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Guild TT, Crawford AM, Striano BM, Mortensen S, Wixted JJ. The epidemiology and management of iliopsoas hematoma with femoral nerve palsy: A descriptive systematic review of 174 cases. Injury 2023; 54:280-287. [PMID: 36586813 DOI: 10.1016/j.injury.2022.11.057] [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] [Received: 07/06/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Iliopsoas hematoma with femoral nerve palsy is a rare phenomenon with no consensus treatment algorithm. The objective of this study was to perform a systematic review of all reported cases of femoral nerve palsy secondary to iliopsoas hematoma to better elucidate it's optimal treatment. MATERIALS AND METHODS Queries of the PubMed, Embase, and Cochrane databases were performed for reports available in English of femoral nerve palsy secondary to iliopsoas, psoas, or iliacus hematoma. 1491 articles were identified. After removal of duplicated publications and review of abstract titles via a majority reviewer consensus, 217 articles remained for consideration. Dedicated review of the remaining articles (including their reference sections) yielded 122 articles representing 174 distinct cases. Clinical data including patient age, sex, medical history, use of pharmacologic anticoagulation, sensory and motor examination at presentation and follow-up, hematoma etiology and location, time to intervention, and type of intervention were collected. Descriptive statistics were generated for each variable. RESULTS Femoral nerve palsy secondary to iliopsoas hematoma occurred at a mean age of 44.5 years old. A majority of patients (60%) were male, and a majority of hematomas (54%) occurred due to pharmacologic anticoagulation. Most hematomas (57%) were treated conservatively, and almost half (49%) - regardless of treatment modality - resulted in persistent motor deficits at final follow-up. A minority of patients treated surgically (34%) had residual motor deficit at final follow-up, while 66% of those treated medically had resultant motor deficits, although no direct statistical comparison was able to be performed. DISCUSSION AND CONCLUSIONS The disparate available data on iliopsoas hematoma with femoral nerve palsy precludes the completion of a true metanalysis, and therefore any conclusions on an optimal treatment algorithm. Based on review of the literature, small to moderate hematomas are often treated conservatively, while larger hematomas with progressive neurological symptoms are usually managed with a percutaneous decompression or surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Theodore T Guild
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA.
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Boston, MA
| | - John J Wixted
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Lo L, Duarte A, Bencardino JT. Nerve Entrapments in the Pelvis and Hip. Semin Musculoskelet Radiol 2022; 26:153-162. [PMID: 35609576 DOI: 10.1055/s-0042-1750211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Clinical symptoms of pelvic entrapment neuropathies are widely variable and frequently nonspecific, thus rendering it difficult to localize and diagnose. Magnetic resonance imaging (MRI), and in particular MR neurography, has become increasingly important in the work-up of entrapment neuropathies involving the pelvic and hip nerves of the lumbosacral plexus. The major sensory and motor peripheral nerves of the pelvis and hip include the sciatic nerve, superior and inferior gluteal nerves, femoral nerve, lateral femoral cutaneous nerve, obturator nerve, and pudendal nerve. Familiarity with the anatomy and imaging appearance of normal and pathologic nerves in combination with clinical presentation is crucial in the diagnosis of entrapment neuropathies.
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Affiliation(s)
- Lawrence Lo
- Department of Radiology, University of Pennsylvania, Penn Medicine at University City, Philadelphia, Pennsylvania
| | - Alejandra Duarte
- Division of Musculoskeletal Radiology, Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Jenny T Bencardino
- Division of Musculoskeletal Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Iatrogenic femoral nerve injuries: Analysis of medico-legal issues through a scoping review approach. Ann Med Surg (Lond) 2021; 72:103055. [PMID: 34815865 PMCID: PMC8593564 DOI: 10.1016/j.amsu.2021.103055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Accidental femoral nerve injury is a well-known iatrogenic complication of orthopaedic, abdominal, and pelvic surgery. Because of the largely transitory nature of the symptoms associated with nerve damage, its true incidence is in all likelihood underestimated. This work aims to illustrate the surgical contexts within which this nerve injury is reported, based on the evidence obtained from a Scoping Review of the literature of the last 20 years, with specific reference to the underlying etiopathogenetic mechanisms and prognostic outcomes, to highlight the evaluation issues of medico-legal interest related to this pathology. Methods We conducted a Scoping Review of iatrogenic femoral nerve injuries reported between 2000 and 2021 by searching the electronic databases Pubmed, Scopus, Ovid Medline, Ovid Emcare, and Web of Science.We conducted the review according to the five-step methodology outlined by Arksey and O'Malley. Results The literature search identified 104 papers, including case reports, case series, and retrospective studies. Surgical contexts within which iatrogenic femoral nerve injuries were reported include orthopaedic, abdominal, gynaecological, urological, vascular, and plastic surgery, as well as locoregional anaesthesiological procedures. The long-term prognosis was generally favourable. Conclusions Because of its frequent iatrogenic genesis, femoral nerve injury is a topic of intense medico-legal interest. From the perspective of estimating the patient's disability, the mostly favourable nature of the prognosis makes the medico-legal assessment, in some respects, complex, thus requiring a precise evaluation methodology.
