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Munim MA, Nolte MT, Federico VP, Vucicevic RS, Butler AJ, Zavras AG, Walsh JM, Phillips FM, Colman MW. The Effect of Intraoperative Prone Position on Psoas Morphology and Great Vessel Anatomy: Consequences for Prone Lateral Approach to the Lumbar Spine. World Neurosurg 2024; 181:e578-e588. [PMID: 37898268 DOI: 10.1016/j.wneu.2023.10.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND This study sought to quantify radiographic differences in psoas morphology, great vessel anatomy, and lumbar lordosis between supine and prone intraoperative positioning to optimize surgical planning and minimize the risk of neurovascular injury. METHODS Measurements on supine magnetic resonance imaging and prone intraoperative computed tomography with O-arm from L2 to L5 levels included the anteroposterior and mediolateral proximity of the psoas, aorta, inferior vena cava (IVC), and anterior iliac vessels to the vertebral body. Psoas transverse and longitudinal diameters, psoas cross-sectional area, total lumbar lordosis, and segmental lordosis were assessed. RESULTS Prone position produced significant psoas lateralization, especially at more caudal levels (P < 0.001). The psoas drifted slightly anteriorly when prone, which was non-significant, but the magnitude of anterior translation significantly decreased at more caudal segments (P = 0.038) and was lowest at L5 where in fact posterior retraction was observed (P = 0.032). When prone, the IVC (P < 0.001) and right iliac vein (P = 0.005) migrated significantly anteriorly, however decreased anterior displacement was seen at more caudal levels (P < 0.001). Additionally, the IVC drifted significantly laterally at L5 (P = 0.009). Mean segmental lordosis significantly increased when prone (P < 0.001). CONCLUSION Relative to the vertebral body, the psoas demonstrated substantial lateral mobility when prone, and posterior retraction specifically at L5. IVC and right iliac vein experienced significant anterior mobility-particularly at more cephalad levels. Prone position enhanced segmental lordosis and may be critical to optimizing sagittal restoration.
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Affiliation(s)
- Mohammed A Munim
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Rajko S Vucicevic
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander J Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Justin M Walsh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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El Aoufir O, Hassani A, Kaddouri S, Jaddour M, Jroundi L, Laamrani FZ. [A psoitis]. Rev Med Interne 2023; 44:617-618. [PMID: 37296034 DOI: 10.1016/j.revmed.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Affiliation(s)
- O El Aoufir
- Service de radiologie des urgences, CHU Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohammed V, 10170 Rabat, Maroc.
| | - A Hassani
- Service de radiologie des urgences, CHU Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohammed V, 10170 Rabat, Maroc
| | - S Kaddouri
- Service de radiologie des urgences, CHU Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohammed V, 10170 Rabat, Maroc
| | - M Jaddour
- Service de radiologie des urgences, CHU Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohammed V, 10170 Rabat, Maroc
| | - L Jroundi
- Service de radiologie des urgences, CHU Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohammed V, 10170 Rabat, Maroc
| | - F Z Laamrani
- Service de radiologie des urgences, CHU Ibn Sina, faculté de médecine et de pharmacie de Rabat, université Mohammed V, 10170 Rabat, Maroc
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Essobiyou TB, Labou AK, Diendere PRC, Sakiye KA. Psoas primary abscess: A case report in an immunocompetent subject. Int J Surg Case Rep 2023; 110:108640. [PMID: 37591192 PMCID: PMC10436164 DOI: 10.1016/j.ijscr.2023.108640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Primary psoas abscess is a rare disease characterised by a purulent collection in the thickness of the psoas muscle. Its incidence and etiopathogenesis are not well defined. It is mainly encountered in developing countries in weakened conditions. The involvement of an immunocompetent subject is exceptional. We report a case of primary psoas abscess in an immunocompetent patient in Togo. CASE PRESENTATION A 67-year-old retired teacher with no previous medical history was seen in the emergency room with acute and severe abdominal pain. The clinical examination revealed an infectious syndrome and a painful abdominal mass in the right iliac fossa. CT scan showed a heterogeneous fluid collection in the right psoas muscle. Surgical drainage was indicated and performed. The patient was treated postoperatively with dual antibiotics with a favourable outcome. No germs were isolated from the collection. CLINICAL DISCUSSION Rare infectious disease, its real incidence is unknown. The most common germ is staphylococcus aureus. Its etiopathogenesis is also poorly understood. Immune deficiency is a predisposing factor for the condition. Diagnosis of the disease is difficult due to a lack of specificity of the signs encountered. Imaging is the key to positive diagnosis with a high sensitivity of CT scan. Treatment is medical-surgical with drainage and antibiotic therapy. CONCLUSION Primary psoas abscess is a potentially serious disease requiring early diagnosis and management.
