Radiographs assessment of changes in the psoas muscle at L4-L5 level after single-level lateral lumbar interbody fusion in patients with postoperative motor weakness.

The purposes of this study were (1) to investigate postoperative changes in cross-sectional area (CSA) and signal intensity (SI) of the psoas muscle (PS) using magnetic resonance imaging (MRI) and (2) to compare the CSA and SI of the PS between patients with and without motor weakness after single-level lateral lumbar interbody fusion (LLIF) at level L4-L5. Sixty patients were divided into two groups-those with postoperative motor weakness and those without-and the two groups were compared. Baseline demographics and clinical characteristics, such as operation time and blood loss, length of hospital stay, and postoperative complications, were recorded. The CSA and SI of the PS were obtained from the MRI regions of interest defined by manual tracing. Patients who developed motor weakness after surgery were significantly older (p = 0.040). The operation time (p = 0.868), LLIF operative time (p = 0.476), and estimated bleeding loss (p = 0.168) did not differ significantly between groups. In both groups, the CSA and SI of the left and right PS increased after surgery. The change in the CSA of the left PS was significantly higher in patients with weakness (247.6 ± 155.2 mm2) than without weakness (152.2 ± 133.1 mm2) (p = 0.036). The change in SI of the left PS did not differ between the two groups (p = 0.530). To prevent postoperative motor weakness regardless of the operation time, surgeons should be aware of the potential for surgical invasive of the PS during LLIF in older people.

Analysis of Cost and 30-Day Outcomes in Single-Level Transforaminal Lumbar Interbody Fusion and Less Invasive, Stand-Alone Lateral Transpsoas Interbody Fusion.

BACKGROUND: A comparative evaluation of operative costs between single-level transforaminal interbody fusion (TLIF) and stand-alone lateral transpsoas interbody fusion (LIF) has not yet been done. We analyzed the costs, operative parameters, and early outcomes of single-level stand-alone LIF versus single-level TLIF. METHODS: Ten patients who underwent single-level TLIF and 10 patients who underwent single-level stand-alone LIF were included in the analysis. Total, variable, and fixed costs from perioperative data were available from a single institution. In addition, patient demographics, length of hospital stay, and 30-day outcomes and readmission rates were reviewed. RESULTS: Total cost, variable cost, and fixed costs were significantly lower in the LIF group, and there was no difference in outcomes. CONCLUSIONS: Single-level stand-alone LIF may prove to be more cost-effective and provide cost savings with analogous 30-day outcomes compared with single-level TLIF procedures.

Risk Management for Avoidance of Major Vascular Injury due to Lateral Transpsoas Approach.

STUDY DESIGN: A retrospective study using 323 contrast-enhanced, multi-planner three-dimensional computed (3D-CT) scans. OBJECTIVE: The aim of this study was to identify risk factors for injury to the major vessels in the lateral transpsoas approach. SUMMARY OF BACKGROUND DATA: To avoid critical complications such as major vessel injury, it is essential to examine anatomical information related to preoperative risk management that is specific to the lateral transpsoas approach. METHODS: The abdominal contrast-enhanced, multi-planner 3D-CT scans of 323 consecutive subjects (203 males and 120 females, 15-89 years old) were retrospectively reviewed. The true axial views were used for evaluation of the locations of the major vein and artery at L3 to L4 and L4 to L5. According to the Moro system, the axial view was divided into 6 zones from the front side (A, I II, III, IV, P) and the locations of the dorsal tangential line of the major vessels were evaluated. RESULTS: At the L3 to L4 level, the dorsal tangential line of the major vein located in zone A was found in 18% of subjects, in zone I in 74%, and in zone II in 8%. The line of the major artery was located in zone A in 92.6% of subjects and in zone I in 7.1%. At the L4 to L5 level, the line of the major vein was located in zone A in 5% of subjects, in zone I in 75%, in zone II in 20%, and in zone III in only 1 subject. The line of the major artery was identified in zone A in 87% of subjects, in zone I in 12%, and in zone II in 1%. Women had significant dorsal-migrated veins and arteries at both spinal levels (P < 0.01). CONCLUSION: To avoid critical complications in extreme lateral lumbar interbody fusion, careful preoperative radiological evaluation of the major vessels and intraoperative care are important. LEVEL OF EVIDENCE: 3.

Assessment of hip rotation after gait improvement surgery in cerebral palsy.

Sixteen children with diplegic type of cerebral palsy and spastic internal rotation gait were evaluated using gait analysis before and an average of 3 years after multiple soft tissue surgery. Significant correction of the internal rotation gait was observed after multi-level soft tissue surgery which included medial hamstring lengthening in all cases. Our results suggest that for children with spastic internal rotation gait, multi-level soft tissue surgery effectively corrects the dynamic internal rotation gait in the absence of fixed bony rotational deformities.

Resection of giant schwannoma by combined surgical exposure.

Contrary to the past experience the giant Schwannoma with symptoms of canalis vertebralis compression has been removed by combined surgical exposure in one sitting. Laminectomy, decompression of the canalis vertebralis and immediately subsequent extracanalicular resection of the tumour by retroperitoneal approach was performed in one sitting by two surgical teams. The advantages of the combined surgical exposure: 1. The affliction of the patients caused by the operation significantly decreased. 2. The expenses of the treatment, nursing and hotel decreased as well. 3. The surgical team of different specialists remove the tumour together in both approaches.