Utilidad de la medición de los músculos psoas y paraespinales mediante tomografía computarizada y resonancia magnética / Usefulness of the measurement of the psoas and paraspinal muscles by computed tomography and magnetic resonance

Introducción: La sarcopenia está revistiendo importancia en el estudio de diferentes enfermedades para predecir la morbimortalidad en el perioperatorio. Los objetivos de este estudio fueron evaluar la eficacia de la tomografía y la resonancia en la medición de la musculatura del psoas y los paraespinales, y comparar estos índices con la edad, el sexo y la enfermedad. materiales y métodos: Se utilizaron las tomografías computarizadas y las resonancias magnéticas de pacientes ambulatorios. La medición de los músculos se realizó en los pedículos de L3 y L4. Resultados: El estudio incluyó 18 tomografías y 34 resonancias. El rango de edad de los pacientes era de 15 a 80 años, divididos en grupos etarios. En los promedios globales, en ambos estudios, el sexo masculino estaba por encima del promedio global. Con respecto a los rangos etarios, se observó que el primer grupo (15-29 años) tenía un mayor volumen muscular y de unidades Hounsfield en el psoas comparado con el grupo >60 años. Los pacientes que consultaron por espondilolistesis tenían menos masa muscular que aquellos con discopatías. Conclusiones: No existe diferencia entre la resonancia magnética y la tomografía computarizada en cuanto a la medición de los músculos paraespinales y psoas. Queda en evidencia que la disminución del volumen muscular es común en pacientes de mayor edad y con enfermedades que afectan el balance espinal. Nivel de Evidencia: IV

background: Sarcopenia is becoming increasingly significant in the research of various diseases to predict morbidity and mortal-ity in the perioperative period. Objectives: The objectives of this study were to evaluate the efficacy of computed tomography and magnetic resonance imaging in measuring the psoas and paraspinal muscles and to compare these indexes with age, sex, and pathology. materials and methods: Computed tomography and magnetic resonance imaging of outpatients were used. Muscle measurements were taken at the L3 and L4 pedicles. Results: The study included 18 CT and 34 MRI scans. The patients were divided into groups based on their age range, which was 15 to 80 years. In the overall averages, males were above the global average in both studies. Regarding age ranges, it was observed that the first group (15-29 years) had a higher muscle volume and Hounsfield units in the psoas compared to the >60 age group. Patients consulting for spondylolisthesis had less muscle mass than those with discopathy. Conclusions: There is no difference between magnetic resonance imaging and computed tomography in measuring the paraspinal and psoas muscles. It is evident that the decrease in muscle volume is common in older patients and those with diseases that affect spinal balance. Level of Evidence: IV

Hematoma espontáneo del músculo psoas ilíaco secundario a anticoagulación como causa de muerte: reporte de caso / Spontaneous hematoma of the iliac psoas muscle secondary to anticoagulation as cause of death: case report

Resumen El uso de tromboprofilaxis posterior a las cirugías cervicales es una práctica recomendada a nivel mundial debido a que este tipo de pacientes presentan un mayor riesgo de desarrollar tromboembolismos venoso. Dentro de los efectos adversos de esta terapia se ha descrito la epistaxis, hematuria, formación de hematomas y sangrados. El hematoma espontáneo del músculo psoas iliaco, se considera una entidad poco frecuente, que suele asociarse a alteraciones de la coagulación, hemofilia o discrasias sanguíneas y como terapia anticoagulante, siendo este último la principal causa. En la autopsia médico legal, el hematoma del músculo psoas iliaco, suele ser un hallazgo incidental y en la mayoría de casos no contribuye en la causa de muerte. En el presente artículo se expone el caso de un masculino conocido con una enfermedad renal crónica, el cual desarrolló un hematoma espontáneo del músculo psoas iliaco, secundario al uso de enoxaparina como tromboprofilaxis posterior a una intervención quirúrgica en el cuello, que lo condujo a un shock mixto ocasionándole la muerte.

