1
|
Schönnagel L, Chiaparelli E, Camino-Willhuber G, Zhu J, Caffard T, Tani S, Burkhard MD, Kelly M, Guven AE, Shue J, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Spine-specific sarcopenia: distinguishing paraspinal muscle atrophy from generalized sarcopenia. Spine J 2024; 24:1211-1221. [PMID: 38432297 DOI: 10.1016/j.spinee.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/12/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND CONTEXT Atrophy of the paraspinal musculature (PM) as well as generalized sarcopenia are increasingly reported as important parameters for clinical outcomes in the field of spine surgery. Despite growing awareness and potential similarities between both conditions, the relationship between "generalized" and "spine-specific" sarcopenia is unclear. PURPOSE To investigate the association between generalized and spine-specific sarcopenia. STUDY DESIGN Retrospective cross-sectional study. PATIENT SAMPLE Patients undergoing lumbar spinal fusion surgery for degenerative spinal pathologies. OUTCOME MEASURES Generalized sarcopenia was evaluated with the short physical performance battery (SPPB), grip strength, and the psoas index, while spine-specific sarcopenia was evaluated by measuring fatty infiltration (FI) of the PM. METHODS We used custom software written in MATLAB® to calculate the FI of the PM. The correlation between FI of the PM and assessments of generalized sarcopenia was calculated using Spearman's rank correlation coefficient (rho). The strength of the correlation was evaluated according to established cut-offs: negligible: 0-0.3, low: 0.3-0.5, moderate: 0.5-0.7, high: 0.7-0.9, and very high≥0.9. In a Receiver Operating Characteristics (ROC) analysis, the Area Under the Curve (AUC) of sarcopenia assessments to predict severe multifidus atrophy (FI≥50%) was calculated. In a secondary analysis, factors associated with severe multifidus atrophy in nonsarcopenic patients were analyzed. RESULTS A total of 125 (43% female) patients, with a median age of 63 (IQR 55-73) were included. The most common surgical indication was lumbar spinal stenosis (79.5%). The median FI of the multifidus was 45.5% (IQR 35.6-55.2). Grip strength demonstrated the highest correlation with FI of the multifidus and erector spinae (rho=-0.43 and -0.32, p<.001); the other correlations were significant (p<.05) but lower in strength. In the AUC analysis, the AUC was 0.61 for the SPPB, 0.71 for grip strength, and 0.72 for the psoas index. The latter two were worse in female patients, with an AUC of 0.48 and 0.49. Facet joint arthropathy (OR: 1.26, 95% CI: 1.11-1.47, p=.001) and foraminal stenosis (OR: 1.54, 95% CI: 1.10-2.23, p=.015) were independently associated with severe multifidus atrophy in our secondary analysis. CONCLUSION Our study demonstrates a low correlation between generalized and spine-specific sarcopenia. These findings highlight the risk of misdiagnosis when relying on screening tools for general sarcopenia and suggest that general and spine-specific sarcopenia may have distinct etiologies.
Collapse
Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Luisenstraße 64, 10117 Berlin, Germany
| | - Erika Chiaparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA; Asuncion Klinikia, Izaskungo Aldapa, 20400 Tolosa, Spain
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA; Universitätsklinikum Ulm, Klinik für Orthopädie, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Soji Tani
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Tokyo, Japan
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Michael Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 520 E 70th New York, NY 10021, USA.
| |
Collapse
|
2
|
Yoon SH, Tabansi P, Javed S. Peripheral nerve stimulation for psoas muscle pain. Pain Manag 2024; 14:119-124. [PMID: 38440795 DOI: 10.2217/pmt-2023-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
The psoas muscle is the largest muscle in the lower lumbar spine and is innervated by the ipsilateral lumbar spinal nerve roots (L2-L4). Here, we present a 44-year-old female with left hip pain in the posterolateral aspect of the left hip radiating to the ipsilateral hamstring, and psoas atrophy (based on imaging). She is now reported to have over 50% improvement in pain scores after underdoing temporary peripheral nerve stimulation of the psoas muscle as well as significant improvement in muscle atrophy based on an electromyography (EMG) study. This case study is the first to report documented improvement in muscle atrophy based on EMG after peripheral nerve stimulation of the targeted area.