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Deng B, Hong HN, Feng XB, Hong ZH, Cai GP, Hong D. Psoas hematoma as a rare complication of posterior lumbar interbody fusion: a case report. BMC Surg 2020; 20:279. [PMID: 33176755 PMCID: PMC7661274 DOI: 10.1186/s12893-020-00942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Psoas hematoma rarely occurs in patients with spondylolisthesis who undergo posterior lumbar interbody fusion (PLIF) surgery. Case presentation Here we reported a case of a 57-year-old male patient diagnosed with spondylolisthesis who underwent PLIF at the local hospital. Seven days post-surgery, abdominal pain occurred, and the pain in the right lower limb gradually increased. The computerized tomography (CT) indicated a formation of hematoma around the psoas muscle. Digital-subtraction angiography (DSA) suggested a vascular injury, a rupture of the right segmental artery of the lumbar vertebral level 4. The patient then received DSA vascular embolization, after which the lower lumbar segmental artery active bleeding was stopped. One month after discharge, the abdominal hematoma was gradually absorbed, and the pain in the waist, leg, and abdomen disappeared. Conclusion Symptoms such as abdominal pain, abdominal distension, and exacerbation of lower limb pain, may suggest the occurrence of psoas hematoma after PLIF. DSA vascular embolization is suggested as the first treatment approach for this type of complication.
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Affiliation(s)
- Bo Deng
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Hai Nan Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Xin Bing Feng
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Zheng Hua Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China.
| | - Guo Ping Cai
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Dun Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
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Almazrua IS, Almarshad AY, Binzuman G, Alrabiah AM. Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report. Orthop Res Rev 2020; 12:127-132. [PMID: 33061676 PMCID: PMC7519345 DOI: 10.2147/orr.s272077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Psoas hematoma is an uncommon complication following spinal surgeries. It has been reported in both extreme lateral interbody fusion (XLIF) and posterior spinal fusion with instrumentation. Minimally invasive techniques are gaining popularity in recent years due to the appealing advantages of reduced operative time, blood loss, hospital stay, and faster recovery. Case Presentation We are presenting a case of a 77-year-old male with chronic low back pain, diagnosed to have multilevel degenerative disc disease with central and foraminal disc protrusion at L2-L3, L3-L4, L4-L5 with secondary spinal stenosis, underwent XLIF at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws. On the fourth day post-operatively, the patient had flank pain and dropping hemoglobin with femoral nerve palsy symptoms, a CT scan revealed a large psoas hematoma. Conservative management was decided on; a follow-up CT scan and examination showed complete resolution of the hematoma and femoral nerve recovery. Discussion The approach to iliopsoas hematoma post spinal surgeries remains controversial. Iliopsoas hematoma should be suspected in any patients post spinal surgeries even with delayed presentations. The decision to proceed with either surgical intervention or conservative management depends on multiple factors, including patient hemodynamic status, progression of collection and femoral nerve palsy. Conclusion The exact cause of iliopsoas hematoma post different spinal surgery approaches remains vague. In our opinion, other causes including pre- and post-operative anticoagulants should be investigated. Rushing to drain iliopsoas hematomas in case of femoral nerve palsy might not be the ideal option. Instead, monitoring patient responses to resuscitation and taking a watch and wait approach for femoral nerve palsy might be the proper approach.