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Affiliation(s)
| | - Albert Kossi Labou
- Department of Surgery and Surgical Specialties, university of Lome, Togo
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Urakawa H, Sato K, Vaishnav AS, Lee R, Chaudhary C, Mok JK, Virk S, Sheha E, Katsuura Y, Kaito T, Gang CH, Qureshi SA. Preoperative cross-sectional area of psoas muscle correlates with short-term functional outcomes after posterior lumbar surgery. Eur Spine J 2023; 32:2326-2335. [PMID: 37010611 DOI: 10.1007/s00586-023-07533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the optimal level for the measurement of psoas cross-sectional area and examine the correlation with short-term functional outcomes of posterior lumbar surgery. METHODS Patients who underwent minimally invasive posterior lumbar surgery were included in this study. The cross-sectional area of psoas muscle was measured at each intervertebral level on T2-weighted axial images of preoperative MRI. Normalized total psoas area (NTPA) (mm2/m2) was calculated as total psoas area normalized to patient height. Intraclass Correlation Coefficient (ICC) was calculated for the analysis of inter-rater reliability. Patient reported outcome measures including Oswestry disability index (ODI), visual analog scale (VAS), short form health survey (SF-12) and patient-reported outcomes measurement information system were collected. A multivariate analysis was performed to elucidate independent predictors associated with failure to reach minimal clinically important difference (MCID) in each functional outcome at 6 months. RESULTS The total of 212 patients were included in this study. ICC was highest at L3/4 [0.992 (95% CI: 0.987-0.994)] compared to the other levels [L1/2 0.983 (0.973-0.989), L2/3 0.991 (0.986-0.994), L4/5 0.928 (0.893-0.952)]. Postoperative PROMs were significantly worse in patients with low NTPA. Low NTPA was an independent predictor of failure to reach MCID in ODI (OR = 2.68; 95% CI: 1.26-5.67; p = 0.010) and VAS leg (OR = 2.43; 95% CI: 1.13-5.20; p = 0.022). CONCLUSION Decreased psoas cross-sectional area on preoperative MRI correlated with functional outcomes after posterior lumbar surgery. NTPA was highly reliable, especially at L3/4.
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Affiliation(s)
- Hikari Urakawa
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Kosuke Sato
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Avani S Vaishnav
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Ryan Lee
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Chirag Chaudhary
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Jung Kee Mok
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Sohrab Virk
- North Shore University Hospital, 300 Community Dr, Manhasset, NY, USA
- Long Island Jewish Medical Center, 825 Northern Blvd, Great Neck, NY, USA
| | - Evan Sheha
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY, USA
| | | | - Takashi Kaito
- Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
- Weill Cornell Medical College, 1300 York Ave, New York, NY, USA.