Collapse
Affiliation(s)
- Syn Hae Yoon
- Department of Anesthesiology & Pain Medicine, El-Hospital, Namyang-ju, 12122, South Korea
| | - Precious Tabansi
- Department of Pain medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saba Javed
- Department of Pain medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
3
|
Godolias P, Frieler S, Tataryn ZL, McBride P, Nunna R, Ghayoumi P, Charlot K, Tran A, Al-Awadi H, Gerstmeyer JR, Ruetten S, Chapman JR, Oskouian RJ. Towards a More Realistic Appraisal of Complications Following Staged Lateral Lumbar Interbody Fusion: A Single Institution Series. Global Spine J 2024; 14:130-137. [PMID: 35446693 PMCID: PMC10676158 DOI: 10.1177/21925682221096621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES With steadily increasing implementation of far lateral approaches in spine surgery, surgeons can utilize the advantages of different approaches synergistically to ensure an optimal patient outcome. Our single institution study aimed to assess the complication rates of patients who underwent a lateral interbody fusion as the index procedure and additional anterior or posterior instrumentation as part of a planned staged surgical reconstruction effort. METHODS This study was approved by our institutional review board (STUDY2021000113). We included 576 patients who received a lateral lumbar interbody fusion (LLIF) as the index procedure followed by transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior lumbar interbody fusion (ALIF) between 2016 and 2020. Primary outcomes were complications identified during the initial inpatient stay, which were categorized into approach-related and secondary complications. Secondary outcomes tracked up to 6 years post-surgery. RESULTS The overall complication rate was 19.2% (10.5% approach related, 8.7% secondary complications). Significant intraoperative hemorrhage (mean 659.3 mL vs 131.4 mL, P < .01) was the most common approach related complication with an incidence of 4%, followed by temporary hip flexor weakness in 2.6%. A permanent (femoral) nerve damage was verified in 1 patient. The most common secondary complication was impaired wound healing in 12 patients (2.1%). We identified a 7.1% (41 of 576 patients) rate of revision surgery, on average after 372 days (±34 days). CONCLUSIONS We recorded an overall complication rate of 19.2% for staged adult deformity corrective surgeries utilizing far lateral interbody fusions at several lumbar levels followed by a more comprehensive posterior surgical reconstruction.
Collapse
Affiliation(s)
- Periklis Godolias
- Seattle Science Foundation, Seattle, WA, USA
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sven Frieler
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | | | | | - Ravi Nunna
- Seattle Science Foundation, Seattle, WA, USA
| | | | | | - Angela Tran
- Seattle Science Foundation, Seattle, WA, USA
| | | | - Julius R. Gerstmeyer
- Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group–Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital/Marien Hospital Witten, Herne, Germany
| | | | | |
Collapse
|
4
|
Suraj D, Zhang A, Appelbaum T, Ahmed N, Shih S, Gofman J, Kalenja K, Abrigo JN, Shaporova V, Mannan A, Jacobs RJ. Clinical Presentation and Management of Malignant Psoas Syndrome: A Scoping Review of Case Reports and Case Series. Cureus 2023; 15:e41522. [PMID: 37551242 PMCID: PMC10404467 DOI: 10.7759/cureus.41522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Malignant psoas syndrome (MPS) is a rare and underreported clinical syndrome that significantly impacts the quality of life of cancer patients through metastatic infiltration of the iliopsoas muscle. Patients suffering from MPS often present with painful hip flexion, loss of mobility, and immense pain in their legs and back. The current literature describing the clinical presentation, management, and prognosis of MPS is limited primarily to case reports and outdated literature reviews. There remains a gap in the current knowledge of MPS and in the management of this complex cancer-related pain syndrome. Thus, this scoping review aimed to map current case reports and case series on MPS for clinical presentation, treatment modalities, and resulting prognoses of MPS in late-stage cancer patients. A systemized search using the databases Embase and PubMed (Medline) was conducted to access case reports and case series published between January 1990 and October 2022 that met the study's inclusion criteria: (1) adult patients with metastatic cancer; (2) MPS symptoms secondary to infiltration of iliopsoas; (3) clinical presentation, treatment modality, and prognosis; and (4) English-language text. Our search strategy yielded 1926 citations. After removing 629 duplicates, 1,283 reports were excluded due to failure to meet eligibility criteria (n=1,271) or inaccessibility (n=12). Using the JBI appraisal tools for case reports and case series, a total of 14 articles remained for the final review. With histories of either genitourinary, hepatic, gastric, or skin cancer, each case reported new onset intense pain in the legs, back, abdomen, or pelvis with associated symptoms such