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Affiliation(s)
- Ibrahim S Almazrua
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdullah Y Almarshad
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ghadah Binzuman
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Anwar M Alrabiah
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Seo JG, Yang JC, Kim TW, Park KH. Intramuscular Hematoma on the Psoas Muscle. Korean J Neurotrauma 2019; 15:234-238. [PMID: 31720283 PMCID: PMC6826083 DOI: 10.13004/kjnt.2019.15.e29] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/03/2019] [Accepted: 09/20/2019] [Indexed: 11/22/2022] Open
Abstract
Intramuscular hematomas on the psoas muscle are rare and usually occur as a result of trauma, iatrogenic etiology during lumbar surgery, rupture of the aortic aneurysm, and hematologic diseases. The incidence of spontaneous psoas muscle hematomas has slowly increased as a result of using anticoagulation and antiplatelet agents. Magnetic resonance (MR) imaging is a more sensitive option compared to computed tomography (CT) when diagnosing a hematoma. Coronal T2-weighted images are more useful. CT imaging is also useful to establish the rapid diagnosis of hematoma. When a prolonged prothrombin time and international normalized ratio and decrease platelet count are noted, psoas muscle hematomas should be considered, if there was no lesion in the spinal canal. Most hematomas resolve spontaneously without clinical complications if the hematoma is not large or it is not compressing the surrounding important structures, irrespective of cause.
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Affiliation(s)
- Jun Gue Seo
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Joo Chul Yang
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Kwan Ho Park
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
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Abstract
We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan to diagnose the cause of persistent severe radicular pain in the postoperative period.
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Affiliation(s)
- Sandesh Lakkol
- Department of Orthopaedics, Kings College Hospital, London SE9 5RS, UK,Address for correspondence: Mr. Sandesh Lakkol, Department of Orthopaedics, Kings College Hospital, London SE9 5RS, UK. E-mail:
| | - Praveen Sarda
- Department of Orthopaedics, University Hospital North Tees, Hardwik Road, Stockton on Tees, TS19 8PE, United Kingdom
| | - Prasad Karpe
- Department of Orthopaedics, University Hospital North Tees, Hardwik Road, Stockton on Tees, TS19 8PE, United Kingdom
| | - Manoj Krishna
- Department of Orthopaedics, University Hospital North Tees, Hardwik Road, Stockton on Tees, TS19 8PE, United Kingdom
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Peripheral nerve injuries in haemophilia. BLOOD TRANSFUSION 2012; 12 Suppl 1:s313-8. [PMID: 23245720 DOI: 10.2450/2012.0111-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/24/2012] [Indexed: 11/21/2022]
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Poultsides LA, Bedi A, Kelly BT. An algorithmic approach to mechanical hip pain. HSS J 2012; 8:213-24. [PMID: 24082863 PMCID: PMC3470663 DOI: 10.1007/s11420-012-9304-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND As our understanding of hip pathology evolves, the focus is shifting toward earlier identification of hip pathology. Therefore, it is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging. QUESTIONS/PURPOSES The objective was to address the following research questions: (1) Can an algorithmic approach to physical examination of a painful non-arthritic hip provide a more accurate diagnosis and improved treatment plan? (2) Does an anatomical layered concept of clinical diagnosis improve diagnostic accuracy? (3) What are the diagnostic tools necessary for the accurate application of a four-layer (osteochondral, inert, contractile, and neuromechanical) diagnosis? METHODS An unrestricted computerized search of MEDLINE was conducted. Different terms were used in various combinations. RESULTS An algorithmic approach to physical examination of a painful nonarthritic hip, including history, physical examination (specific tests), and advanced imaging allow for better interpretation of debilitating intra- and extra-articular disorders and their effect on core performance. Additionally, it improves our understanding as to how underlying abnormal joint mechanics may predispose the hip joint and the associated hemipelvis to asymmetric loads. These abnormal joint kinematics (layer I) can lead to cartilage and labral injury (layer II), as well as resultant injury to the musculotendinous (layer III) and neural structures (layer IV) about the hip joint and the hemipelvis. The layer concept is a systematic means of determining which structures about the hip are the source of hip pathology and how to best implement treatment. CONCLUSIONS A clear understanding of the differential diagnosis of hip pain through a detailed and systematic physical examination, diagnostic imaging assessment, and the interpretation of how mechanical factors can result in such a wide range of compensatory injury patterns about the hip can facilitate the diagnosis and treatment recommendations.