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Pigneur F, Di Palma M, Raynard B, Guibal A, Cohen F, Daidj N, Aziza R, El Hajjam M, Louis G, Goldwasser F, Deluche E. Psoas muscle index is not representative of skeletal muscle index for evaluating cancer sarcopenia. J Cachexia Sarcopenia Muscle 2023. [PMID: 37203274 PMCID: PMC10401530 DOI: 10.1002/jcsm.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/01/2023] [Accepted: 02/28/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND A common method for diagnosing sarcopenia involves estimating the muscle mass by computed tomography (CT) via measurements of the cross-sectional muscle area (CSMA) of all muscles at the third lumbar vertebra (L3) level. Recently, single-muscle measurements of the psoas major muscle at L3 have emerged as a surrogate for sarcopenia detection, but its reliability and accuracy remain to be demonstrated. METHODS This prospective cross-sectional study involved 29 healthcare establishments and recruited patients with metastatic cancers. The correlation between skeletal muscle index (SMI = CSMA of all muscles at L3/height2 , cm2 /m2 ) and psoas muscle index (PMI = CSMA of psoas at L3/height2 , cm2 /m2 ) was determined (Pearson's r). ROC curves were prepared based on SMI data from a development population (n = 488) to estimate suitable PMI thresholds. International low SMI cut-offs according to gender were studied for males (<55cm2 /m2 ) and for females (<39 cm2 /m2 ). Youden's index (J) and Cohen's kappa (κ) were calculated to estimate the test's accuracy and reliability. PMI cut-offs were validated in a validation population (n = 243) by estimating the percentage concordance of sarcopenia diagnoses with the SMI thresholds. RESULTS Seven hundred and sixty-six patients were analysed (mean age 65.0 ± 11.8 years, 50.1% female). Low SMI prevalence was 69.1%. Correlation between the SMI and PMI for the entire population was 0.69 (n = 731, P < 0.01). PMI cut-offs for sarcopenia were estimated in the development population at <6.6cm2 /m2 in males and at <4.8 cm2 /m2 for females. The J and κ coefficients for PMI diagnostic tests were weak. The PMI cut-offs were tested in the validation population where 33.3% of the PMI measurements were dichotomously discordant. CONCLUSIONS A diagnostic test employing single-muscle measurements of the psoas major muscle as a surrogate for sarcopenia detection was evaluated but found to be unreliable. The CSMA of all muscles must be considered for evaluating cancer sarcopenia at L3.
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Affiliation(s)
- Frédéric Pigneur
- Department of Medical Imaging, Henri Mondor University Hospitals, AP-HP, Créteil, France
| | - Mario Di Palma
- Cancerology, American Hospital of Paris, Neuilly-sur-Seine, France
| | - Bruno Raynard
- Department of Nutrition, Gustave-Roussy Institute, Villejuif, France
| | | | - Frédéric Cohen
- Radiology Department, European Hospital of Marseille, Marseille, France
| | - Nassima Daidj
- Department of Medical Imaging, Paoli-Calmette Institute, Marseille, France
| | - Richard Aziza
- Department of Medical Imaging, The Toulouse University-Institute of Cancer, Toulouse, France
| | - Mostafa El Hajjam
- Department of Medical Imaging, Ambroise-Paré Hospital, APHP-Paris Saclay, Boulogne, France
| | - Guillaume Louis
- Diagnostic and Interventional Medical Imaging, Timone Hospital CHU Marseille, Marseille, France
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Grova M, Crispino F, Maida M, Vitello A, Renna S, Casà A, Tesè L, Macaluso FS, Orlando A. Sarcopenia is a negative predictive factor for endoscopic remission in patients with Crohn's disease treated with biologics. Dig Liver Dis 2023:S1590-8658(23)00482-6. [PMID: 36925319 DOI: 10.1016/j.dld.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Sarcopenia has been associated with poor prognosis in chronic diseases. AIMS To investigate the role of sarcopenia in predicting clinical and endoscopic outcomes in patients with Crohn's disease (CD). METHODS Consecutive CD patients who started biologics between 2014 and 2020 and underwent abdominal magnetic resonance or computed tomography within 6 months from the beginning of the biological therapy were enroled. Sarcopenia was defined as Psoas Muscle Index (PMI) lower than 5.4 cm²/m² (men) and 3.56 cm²/m² (women). Univariate and multivariate analyses were used to evaluate whether sarcopenia could predict steroid-free clinical remission (SFCR), endoscopic remission (ER), hospitalisation and surgery after 12 months of therapy. RESULTS 358 patients were included. Sarcopenia was found in 18.2% of patients, and it was associated with a lower rate of ER (14.8% vs 47.7%; p = 0.002) after 12 months of therapy, while it was not associated with SFCR (65.1% vs 70.1%; p = 0.435), hospitalisation (9.2% vs 7.8%; p = 0.801) and surgery (3.1% vs 6.1%; p = 0.549). Sarcopenia was identified as a predictor of lack of ER (odds ratio [OR]=5.2; p = 0.006), as well as smoking (OR=2.5; p = 0.028) and perianal disease (OR=2.6; p = 0.020). CONCLUSION Sarcopenia is a negative prognostic factor for ER in CD patients treated with biologics.