Abstract The use of thromboprophylaxis after cervical surgeries is a recommended practice worldwide due to the fact that these types of patients have a higher risk of developing venous thromboembolisms. Among the adverse effects of this therapy it has been described epistaxis, hematuria, formation of hematomas and bleeding. Spontaneous hematoma of the iliac psoas muscle is considered a rare entity, which is usually associated with coagulation disorders, hemophilia or blood dyscrasias and anticoagulant therapy, the latter being the main cause. In the medico-legal autopsy, the hematoma of the iliopsoas muscle is usually an incidental finding and in most cases does not contribute to the cause of death. This article describes the case of a male known with chronic kidney disease, who developed a spontaneous hematoma of the iliac psoas muscle, secondary to the use of enoxaparin as thromboprophylaxis after a surgical intervention in the neck, which led to a mixed shock causing death.

Split unilateral del nervio femoral a nivel del músculo psoas mayor: reporte de caso / Unilateral femoral nerve split at the psoas major muscle: case report

RESUMEN: El nervio femoral (NF) es el mayor o ramo del plexo lumbar. Normalmente se origina de las divisiones posteriores del segundo al cuarto ramo anterior del plexo lumbar (L2-L4). El músculo psoas mayor tiene su origen a nivel de las vértebras T12 a L5, se fusiona con el músculo ilíaco para luego insertarse en el trocánter menor del fémur. Normalmente, a nivel de la pelvis menor el NF se encuentra entre los músculos ilíaco y psoas mayor. En este trabajo presentamos un caso donde el músculo psoas mayor se relaciona con divisiones o split del NF, esta es una rara variación en la división y curso del NF con relación al músculo psoas mayor. Se observó que el NF se dividía en dos ramos por sobre el plano del ligamento inguinal después de su origen en el plexo lumbar. El NF del lado izquierdo se formó por las ramas ventrales de L2 a L4, a nivel de L5 el nervio es perforado por fascículos del músculo psoas mayor. La división inferior del NF pasaba profundamente a las fibras del músculo iliopsoas y la división superior pasaba superficialmente al músculo psoas mayor y profundo a la fascia ilíaca. Después de un trayecto de 60,21 mm ambas divisiones se unieron, después de atrapar fibras músculo iliopsoas justo inmediatamente proximal al ligamento inguinal para formar el tronco del NF. Si bien las causas embriológicas de las variaciones de los nervios periféricos se remontan a la quinta y sexta semana de vida intrauterina, la expresión clínica de disfunciones neuromusculares aparecerá varios decenios después. De modo que los médicos de las áreas de la traumatología y neurología deben estar al tanto de tales variantes anatómicas para entender mejor el dolor y los síndromes asociados a la compresión nerviosa y durante las maniobras quirúrgicas en esta región.

SUMMARY: AbstractThe femoral nerve (NF) is the major branch (or ramus) of the lumbar plexus. It normally originates from the posterior divisions of the second to fourth anterior branches of the lumbar plexus (L2-L4). The psoas major muscle originates at the level of the T12 to L5 vertebrae, fuses with the iliacus muscle and then inserts into the lesser trochanter of the femur. Normally, at the level of the lesser pelvis, the NF is found between the iliacus and psoas major muscles. In this paper we present a case where the psoas major muscle is related to divisions or splitting of the NF, this is a rare variation in the division and course of the NF in relation to the psoas major muscle. The NF was observed to divide into two branches above the plane of the inguinal ligament after its origin in the lumbar plexus. The NF on the left side was formed by ventral branches from L2 to L4, at the level of L5 the nerve is perforated by fascicles of the psoas major muscle. The lower division of the NF passed deep to the fibers of the iliopsoas muscle and the upper division passed superficial to the psoas major muscle and deep to the iliac fascia. After a path of 60.21 mm both divisions joined, after trapping iliopsoas muscle fibers just immediately proximal to the inguinal ligament to form the NF trunk. While the embryological causes of peripheral nerve variations date back to the fifth and sixth week of intrauterine life, the clinical expression of neuromuscular dysfunctions will appear several decades later. Thus, physicians in the areas of traumatology and neurology should be aware of such anatomical variants to better understand pain and syndromes associated with nerve compression and during surgical maneuvers in this region.

