS was decreased from preoperative 7.31±0.75 to 2.31±0.75 at final follow-up(<0.05); ODI was decreased from preoperative (42.58±1.55)% to (12.55±0.84)% at final follow-up(<0.05). At final follow-up, CT scanning confirmed 8 cases completely fused and 5 cases partly fused;the intervertebral foramen area was increased from preoperative (94.86±2.44)mm2 to (150.70±7.02)mm2(<0.05).</p><p><b>CONCLUSIONS</b>Extreme lateral interbody fusion combined with percutaneous pedicle screw fixation is an ideal method and can obtain early good clinical effects in treating lumbar degenerative disease.</p>

Extreme lateral interbody fusion for degenerative scofiosis / 中华显微外科杂志

@#Objective To introduce extreme lateral interbody fusion (XLIF) as a new minimally inva-sire spinal surgery with established correction and fusion methods to assess its clinic use for degenerative scoliosis. It is emphasized the value and highlight of this technique in spinal surgery. Methods Surgical treatment of 8 patients with degenerative scoliosis were performed with XLIF between March 2006 and April 2008. In this group of patients, 5 cases provided an anterior cage in every disc space, and another 3 supplemented with vertebrae screw fixation. Blood loss was 50 ml every procedure. To observe the low back pain, corrective rate, achieving a balanced and complications. Results The low back pain have been relieved in all patienta after operations, the disc height can be restored, allowing more room at the foraminal level for nerve roots, and lumber lordosis can be maintained. Corrective rate was 64%, there wasn't neurologic and vascular injury, 2 case had correction loss a little postoperation 6-30 month. Conclusion The potential benefits of XLIF include safe, effective, less approach-related blood loss, improved cosmetic result with smaller incisions, and reduced hospital stay for degenerative scoliosis.