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Affiliation(s)
- Mauro Grova
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
| | - Federica Crispino
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Marcello Maida
- Section of Gastroenterology, "S. Elia-Raimondi" Hospital", Caltanissetta, Italy
| | - Alessandro Vitello
- Section of Gastroenterology, "S. Elia-Raimondi" Hospital", Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Lorenzo Tesè
- Radiology Unit, A.O.O.R. "Villa Sofia-Cervello Hospital", Palermo, Italy
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Guild TT, Crawford AM, Striano BM, Mortensen S, Wixted JJ. The epidemiology and management of ilio psoas 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vervaecke AJ, Declercq H, Wetzels K, van den Broek M. Localized tenosynovial giant cell tumor: a rare case of snapping hip. Skeletal Radiol 2022; 51:2205-10. [PMID: 35536359 DOI: 10.1007/s00256-022-04064-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/03/2022] [Indexed: 02/02/2023]
Abstract
We report on a 40-year-old male with a 9-month-long history of snapping of his right hip caused by a previously undescribed etiology of internal extra-articular snapping hip, namely due to a localized tenosynovial giant cell tumor. Both dynamic ultrasound evaluation and MRI proved to be crucial in the diagnosis of this rare entity. Auto-provocation of the snapping showed an anterior hip mass moving posteriorly to the psoas tendon which elucidated the pain and clicking sensation. Subsequent MRI demonstrated a peripheral low-intensity rim due to hemosiderin deposition around the synovial mass which is indicative for pigmented villonodular tenosynovitis. Treatment consisted of arthroscopic shaver burr resection. Immediately postoperatively, the snapping sensation could not be provoked anymore by the patient. The purpose of reporting on this case report is to emphasize several successive learning points. First, dynamic ultrasound aids in diagnosis and differentiation of the types of snapping hip. Second, specific MRI features are suggestive of tenosynovial giant cell tumor, recognizing these traits may prevent delayed diagnosis and subsequent aggravated clinical course. Third, localized pigmented villonodular tenosynovitis around the hip may present as an internal extra-articular snapping hip and is of consideration in the differential diagnosis of recurrent snapping hip.
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Huang CB, Hu JS, Tan K, Zhang W, Xu TH, Yang L. Application of machine learning model to predict osteoporosis based on abdominal computed tomography images of the psoas muscle: a retrospective study. BMC Geriatr 2022; 22:796. [PMID: 36229793 PMCID: PMC9563158 DOI: 10.1186/s12877-022-03502-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With rapid economic development, the world's average life expectancy is increasing, leading to the increasing prevalence of osteoporosis worldwide. However, due to the complexity and high cost of dual-energy x-ray absorptiometry (DXA) examination, DXA has not been widely used to diagnose osteoporosis. In addition, studies have shown that the psoas index measured at the third lumbar spine (L3) level is closely related to bone mineral density (BMD) and has an excellent predictive effect on osteoporosis. Therefore, this study developed a variety of machine learning (ML) models based on psoas muscle tissue at the L3 level of unenhanced abdominal computed tomography (CT) to predict osteoporosis. METHODS Medical professionals collected the CT images and the clinical characteristics data of patients over 40 years old who underwent DXA and abdominal CT examination in the Second Affiliated Hospital of Wenzhou Medical University database from January 2017 to January 2021. Using 3D Slicer software based on horizontal CT images of the L3, the specialist delineated three layers of the region of interest (ROI) along the bilateral psoas muscle edges. The PyRadiomics package in Python was used to extract the features of ROI. Then Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) algorithm were used to reduce the dimension of the extracted features. Finally, six machine learning models, Gaussian naïve Bayes (GNB), random forest (RF), logistic regression (LR), support vector machines (SVM), Gradient boosting machine (GBM), and Extreme gradient boosting (XGBoost), were applied to train and validate these features to predict osteoporosis. RESULTS A total of 172 participants met the inclusion and exclusion criteria for the study. 