Asociación entre sarcopenia medida con el índice del psoas por tomografía abdominal y complicaciones posoperatorias tempranas en pacientes concáncer gástrico / Association between sarcopenia measured with the psoas index by abdominal tomography and early postoperative complications in patients with gastric cancer

Introducción. En Colombia el cáncer gástrico representa un problema de salud pública teniendo en cuenta su alta incidencia y sus elevadas tasas de mortalidad. Cerca del 15 % de los pacientes sufren una pérdida significativa de peso, lo que se asocia con un incremento en la morbilidad y mortalidad. Método. Se realizó un estudio de corte transversal, con el objetivo de determinar la presencia de sarcopenia a través de la medición del índice del psoas por tomografía computarizada y su asociación con morbimortalidad postoperatoria temprana en pacientes con cáncer gástrico. Se incluyeron los pacientes con cáncer gástrico admitidos entre el 1° de enero de 2014 y el 31 de agosto de 2019 en el Hospital Militar Central, en Bogotá, D.C., Colombia. Se hizo un análisis descriptivo, un análisis bivariado y un análisis de regresión logística univariado para determinar la asociación de sarcopenia y complicaciones a 30 días. Todos los análisis fueron realizados en R®. Resultados. Se estudiaron 70 pacientes, encontrando una frecuencia de sarcopenia de 54,3 % (n=38), edad media de 69 años (RIC 54 - 74), mayor proporción de hombres 68,6 % (n=48), siendo menor en el grupo de sarcopenia 55,3 % (n=21), índice de psoas de 0,63 mm (RIC 0,55 - 0,7), mortalidad 2,9 % (n=2) y asociación de sarcopenia con desenlaces a 30 días (OR 1,2; IC95% 0,59 - 2,4). Discusión. Se encontraron resultados similares a los informados en la literatura mundial, con una mortalidad inferior al 3 %. En este estudio, la sarcopenia no se asoció con la aparición de complicaciones a 30 días

Introduction. Gastric cancer represents a public health problem in Colombia considering its high incidence and high mortality rates. About 15% of patients suffer a significant weight loss, which is associated with an increase in morbidity and mortality.Method. A cross-sectional study was carried out in order to determine the presence of sarcopenia by measuring the psoas index by computed tomography and its association with early postoperative morbidity and mortality in patients with gastric cancer. Gastric cancer patients admitted between January 1, 2014 and August 31, 2019 at Hospital Militar Central, in Bogotá, D.C., Colombia were included. Descriptive analysis, bivariate analysis, and univariate logistic regression analysis were performed to determine the association of sarcopenia and complications at 30 days. All analyzes were performed in R®.Results. Seventy patients were studied, finding a frequency of sarcopenia of 54.3% (n=38), mean age of 69 years (IQR 54-74), higher proportion of men 68.6% (n=48), being lower in sarcopenia group 55.3% (n=21), psoas index of 0.63 mm (IQR 0.55 - 0.7), mortality 2.9% (n=2) and no association of sarcopenia with outcomes a 30 days (OR 1.2; 95% CI 0.59 - 2.4). Discussion. Similar results were found to those reported in the world literature, with a mortality of less than 3%. In this study, sarcopenia was not associated with the development of complications at 30 days

Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

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.

Absceso de psoas iliaco: un desafío diagnóstico / Psoas-Iliac Abscess a dignotic challengen

El absceso de músculo psoas iliaco se considera una rare-za. Su detección ha mejorado con la utilización de imágenes como la tomografía computada o la resonancia magnética. Presentamos una revisión de casos de absceso de psoas-iliaco internados entre julio de 2015 y febrero de 2018 en un hospital de CABA, Argentina.En este periodo se diagnosticaron un paciente conside-rado de origen primario y ocho de origen secundario. Se observó predominio de colecciones asociadas a es-pondilodiscitis. El síntoma más frecuente fue la fiebre. Staphylococcus aureus fue el germen más rescatado en muestras microbiológicas. Se debe tener alto índice de sospecha de esta patología ante la presencia de fiebre, dolor lumbar y en ocasiones alteración de la marcha. El empleo de antibióticos de amplio espectro sumado a la evacuación de colecciones constituyen la estrategia más efectiva

Psoas-iliac muscle abscess is considered a rarity, the use of images such as computed tomography or magnetic reso-nance imaging has improved its detection.This study reviews cases of psoas-iliac abscess in hospi-talized patients between July 2015 and February 2018 in a hospital in CABA, Argentina.In one of the patients the origin was considered primary ,while in the other eight it was secondary. There was a pre-dominance of collections associated with spondylodiscitis. The most frequent symptom was fever. Staphylococcus au-reus was the most frequent organism obtained in microbio-logical samples. A high level of suspicion must be held in the presence of fever, lumbar pain and sometimes alteration of the gait. The use of broad spectrum antibiotics in addition to evacuation of collections is the most effective strategy.

