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.

Efficacy of Decompression and Fixation for Metastatic Spinal Cord Compression: Analysis of Factors Prognostic for Survival and Postoperative Ambulation

OBJECTIVE: The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC. METHODS: We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo- or radiation therapy, were analyzed retrospectively. RESULTS: Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) (p=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; p=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; p=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; p=0.038) were prognostic of postoperative ambulation. CONCLUSION: We found that postoperative ambulation and preoperative high Tokuhashi score were significantly associated with longer patient survival. In addition, preoperative hip flexion power greater than grade III was critical for postoperative ambulation.

PECULIARITY OF MUSCLE STRENGTH IN THE LOWER LIMBS OF SOCCER PLAYERS FROM THE PERSPECTIVE OF ISOKINETIC MUSCLE STRENGTH AND MRI FINDINGS IN COMPARISON WITH THOSE OF ARCHERS / 体力科学

This study examined peculiarities in both muscle strength and cross-sectional area (CSA) among soccer players in comparison with those of archers as contrasting athletes. Subjects were 15 male soccer players and 9 male archers at N University. Measurement items were height, body weight (BW), isokinetic muscle strength (knee extension, knee flexion, hip extension, hip flexion) and CSA (psoas muscles). Isokinetic muscle strength (30, 120, 240°/sec.) was measured by Cybex6000 (Lumex Co.), and the psoas muscle CSA was determined using magnetic resonance imaging (Hitachi, Japan). Results were as follows : 1. There was no significant difference in isokinetic knee extension and flexion strength/BW at all angular velocities between soccer players and archers. 2. On isokinetic hip flexion strength/BW, the average values of soccer players were significantly higher at all angular velocities than those of archers. However, there was no significant difference in the average values of isokinetic hip extension strength at all angular velocities between the two groups. 3. The average value for the psoas muscle CSA in soccer players was significantly higher than that of archers. In this study, the biggest difference in muscle strength between soccer players and archers was hip flexion strength, and the CSA of the psoas muscle in soccer players, which is the main component of hip flexion, was significantly larger than that of archers. These findings showed the peculiarity of soccer players due to the constant demands of movements involved in ball kicking and running during practice and competition.