82 participants were enrolled in the osteoporosis group, and 90 were in the non-osteoporosis group. Moreover, the two groups had no significant differences in age, BMI, sex, smoking, drinking, hypertension, and diabetes. Besides, 826 radiomic features were obtained from unenhanced abdominal CT images of osteoporotic and non-osteoporotic patients. Five hundred fifty radiomic features were screened out of 826 by the Mann-Whitney U test. Finally, 16 significant radiomic features were obtained by the LASSO algorithm. These 16 radiomic features were incorporated into six traditional machine learning models (GBM, GNB, LR, RF, SVM, and XGB). All six machine learning models could predict osteoporosis well in the validation set, with the area under the receiver operating characteristic (AUROC) values greater than or equal to 0.8. GBM is more effective in predicting osteoporosis, whose AUROC was 0.86, sensitivity 0.70, specificity 0.92, and accuracy 0.81 in validation sets. CONCLUSION We developed six machine learning models to predict osteoporosis based on psoas muscle images of abdominal CT, and the GBM model had the best predictive performance. GBM model can better help clinicians to diagnose osteoporosis and provide timely anti-osteoporosis treatment for patients. In the future, the research team will strive to include participants from multiple institutions to conduct external validation of the ML model of this study.
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Affiliation(s)
- Cheng-Bin Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000, China
| | - Jia-Sen Hu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kai Tan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000, China
| | - Wei Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Tian-Hao Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000, China
| | - Lei Yang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000, China. .,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000, China.
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Song J, Araghi K, Dupont MM, Shahi P, Bovonratwet P, Shinn D, Dalal SS, Melissaridou D, Virk SS, Iyer S, Dowdell JE, Sheha ED, Qureshi SA. Association between muscle health and patient-reported outcomes after lumbar microdiscectomy: early results. Spine J 2022; 22:1677-1686. [PMID: 35671940 DOI: 10.1016/j.spinee.2022.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/05/2022] [Accepted: 05/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Poor muscle health has been implicated as a source of back pain among patients with lumbar spine pathology. Recently, a novel magnetic resonance imaging (MRI)-based lumbar muscle health grade was shown to correlate with health-related quality of life scores. However, the impact of muscle health on postoperative functional outcomes following spine surgery remains to be investigated. PURPOSE To determine whether muscle health grade measured by preoperative psoas and paralumbar muscle cross-sectional areas impact the achievement of minimal clinically important difference (MCID) following lumbar microdiscectomy. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Consecutive patients who underwent 1-level lumbar microdiscectomy in a single institution between 2017 and 2021. OUTCOME MEASURES Rate of MCID achievement, time to MCID achievement, PROMs including Oswestry Disability Index (ODI), visual analog scale for back pain (VAS back), VAS leg, Short Form 12 Physical Component Summary (SF-12 PCS), SF-12 Mental Component Summary (SF-12 MCS), and Patient Reported Outcomes Measurement Information System Physical Function (PROMIS PF). METHODS Two previously validated methods for muscle health grading were applied. Axial T2 MRI were analyzed for muscle measurements. The psoas-based method utilized the normalized total psoas area (NTPA), which is the psoas cross-sectional area divided by the square of patient height (mm2/m2). Patients were divided into low and high NTPA groups based on sex-specific lowest quartile NTPA thresholds. The paralumbar-based method incorporated the paralumbar cross-sectional area normalized by body mass index (PL-CSA/BMI) and Goutallier classification. Score of 1 was added for either PL-CSA/BMI >130 or Goutallier class of ≤2. "Good" muscle health was defined as score of 2, and "poor" muscle health was defined as score of 0 to 1. Prospectively collected PROMs were analyzed at 2-week, 6-week, 3-month, 6-month, 1-year, and 2-year postoperative timepoints. The rate of and time to MCID achievement were compared among the cohorts. Bivariate analyses were performed to assess for correlations between psoas/paralumbar cross-sectional areas and change in PROM scores from baseline. RESULTS The total cohort included 163 patients with minimum follow-up of 6 months and mean follow-up of 16.5 months. 