A multiply split femoral nerve and psoas quartus muscle / 대한해부학회지

Intramuscular Hematoma on the Psoas Muscle / 대한신경손상학회지

Intramuscular hematomas on the psoas muscle are rare and usually occur as a result of trauma, iatrogenic etiology during lumbar surgery, rupture of the aortic aneurysm, and hematologic diseases. The incidence of spontaneous psoas muscle hematomas has slowly increased as a result of using anticoagulation and antiplatelet agents. Magnetic resonance (MR) imaging is a more sensitive option compared to computed tomography (CT) when diagnosing a hematoma. Coronal T2-weighted images are more useful. CT imaging is also useful to establish the rapid diagnosis of hematoma. When a prolonged prothrombin time and international normalized ratio and decrease platelet count are noted, psoas muscle hematomas should be considered, if there was no lesion in the spinal canal. Most hematomas resolve spontaneously without clinical complications if the hematoma is not large or it is not compressing the surrounding important structures, irrespective of cause.

Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis

BACKGROUND/AIMS: The most widely used method for diagnosing sarcopenia is the skeletal muscle index (SMI). Several studies have suggested that psoas muscle thickness per height (PMTH) is also effective for detecting sarcopenia and predicting prognosis in patients with cirrhosis. The aim of this study was to evaluate the optimal cutoff values of PMTH for detecting sarcopenia in cirrhotic patients. METHODS: All cirrhotic patients who underwent abdominal computed tomography (CT) scan including L3 and umbilical levels for measuring SMI and transverse psoas muscle thickness, respectively, were included. Two definitions of sarcopenia were used: (1) sex-specific cutoffs of SMI (≤52.4 cm² /m² in men and ≤38.5 cm² /m² in women) for SMI-sarcopenia and (2) cutoff of PMTH ( < 16.8 mm/m) for PMTH-sarcopenia. RESULTS: Six hundred fifty-three patients were included. The average age was 53.6 ± 10.2 years, and 499 patients (76.4%) were men. PMTH correlated well with SMI in both men and women (P < 0.001). Two hundred forty-one (36.9%) patients met the criteria for SMI-sarcopenia. The best PMTH cutoff values for predicting SMI-sarcopenia were 17.3 mm/m in men and 10.4 mm/m in women, and these were defined as sex-specific cutoffs of PMTH (SsPMTH). The previously published cutoff of PMTH was defined as sex-nonspecific cutoff of PMTH (SnPMTH). Two hundred thirty (35.2%) patients were diagnosed with SsPMTH-sarcopenia, and 280 (44.4%) patients were diagnosed with SnPMTH-sarcopenia. On a multivariate Cox regression analysis, SsPMTH-sarcopenia (hazard ratio [HR], 1.944; 95% confidence interval [CI], 1.144–3.304; P=0.014) was significantly associated with mortality, while SnPMTH-sarcopenia was not (HR, 1.446; 95% CI, 0.861–2.431; P=0.164). CONCLUSIONS: PMTH was well correlated with SMI in cirrhotic patients. SsPMTH-sarcopenia was an independent predictor of mortality in these patients and more accurately predicted mortality compared to SnPMTH-sarcopenia.

Abcès du muscle psoas révélant une infection à VIH

Les auteurs rapportent l'observation d'un volumineux abcès primitif du muscle psoas révélateur d'une infection à VIH chez un adulte sans antécédent ni co-morbidité connus. L'abcès primitif du psoas est une affection rare. Son association avec l'infection à VIH apparait singulière. Nous exposons les particularités étiopathogéniques de cette association pathologique et les possibilités diagnostiques au regard de la littérature. La lombotomie reste notre traitement de choix des volumineux abcès du muscle ps

Relationship between Displacement of the Psoas Major Muscle and Spinal Alignment in Patients with Adult Spinal Deformity