as flexion of the hip or gait disorder. A computerized tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan typically confirmed metastasis into the iliopsoas causing these symptoms, which suggested MPS. Each case utilized two to seven different pain management strategies to alleviate MPS symptoms. Many cases first used opioids for pain relief. Following a necessitated increase in morphine equivalent daily dose, a subsequent increase in the strength of analgesic, change in route of administration, and integration of combination drug therapy were generally added to the treatment regime. Many cases reported successful management of symptoms through utilizing methadone, radiation therapy, botulinum toxin injection, increased opioid dosage, or epidural catheter administration of opioids. A unified clinical definition of MPS may be required to inform physicians of this syndrome to help support clinical decisions regarding treatments for patients. The studies indicated that a clearer guideline for treatment protocol may be warranted as most cases reported utilizing various treatment medication dosages and procedures with vastly differing results.
Collapse
Affiliation(s)
- Delwin Suraj
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Angel Zhang
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Taylor Appelbaum
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Nahiyan Ahmed
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Susana Shih
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Joseph Gofman
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Klea Kalenja
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Juanito N Abrigo
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Valeriya Shaporova
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Arhum Mannan
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Robin J Jacobs
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| |
Collapse
|
5
|
Lumbosacral plexus 3D printing with dissection validation - a baseline study with regards to lateral spine surgery. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
6
|
Zhao X, Liang H, Hua Z, Li W, Li J, Wang L, Shen Y. The morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation. BMC Musculoskelet Disord 2022; 23:994. [DOI: 10.1186/s12891-022-05968-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective
The objective of this study was to explore the morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation.
Methods
This study retrospectively analyzed young patients aged 18–40 years who were hospitalized for lumbar disc herniation in our hospital from June 2017 to June 2020. Data on sex, age, body mass index (BMI), subcutaneous fat tissue thickness (SFTT) at the L1-L2 level, duration of symptoms, degree of lumbar disc herniation, visual analog scale (VAS) for the lower back, Mo-fi-disc score, relative cross-sectional area (RCAS) of the paravertebral muscles (psoas major [PM], multifidus [MF], and erector spinae [ES]), and degree of fat infiltration (DFF) of the paravertebral muscles were collected. The VAS was used to evaluate the intensity of low back pain. Patients with VAS-back >4 points were defined as the low back pain group, and patients with ≤4 points were defined as the control group. The demographic characteristics, as well as the bilateral and ipsilateral paravertebral muscles, of the two groups were compared and analyzed.
Result
A total of 129 patients were included in this study (52 patients in the LBP group and 77 patients in the control group). There were no significant differences in sex, BMI, or Pfirrmann grade of lumbar disc herniation between the two groups (P > 0.05). The age of the LBP group (33.58 ± 2.98 years) was greater than that of the control group (24.13 ± 2.15 years) (P = 0.002), and the SFTT at the L1-L2 level (13.5 ± 7.14 mm) was higher than that of the control group (7.75 ± 6.31 mm) (P < 0.05). Moreover, the duration of symptoms (9.15 ± 0.31 months) was longer than that of the control group (3.72 ± 0.48 months) (P < 0.05), and the Mo-fi-disc score (8.41 ± 3.16) was higher than that of the control group (5.53 ± 2.85) (P < 0.05). At L3/4 and L5/S1, there was no significant difference in the RCSA and DFF of the bilateral and ipsilateral paraspinal muscles between the LBP group and the control group. At L4/5, there was no significant difference in the RCSA and DFF of the paraspinal muscles on either side in the LBP group (P > 0.05). In the control group, the RCSA of the MF muscle on the diseased side was smaller than that on the normal side (P < 0.05), and the DFF of the MF muscle on the diseased side was larger than that on the normal side (P < 0.05). In addition, there was no significant difference in the ES and PM muscles on both sides (P > 0.05). At L4/5, the RCSA of the MF muscle on the normal side was significantly smaller in the LBP group than in the control group (P < 0.05), and the DFF of the MF muscle on the normal side was significantly larger in the LBP group than in the control group (P < 0.05). There was no significant difference in the ES and PM muscles on the same side between the two groups (P > 0.05).