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Affiliation(s)
- Lazaros A. Poultsides
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| | - Asheesh Bedi
- Sports Medicine and Shoulder Surgery, MedSport, University of Michigan Health System, Ann Arbor, MI 48109 USA
| | - Bryan T. Kelly
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
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Glassman SD, Howard J, Dimar J, Sweet A, Wilson G, Carreon L. Complications with recombinant human bone morphogenic protein-2 in posterolateral spine fusion: a consecutive series of 1037 cases. Spine (Phila Pa 1976) 2011; 36:1849-54. [PMID: 20838369 DOI: 10.1097/brs.0b013e3181d133d0] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE The purpose of this study was to report on a large consecutive series of posterolateral fusion cases using rhBMP-2/ACS. SUMMARY OF BACKGROUND DATA Despite evidence that rhBMP-2/ACS is effective as an iliac crest graft substitute in posterolateral fusion, concerns remain regarding potential risk for BMP use in clinical practice. These concerns have been fueled by the serious complications reported with BMP in anterior cervical spine fusion. While none of the literature on posterolateral fusion with rhBMP-2/ACS has suggested an increased complication rate versus iliac crest bone graft, this issue has not been specifically studied. METHODS We reviewed medical records for a consecutive series of 1037 patients who underwent posterolateral spine fusion using rhBMP-2 between 2003 and 2006. Medical complications were attributed to the surgical procedure if they occurred within the 3-month perioperative period, whereas complications potentially related to BMP were included regardless of time frame. RESULTS Medical and surgical complications were observed in 190 of 1037 patients (18.3%) with 81 major complications (7.8%) and 110 minor complications (10.2%). Neurologic complications were related to screw malposition in 6 patients and epidural hematoma in 3 patients. New or more severe postoperative radicular symptoms were noted in 7 patients (0.7%). Psoas hematoma was identified by CT scan in 8 patients (0.8%). Complications directly related to rhBMP-2 were observed in at least 1 patient (0.1%) and in a worst case analysis, in as many as 6 patients (0.6%). CONCLUSION This study in 1037 patients confirms the relative safety of rhBMP-2/ACS for posterolateral spine fusion. There were extremely few complications directly attributed to rhBMP-2/ACS, and the overall complication rates were consistent with established norms. The stark contrast between this experience and the markedly elevated complication rate reported with anterior cervical BMP usage emphasizes the need to evaluate risks and benefits of bioactive technologies in a site-specific and procedure-specific manner.
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Abrams BM. Femoral and Saphenous Neuropathies. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Petchprapa CN, Rosenberg ZS, Sconfienza LM, Cavalcanti CFA, Vieira RLR, Zember JS. MR Imaging of Entrapment Neuropathies of the Lower Extremity. Radiographics 2010; 30:983-1000. [PMID: 20631364 DOI: 10.1148/rg.304095135] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Catherine N Petchprapa
- Department of Radiology, New York University Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003, USA.
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Naroji S, Belin LJ, Maltenfort MG, Vaccaro AR, Schwartz D, Harrop JS, Weinstein M. Vulnerability of the femoral nerve during complex anterior and posterior spinal surgery. J Spinal Cord Med 2009; 32:432-5. [PMID: 19777866 PMCID: PMC2830684 DOI: 10.1080/10790268.2009.11753252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Femoral nerve palsy is not a common adverse effect of lumbar spinal surgery. OBJECTIVE To report 3 unique cases of femoral nerve neuropathy due to instrumentation and positioning during complex anterior and posterior spinal surgery. METHODS Case series RESULTS All 3 patients demonstrated femoral nerve neuropathy. The first patient presented postoperatively but after 6 months, the palsy resolved. Femoral nerve malfunctioning was documented in the second and third patients intraoperatively; however, with rapid patient repositioning and removal of offending instrumentation, postoperative palsy was avoided. CONCLUSIONS Use of motor evoked potential monitoring of the femoral nerve during surgery is vital for the prevention of future neuropathies, an avoidable complication of spinal surgery.