STUDY DESIGN: Cross sectional study. PURPOSE: To clarify the difference in position of the psoas muscle between adult spinal deformity (ASD) and lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: Although it is known that the psoas major muscle deviates in ASD patients, no report is available regarding the difference in comparison with LSS patients. METHODS: This study investigates 39 patients. For evaluating spinal alignment, pelvic tilt (PT), pelvic incidence (PI), sacral slope, lumbar lordosis (LL), PI–LL, Cobb angle, and the convex side, the lumbar curves were measured. For measuring the position of the psoas major at the L4/5 disk level, magnetic resonance imaging was used. The displacements of psoas major muscle were measured separately in the anterior–posterior and lateral directions. We examined the relationship between the radiographic parameters and anterior displacement (AD) and lateral displacement (LD) of the psoas major muscle. RESULTS: AD was demonstrated in 15 cases with ASD and nine cases with LSS (p>0.05). LD was observed in 13 cases with ASD and no cases with LSS (p < 0.01). The Cobb angle was significantly greater in cases with AD than in those without AD (p=0.04). PT, LL, PI–LL, and Cobb angle were significantly greater in cases with LD (p < 0.05). All cases with LD had AD, but no case without AD had LD (p < 0.001). The side of greater displacement at L4/5 and the convex side of the lumbar curve were consistent in all cases. CONCLUSIONS: Despite AD being observed in LSS as well, LD was observed only in the ASD group. Radiographic parameters were worse when LD was seen, rather than AD.

Relationship Between Low Back Pain and the Size and Density of the Erector Spinae Muscle and Multifidus Muscle Using CT Imaging in a Selected Community-Based Population

STUDY DESIGN: Case-control study (retrospective comparative study). OBJECTIVES: The purpose of this study was to define the relationship between low back pain (LBP) and the cross-sectional area (CSA) and density of the erector spinae muscle (ESM) and isolated multifidus muscle (IMM) on computed tomography (CT) scans of patients with a chief complaint other than LBP. SUMMARY OF LITERATURE REVIEW: Most previous studies have focused on radiographic data from patients with a chief complaint of LBP, rather than on radiographic data from patients with a chief complaint other than LBP. MATERIALS AND METHODS: This retrospective study included 475 patients who underwent CT scans between January 1, 2010 and December 31, 2010. The CSA and density of the ESM, IMM, and the psoas muscle (PM) were obtained. All measurements were calculated as the ratio of each muscle. The relationships between the CSA of each muscle and both types of LBP were analyzed. RESULTS: The ESM-to-PM ratio in terms of density was 1.227±0.797 in the LBP group and 0.645±0.732 in the non-LBP group (p=0.174). The IMM-to-PM ratio in terms of density was 0.664±0.515 in the LBP group and 0.806±0.518 in the non-LBP group (p=0.007). CONCLUSIONS: The IMM was more relevant to LBP than the ESM of the back, and density was more relevant to LBP than the CSA of regular muscles. The IMM was more useful than the ESM for analyzing LBP.

Role of Anatomical Landmarks in Identifying Normal and Transitional Vertebra in Lumbar Spine Magnetic Resonance Imaging

STUDY DESIGN: Retrospective study. PURPOSE: Identification of transitional vertebra is important in spine imaging, especially in presurgical planning. Pasted images of the whole spine obtained using high-field magnetic resonance imaging (MRI) are helpful in counting vertebrae and identifying transitional vertebrae. Counting vertebrae and identifying transitional vertebrae is challenging in isolated studies of lumbar spine and in studies conducted in low-field MRI. An incorrect evaluation may lead to wrong-level treatment. Here, we identify the location of different anatomical structures that can help in counting and identifying vertebrae. OVERVIEW OF LITERATURE: Many studies have assessed the vertebral segments using various anatomical structures such as costal facets (CF), aortic bifurcation (AB), inferior vena cava confluence (IC), right renal artery (RRA), celiac trunk (CT), superior mesenteric artery root (SR), iliolumbar ligament (ILL) psoas muscle (PM) origin, and conus medullaris. However, none have yielded any consistent results. METHODS: We studied the locations of the anatomical structures CF, AB, IC, RRA, CT, SR, ILL, and PM in patients who underwent whole spine MRI at our department. RESULTS: In our study, 81.4% patients had normal spinal segmentation, 14.7% had sacralization, and 3.8% had lumbarization. Vascular landmarks had variable origin. There were caudal and cranial shifts with respect to lumbarization and sacralization. In 93.8% of cases in the normal group, ILL emerged from either L5 alone or the adjacent disc. In the sacralization group, ILL was commonly seen in L5. In the lumbarization group, ILL emerged from L5 and the adjacent disc (66.6%). CFs were identified at D12 in 96.9% and 91.7% of patients in the normal and lumbarization groups, respectively. The PM origin was observed from D12 or D12–L1 in most patients in the normal and sacralization groups. CONCLUSIONS: CF, PM, and ILL were good identification markers for D12 and L5, but none were 100% accurate.