Conclusion
In young patients with unilateral neurological symptoms of lumbar disc herniation, symmetrical atrophy of the bilateral MF muscle is more prone to causing low back pain. Older age, higher SFTT at the L1-L2 levels, longer symptom duration, higher Mo-fi-di score, and greater muscle atrophy on the normal side of the MF increased the incidence of low back pain in young patients with unilateral lumbar disc herniation.
Collapse
|
7
|
Iliacus minor and psoas quartus muscles traversing the femoral nerve. Morphologie 2021; 106:307-309. [PMID: 34696972 DOI: 10.1016/j.morpho.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
Anatomical variations of the nerves of the body can be relevant to surgical approaches anesthetic blockade, and other region procedures. Herein, we report a case of three muscle fascicles of the variant psoas quartus and iliacus minor muscles traversing the femoral nerve. Salient literature is reviewed regarding this phenomenon. Variations in the femoral nerve, such as illustrated in the current case, could also help explain hip and thigh pain, and failure of traditional anesthetic placement to block sensation from the femoral nerve completely. Given the procedural relevance of variations in the femoral nerve, further characterizations of nontraditional courses could help to avoid nerve injury during interventions.
Collapse
|
8
|
Leonardo da Vinci and his contribution to our understanding of the lumbosacral plexus. Childs Nerv Syst 2019; 35:2021-2022. [PMID: 30054804 DOI: 10.1007/s00381-018-3918-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
|
9
|
Iliolumbar Vein: Anatomy and Surgical Importance During Lateral Transpsoas and Oblique Approaches to Lumbar Spine. World Neurosurg 2019; 128:e768-e772. [DOI: 10.1016/j.wneu.2019.04.252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/29/2019] [Indexed: 12/30/2022]
|
10
|
Wong TL, Kikuta S, Iwanaga J, Tubbs RS. A multiply split femoral nerve and psoas quartus muscle. Anat Cell Biol 2019; 52:208-210. [PMID: 31338239 PMCID: PMC6624330 DOI: 10.5115/acb.2019.52.2.208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/27/2022] Open
Abstract
The femoral nerve is the largest branch of the lumbar plexus. It is normally composed of the ventral rami of spinal nerves L2 to L4. The psoas major has proximal attachments onto the T12 to L5 vertebrae and related intervertebral discs, fuses with the iliacus deep to the inguinal ligament and then attaches onto the lesser trochanter of the femur. Normally, the anatomical relationship is that the femoral nerve is located between the iliacus and psoas major. Herein, we report a case of the psoas quartus muscle related to several splits of the femoral nerve within the pelvis. Although the embryology for this is unclear, surgeons and physicians should be aware of such anatomical variants in order to better understand pain and entrapment syndromes and during surgical maneuvers in this region such as lateral transpsoas approaches to the lumbar spine.
