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.

Quiste hidatídico en el músculo psoas / Hydatid cyst in the psoas muscle

La hidatidosis es una zoonosis endémica en nuestro país, presentándose en la mayoría de los casos como quistes hidatídicos hepáticos y pulmonares, siendo el músculo psoas una localización infrecuente para esta enfermedad. Los autores presentan un caso clínico de quiste hidatídico en el músculo psoas tratado mediante resección total e inyección de agentes escolicidas, usando el abordaje extraperitoneal.

Hydatidosis is an endemic zoonosis in our country. It presents in most cases as hepatic or pulmonary cyst, being the psoas muscle an uncommon location of hydatid cyst. The authors present a case of hydatid cyst developed in the psoas muscle, treated with total resection and escolicidal agent injection using an extraperitoneal approach.