Treatment of osteonecrosis of the femoral head by botulinum toxin type A injection to the psoas muscle: A case report

Osteonecrosis of the femoral head (ONFH) can cause femoral head depression and cortical discontinuity. Treatment for ONFH remains challenging. We performed botulinum toxin type A injection to psoas major muscle in five patients with radiological femoral head collapse (Association Research Circulation Osseus classification stage III) who were non-responsive after two years of conservative treatment (tramadol 200 mg/day, mefenamic acid 1,000 mg/day). At two weeks after the procedure, their mean hip pain was decreased from 88 ± 0.4/100 mm to 22 ± 0.4/100 mm based on visual analogue scale (VAS). The pain was maintained at a minimum of 20/100 mm and a maximum of 30/100 mm in VAS for at least six weeks after the procedure. These values were mean ± SD. These patients were followed-up for 6 months. There was no exacerbation of pain from repeated (three times) botulinum toxin type A injection to the psoas major muscle.

A brief report on a technical description of ultrasound-guided lumbar sympathetic block

The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.

Asymmetric Atrophy of Paraspinal Muscles in Patients With Chronic Unilateral Lumbar Radiculopathy

OBJECTIVE: To assess the cross-sectional area (CSA) of the muscles for investigating the occurrence of asymmetry of the paraspinal (multifidus and erector spinae) and psoas muscles and its relation to the chronicity of unilateral lumbar radiculopathy using magnetic resonance imaging (MRI). METHODS: This retrospective study was conducted between January 2012 to December 2014. Sixty one patients with unilateral L5 radiculopathy were enrolled: 30 patients had a symptom duration less than 3 months (group A) and 31 patients had a symptom duration of 3 months or more (group B). Axial MRI measured the CSA of the paraspinal and psoas muscles at the middle between the lower margin of the upper vertebra and upper margin of the lower vertebra, and obtained the relative CSA (rCSA) which is the ratio of the CSA of muscles to that of the lower margin of L4 vertebra. RESULTS: There were no differences in the demographics between the two groups. In group B, rCSA of the erector spinae at the L4–5 level, and that of multifidus at the L4–5 and L5–S1 levels, were significantly smaller on the involved side as compared with the uninvolved side. In contrast, no significant muscle asymmetry was observed in group A. The rCSA of the psoas was not affected in either group. CONCLUSION: The atrophy of the multifidus and erector spinae ipsilateral to the lumbar radiculopathy was observed only in patients suffering from unilateral radiculopathy for 3 months or more.

Inyección de músculo psoas guiado por radioscopía en paciente con lumbocruralgia: presentación de caso clínico / Flouroscopy-guided psoas muscle injection in a patient with back pain and cruralgia: case report

Se comunica el caso clínico de una paciente con síndrome del músculo psoas iliaco izquierdo de severa intensidad (Escala Verbal Numérica de 8/10), de 9 meses de evolución. Inicialmente tratado como un síndrome radicular de las raíces L2 y L3. Ante el fracaso del tratamiento fisiátrico instituido así como falta de respuesta a las inyecciones espinales, se coordina para realizar inyección con anestésicos locales y corticoides del musculo psoas. Se realizó inyección guiada por radioscopía con una ligera variante de la técnica descrita clásicamente. Se obtuvo un buen resultado, logrando un alivio completo del dolor a los 20 minutos. A la semana, la paciente refería dolor leve (Escala Verbal Numérica de 2/10), manteniendo dicha respuesta al mes de procedimiento. Se discute la importancia del síndrome del Iliopsoas, así como la técnica de inyección guiada por radioscopía.