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Affiliation(s)
- Swetha Naroji
- 1Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania; 2Department of Trauma Surgery, Jefferson Medical College, Philadelphia, Pennsylvania; 3Department of Orthopaedics, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Laurence J Belin
- 1Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania; 2Department of Trauma Surgery, Jefferson Medical College, Philadelphia, Pennsylvania; 3Department of Orthopaedics, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Mitchell Gil Maltenfort
- 1Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania; 2Department of Trauma Surgery, Jefferson Medical College, Philadelphia, Pennsylvania; 3Department of Orthopaedics, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- 1Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania; 2Department of Trauma Surgery, Jefferson Medical College, Philadelphia, Pennsylvania; 3Department of Orthopaedics, Jefferson Medical College, Philadelphia, Pennsylvania
| | | | - James S Harrop
- 1Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania; 2Department of Trauma Surgery, Jefferson Medical College, Philadelphia, Pennsylvania; 3Department of Orthopaedics, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Michael Weinstein
- 1Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania; 2Department of Trauma Surgery, Jefferson Medical College, Philadelphia, Pennsylvania; 3Department of Orthopaedics, Jefferson Medical College, Philadelphia, Pennsylvania
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Abrams BM. Femoral and Saphenous Neuropathies. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Russell SM, Kline DG. Complication avoidance in peripheral nerve surgery: preoperative evaluation of nerve injuries and brachial plexus exploration--part 1. Neurosurgery 2006; 59:ONS441-7; discussion ONS447-8. [PMID: 17041515 DOI: 10.1227/01.neu.0000235142.83758.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Complication avoidance during peripheral nerve surgery has received little attention in the neurosurgical literature. The goal of our two-part review is to discuss these possible complications, with this initial article highlighting the pitfalls associated with pre- and intraoperative assessment of nerve injuries, as well as the operative nuances used during brachial plexus exploration to minimize complications.
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Affiliation(s)
- Stephen M Russell
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA.
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Abstract
This article provides a succinct and complete method for the clinical evaluation of the hip. Included are descriptions of examination tests as well as their relationships to possible pathology of the hip. The examination is divided into five stages: seated, standing, supine, lateral, and prone; with a total of 11 assessment points. The method for evaluation outlined will assist physicians in determining the location and etiology of presenting hip pathologies. As with any examination, practice and repetition are essential to gain an appreciation of what constitutes a normal as well as an abnormal examination.
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Affiliation(s)
- Brett A Braly
- University of Oklahoma College of Medicine, PO Box 26901, BSEB 100, Box 396, Oklahoma City, OK 73190, USA.
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Gruber H, Peer S, Kovacs P, Marth R, Bodner G. The ultrasonographic appearance of the femoral nerve and cases of iatrogenic impairment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:163-172. [PMID: 12562121 DOI: 10.7863/jum.2003.22.2.163] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the feasibility of ultrasonography of femoral nerves in a cadaveric specimen, healthy volunteers, and patients. METHODS In 1 unembalmed cadaveric specimen (female, 90 years) and 20 healthy volunteers (9 male and 11 female, 18-50 years; n = 40 scans), the topographic features, cross-sectional shapes (oval or triangular), and cross-sectional areas of the femoral nerves were evaluated by ultrasonography (5- to 12-MHz broadband linear array). In a subsequent study, 7 consecutive patients with postoperative findings assigned to the femoral nerve were evaluated and assessed by a neurologist. RESULTS The mean +/- SD anteroposterior and mediolateral diameters of the femoral nerves in the volunteers were 3.1 +/- 0.8 and 9.8 +/- 2.1 mm, respectively, at an average cross-sectional area of 21.7 +/- 5.2 mm2. The cross-sectional shape was oval in 67.5% superior to the inguinal ligament and in 95% inferior to the ligament. The infrainguinal femoral nerve showed variable distances to the femoral artery. In the subsequent patient study, 5 patients had swelling of the femoral nerve in the affected side. In 1 patient, the nerve had a blurred echo structure due to a hematoma. In 1 patient, major damage of the femoral nerve was ruled out clearly. CONCLUSIONS Ultrasonography allows the depiction and assessment of the femoral nerve from about 10 cm superior to 5 cm inferior to the inguinal ligament. In this region, ultrasonography is helpful in detection of impairments and, therefore, in decisions about planning and even acceleration of further treatment.
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Affiliation(s)
- Hannes Gruber
- Department of Radiology, University Hospital Innsbruck, Innsbruck, Austria
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