Collapse
Affiliation(s)
- T L Wong
- Seattle Science Foundation, Seattle, WA, USA
| | - Shogo Kikuta
- Seattle Science Foundation, Seattle, WA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| |
Collapse
|
11
|
Iwanaga J, Simonds E, Schumacher M, Kikuta S, Watanabe K, Tubbs RS. Revisiting the genital and femoral branches of the genitofemoral nerve: Suggestion for a more accurate terminology. Clin Anat 2019; 32:458-463. [PMID: 30592097 DOI: 10.1002/ca.23327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/22/2018] [Indexed: 11/11/2022]
Abstract
The genitofemoral nerve is a branch of the lumbar plexus originating from the ventral rami of the first and second lumbar spinal nerves. During routine dissections of this nerve, we have occasionally observed that the genital branch of the genitofemoral nerve gave rise to the femoral branch, and the femoral branch of the genitofemoral nerve gave rise to the genital branch. Therefore, this study aimed to investigate the aforementioned distributions of the genitofemoral nerve in a large number of cadaveric specimens. Twenty-four sides from fourteen fresh-frozen cadavers derived from nine males and five females were used in this study. For proximal branches of the genitofemoral nerve, that is, as they first arise from the genitofemoral nerve, the terms "medial branch" and "lateral branch" were used. For the final distribution, the terms "genital branch" and "femoral branch" were used. On eight sides (33.3%) with nine branches, one or two branch(s) from either the medial or lateral branch became coursed as the femoral or genital branches (five became femoral and four became genital branches). Our study revealed that the distribution of the genitofemoral nerve is more complicated than previously described. The "medial branch" and "lateral branch" that we have used in the present study for describing the proximal branches of the genitofemoral nerve are more practical terms to describe the genitofemoral nerve. Clin. Anat. 32:458-463, 2019. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | | | | | | | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| |
Collapse
|
12
|
Li J, Wang X, Sun Y, Zhang F, Gao Y, Li Z, Ding W, Shen Y, Zhang W. Safety Analysis of Two Anterior Lateral Lumbar Interbody Fusions at the Initial Stage of Learning Curve. World Neurosurg 2019; 127:e901-e909. [PMID: 30959256 DOI: 10.1016/j.wneu.2019.03.294] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Until now, there were few studies on the safety analysis of oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF) in the initial stage of learning curve. The purpose of this study was to find out the safety differences between the 2 minimally invasive fusion methods in the initial stage of learning curve and to provide reference for beginners. METHODS We retrospectively collected the first 30 cases of lumbar degenerative disease with OLIF or XLIF in our center since June 2014. Patients were divided into group OLIF and group XLIF according to different operative methods. The clinical efficacy and complications of the 2 groups were compared. A P <0.05 was statistically significant. RESULTS Group XLIF were aged 37-74 years (mean 58.4 years) and group OLIF were aged 39-71 years (mean 56.1 years). There were no significant differences between the 2 groups in age, sex, operation time, intraoperative bleeding volume, operation segment, and follow-up time. The incidence of complications in group XLIF was significantly lower than that in group OLIF (10% vs. 33.3%; P = 0.028). CONCLUSIONS OLIF has a higher risk of neurovascular injury in the initial stage of learning. By contrast, the XLIF approach is simple and the incidence of complications is relatively low. Therefore, we believed that XLIF is more acceptable in the initial stage of anterolateral lumbar interbody fusion.
