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.

Manual therapy and segmental stabilization in the treatment of cervical radiculopathy / A terapia manual e a estabilização segmentar no tratamento da radiculopatia cervical

Abstract Introduction: Cervical radiculopathy (CR) is one of the diseases that most affect the cervical spine, causing radicular symptoms in the ipsilateral limb. Conservative treatment aim recover of both mechanical and physiological functions through neural mobilization techniques, along with the activation of the deep neck flexors with cervical segmental stabilization, combining techniques of joint mobilization and manipulation, which seeks mobility improvement of crucial areas of the cervical spine. The objective of this study was to evaluate a multimodal treatment to enhance the outcomes of conservative care in patients diagnosed with CR. Methods: The sample consisted of 11 patients with CR, between 21 and 59 years old, 3 female and 8 male. It was recorded the Visual Analogue Scale (VAS) for pain, the Functional Development of the Neck Pain and Disability Scale (NPDS) and the goniometry during shoulder abduction. The intervention plan was composed by neural mobilization, intermittent cervical traction, pompages, stretching, myofascial inhibition techniques, manipulative techniques and cervical segmental stabilization exercises. After 12 weeks of treatment, subjects underwent a new evaluation process. Results: Before the treatment, subjects reported an average pain of 7 (± 1.48) in VAS, whose dropped to average 1.18 (± 1.99) (p < 0.01). Functional disability evaluated in NPDS was 36 (± 10.95) before treatment decreasing to 11.45 (± 9.8) (p < 0.01) after the treatment. Range of motion of the ipsilateral upper limb was restores by increasing from 9.2° (± 8.2) to 137° (± 24.4) (p < 0.01). Conclusion: The proposed treatment approach was effective, significantly improving the results of analgesia and functional disability a series of cases of patients diagnosed with cervical radiculopathy. {#}.

Resumo Introdução: Sabe-se que a radiculopatia cervical (RC) é uma das patologias que mais acometem a coluna cervical, gerando sintomas radiculares na extremidade superior ipsilateral. Desta forma, no tratamento conservador, busca-se recuperar a função mecânica e fisiológica do sistema nervoso por intermédio da técnica de mobilização neural, além da ativação dos músculos flexores profundos do pescoço com a estabilização segmentar cervical, aliando técnicas de manipulação e mobilização articular, que têm como objetivo melhorar a mobilidade das áreas importantes na mecânica cervical. O objetivo foi avaliar um tratamento multimodal para potencializar o resultado do tratamento conservador nos pacientes diagnosticados com RC. Materiais e métodos: A amostra foi composta por 11 pacientes com diagnóstico médico de RC, com idade entre de 21 e 59 anos, sendo 3 mulheres e 8 homens. Os indivíduos foram avaliados e classificaram sua dor cervical na EVA (Escala Visual Analógica), além de responder ao questionário funcional Development of the Neck Pain and Disability Scale (NPDS) e à goniometria de abdução do ombro ipsilateral a compressão radicular. O método de intervenção utilizado foi composto por: mobilização neural, tração cervical intermitente, pompages, stretching, técnicas de inibição miofascial, técnicas manipulativas de correção e exercícios de estabilização segmentar cervical. Após 12 semanas de tratamento, os indivíduos foram submetidos a um novo processo de avaliação. Resultados: Antes do processo de intervenção, os indivíduos relataram média de dor 7 (± 1,48) na EVA, cuja média reduziu-se a 1,18 (± 1,99) (p < 0,01). Referente à incapacidade funcional avaliada no NPDS, a pontuação média pré-tratamento atingiu média de 36 (± 10,95), diminuindo para 11,45 (± 9,8) (p < 0,01) após o tratamento proposto, que também se mostrou efetivo na recuperação da amplitude de movimento do membro superior ipsilateral, aumentando a média de 9,2° (± 8,2) para 137° (± 24,4) (p < 0,01). Conclusão: O método de tratamento proposto mostrou-se eficaz, melhorando significativamente os resultados de analgesia e incapaciade funcional de uma série de casos de individuos diagnósticados com radiculopatia cervical.