A case of a patient with left Iliopsoas syndrome of severe intensity (Numerical Verbal Scale 8/10) of 9 months of evolution is communicated. Initially, it was treated as a radicular syndrome of L2 and L3 roots. Given the failure of physiatric treatment and the lack of response to spinal injections, psoas muscle injection with local anesthetics and steroids was scheduled. Fluoroscopy guided injection was preformed with a slight variation of the classical described technique. A good result was obtained achieving complete pain relief within 20 minutes of injection. A week later the patient had mild pain (Numerical Verbal Scale 2/10), maintaining the same level of pain a month afterward. The importance of the Iliopsoas syndrome and the fluoroscopy guided injection technique is discussed.

Abscesso do músculo psoas associado à infecção por Mycobacterium tuberculosis em paciente com Aids / Psoas muscle abscess associated with Mycobacterium tuberculosis infection in patient with AIDS

Abscesso do músculo psoas é uma condição rara de difícil diagnóstico clínico, pois apresenta sinais e sintomas inespecíficos. No presente relato de caso, ilustramos um exemplo de abscesso do músculo psoas associado ao Mycobacterium tuberculosis em paciente do sexo feminino, 48 anos, com diagnóstico de Aids há cinco anos. O exame físico da paciente evidenciou massa palpável em região lombar que foi confirmada pela ultrassonografia e tomografia computadorizada. A baciloscopia do líquido obtido da punção do abscesso demonstrou a presença de bacilos álcool-ácido resistentes. Após iniciado esquema terapêutico combinado, com drogas antituberculosas, a paciente evoluiu com melhora clínica. Apesar de raro, o abscesso de músculo psoas é uma enfermidade que tem sido mais frequentemente observada em pacientes imunocomprometidos, principalmente aqueles que apresentam a co-infecção HIV-tuberculose.Neste caso, a identificação do agente etiológico associado ao abscesso foi fundamental para garantir a conduta terapêutica adequada e consequentemente a boa evolução do quadro clínico.

Psoas muscle abscess is a rare condition difficult to diagnose clinically, as have non-specific signs and symptoms. In this case report, we illustrate an example of psoas muscle abscess associated with Mycobacterium tuberculosis in female patient, 48 years old, with diagnosis of AIDS five years ago. Physical examination showed the patient’s palpable mass in the lower back which was confirmed by ultrasonography and computed tomography. The smear obtained from the abscess puncture liquid showed the presence of resistant acid-fast bacilli. After combined treatment regimen started with antituberculosis drugs, the patient improved clinically. Although rare, the psoas muscle abscess is a disease that has been most frequently observed in immunocompromised patients, especially those with HIV-tuberculosis co-infection. In this case, the identification of the etiologic agent associated with the abscess was criticalto ensure an adequate therapeutic conduct and consequently the good progression of the disease.

A study to investigate needle insertion at Shenshu (BL23) to puncture psoas major muscle / 中西医结合学报

<p><b>OBJECTIVE</b>It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu (BL23).</p><p><b>METHODS</b>Twelve dissected specimens were used for studying the needling pathway of BL23 by perpendicularly inserting the depth-measuring blade of a vernier caliper at BL23. Dimensions of psoas muscle were measured. Correlation studies were conducted. In addition, our samples were grouped by gender and underlying medical conditions for analysis.</p><p><b>RESULTS</b>Half (50%) of the needle insertions successfully punctured psoas muscle. The mean depth of needle insertion to puncture psoas muscle (Dmin) in the group with short-term underlying medical conditions was 38.0 mm (interquartile range 29.0-51.8 mm), approximately 6 mm deeper than 32.0 (29.3-42.5) mm in the group with long-term health problems (P = 0.041). The cross-sectional area (CSA) of psoas muscle in the former group was on average approximately 1.5 times that of the latter group (P = 0.04). When the data were analysed by gender, the thickness of psoas muscle in the male group was 19.0 (6.5-24.0) mm compared to 19.5 (5.8-34.8) mm in the female group (P = 0.02). The age in the female group (P = 0.04) and the body length of the total group (P =0.04) negatively correlated to Dmin.</p><p><b>CONCLUSION</b>Needle insertion at BL23 might be able to puncture psoas muscle. Differences in the CSA of psoas muscle and Dmin were observed in groups with short-term and long-term underlying medical conditions.</p>