Collapse
Affiliation(s)
- Jiaqi Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xianzheng Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yapeng Sun
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Gao
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zeyang Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Shen
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
| |
Collapse
|
13
|
Zeng ZY, Xu ZW, He DW, Zhao X, Ma WH, Ni WF, Song YX, Zhang JQ, Yu W, Fang XQ, Zhou ZJ, Xu NJ, Huang WJ, Hu ZC, Wu AL, Ji JF, Han JF, Fan SW, Zhao FD, Jin H, Pei F, Fan SY, Sui DX. Complications and Prevention Strategies of Oblique Lateral Interbody Fusion Technique. Orthop Surg 2018; 10:98-106. [PMID: 29878716 DOI: 10.1111/os.12380] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To analyze the early complications and causes of oblique lateral interbody fusion, and put forward preventive measures. METHODS There were 235 patients (79 males and 156 females) analyzed in our study from October 2014 to May 2017. The average age was 61.9 ± 0.21 years (from 32 to 83 years). Ninety-one cases were treated with oblique lateral interbody fusion (OLIF) alone (OLIF alone group) and 144 with OLIF combined with posterior pedicle screw fixation through the intermuscular space approach (OLIF combined group). In addition, 137/144 cases in the combined group were primarily treated by posterior pedicle screw fixation, while the treatments were postponed in 7 cases. There were 190 cases of single fusion segments, 11 of 2 segments, 21 of 3 segments, and 13 of 4 segments. Intraoperative and postoperative complications were observed. RESULTS Average follow-up time was 15.6 ± 7.5 months (ranged from 6 to 36 months). Five cases were lost to follow-up (2 cases from the OLIF alone group and 3 cases from the OLIF combined group). There were 7 cases of vascular injury, 22 cases of endplate damage, 2 cases of vertebral body fracture, 11 cases of nerve injury, 18 cases of cage sedimentation or cage transverse shifting, 3 cases of iliac crest pain, 1 case of right psoas major hematoma, 2 cases of incomplete ileus, 1 case of acute heart failure, 1 case of cerebral infarction, 3 case of left lower abdominal pain, 9 cases of transient psoas weakness, 3 cases of transient quadriceps weakness, and 8 cases of reoperation. The complication incidence was 32.34%. Thirty-three cases occurred in the OLIF alone group, with a rate of 36.26%, and 43 cases in the group of OLIF combined posterior pedicle screw fixation, with a rate of 29.86%. Fifty-seven cases occurred in single-segment fusion, with a rate of 30.0% (57/190), 4 cases occurred in two-segment fusion, with a rate of 36.36% (4/11), 9 cases occurred in three-segment fusion, with a rate of 42.86% (9/21), and 6 cases occurred in four-segment fusion, with a rate of 46.15% (6/13). CONCLUSION In summary, OLIF is a relatively safe and very effective technique for minimally invasive lumbar fusion. Nonetheless, it should be noted that OLIF carries the risk of complications, especially in the early stage of development.
Collapse
Affiliation(s)
- Zhong-You Zeng
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China.,Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Zhao-Wan Xu
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Deng-Wei He
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China.,Department of Spine, Lishui Center Hospital, Lishui, China
| | - Xing Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Wei-Hu Ma
- Department of Spine, Ningbo Sixth Hospital, Ningbo, China
| | - Wen-Fei Ni
- Department of Spine, The second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yong-Xing Song
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Jian-Qiao Zhang
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Wei Yu
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Xiang-Qian Fang
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Zhi-Jie Zhou
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Nan-Jian Xu
- Department of Spine, Ningbo Sixth Hospital, Ningbo, China
| | - Wen-Jian Huang
- Department of Spine, Lishui Center Hospital, Lishui, China
| | - Zhi-Chao Hu
- Department of Spine, The second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ai-Lian Wu
- Department of Spine, The second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian-Fei Ji
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Jian-Fu Han
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Feng-Dong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital of Medical College of Zhejiang University, Hangzhou, China
| | - Hui Jin
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Fei Pei
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - Shi-Yang Fan
- Second Department of Orthopedics, Jiaxing Hospital of Zhejiang General Corps of Armed Police Forces, Jiaxing, China
| | - De-Xiu Sui
- Orthopedics Medical Instruments of Hanwei, Weifang, China
| |
Collapse
|
14
|
Vetter M, Iwanaga J, Oskouian RJ, Tubbs RS. Piercing of the Lumbocostal Ligament by the Subcostal Nerve: A Previously Unreported Case. Cureus 2017; 9:e1825. [PMID: 29321949 PMCID: PMC5755947 DOI: 10.7759/cureus.1825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As lateral approaches gain popularity in lumbar spine surgery, detailed discussions regarding anatomical variations in the innervation of the thoracolumbar region are of increasing importance. Damage to intercostal or subcostal nerves can lead to post-operative complications including regional loss of sensitivity, motor function, or abdominal wall hernias. More specifically, the subcostal nerve has been identified in the literature as one of the more vulnerable structures during such procedures. A clear understanding of the position of the subcostal nerve relative to nearby anatomical structures is therefore important for medical professionals. We herein report a rare anatomical variation in which the subcostal nerve pierces the lumbocostal ligament.
Collapse
|