40 patients (24.5%) were categorized into the low NTPA group, and 55 patients (33.7%) were categorized into the poor paralumbar muscle group. Low NTPA was associated with older age, lower BMI, and greater frequencies of Charlson Comorbidity Index (CCI) ≥1. Poor paralumbar muscle health was associated with older age, female sex, higher BMI, and CCI ≥1. There were no differences in rates of MCID achievement for any PROMs between low versus high NTPA groups or between poor versus good paralumbar groups. Low NTPA was associated with longer time to MCID achievement for ODI, VAS back, VAS leg, and SF-12 MCS. Poor paralumbar muscle health was associated with longer time to MCID achievement for VAS back, VAS leg, and SF-12 PCS. NTPA negatively correlated with change in VAS back (6-week, 12-week) and VAS leg (6-month). PL-CSA/BMI positively correlated with change in PROMIS-PF at 3 months follow-up. CONCLUSIONS Among patients undergoing lumbar microdiscectomy, patients with worse muscle health grades achieved MCID at similar rates but required longer time to achieve MCID. Lower NTPA was weakly correlated with larger improvements in pain scores. PL-CSA/BMI positively correlated with change in PROMIS-PF. Our findings suggest that with regards to functional outcomes, patients with worse muscle health may take longer to recuperate postoperatively compared to those with better muscle health.
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Affiliation(s)
- Junho Song
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Kasra Araghi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Marcel M Dupont
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Pratyush Shahi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | | | - Daniel Shinn
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Sidhant S Dalal
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | | | - Sohrab S Virk
- Northwell Health Long Island Jewish Medical Center, 270-05 76th Ave, Queens, NY 10040, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - James E Dowdell
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Evan D Sheha
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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D'Oria M, Grando B, Taglialavoro J, Gorgatti F, Calvagna C, Bassini S, Riccitelli F, Griselli F, D'Andrea A, Lepidi S. Association Between Psoas Muscle Sarcopenia and Long-Term Survival Following Elective EVAR. J Surg Res 2022; 280:459-68. [PMID: 36058011 DOI: 10.1016/j.jss.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The aims of this study were as follows: i) to identify the prevalence of sarcopenia in patients undergoing elective endovascular aortic repair (EVAR) for intact abdominal aortic aneurysm; ii) to assess its association with perioperative morbidity and long-term survival; and iii) to estimate its diagnostic accuracy for prediction of 5-year mortality following the intervention. METHODS We performed a retrospective review of all patients who underwent elective EVAR from January 1, 2010 through December 31, 2019. The lean psoas muscle area (LPMA; cm2 × HU) was calculated on computed tomography angiography by multiplying psoas muscle area and psoas muscle density. The main exposure variable for this study was the presence of preoperative sarcopenia (LPMA value < 350), and the study cohort was divided in two groups for all subsequent analyses. The primary endpoint was all-cause mortality. RESULTS The study cohort eventually comprised 338 patients who underwent elective EVAR for intact abdominal aortic aneurysm. In the overall population, 154 patients (45.5%) were classified as sarcopenic. At baseline, patients with sarcopenia were older (mean age: 78 ± 5 versus 75 ± 7 y, P < 0.001) and had lower proportion of males (73.5% versus 93.5%, P < 0.001). At 5 y, the estimated survival rates were 52% versus 74% in sarcopenic and nonsarcopenic patients, respectively (P < 0.001). Using multivariate Cox proportional hazard regression, an independent association was identified between sarcopenia and all-cause mortality in the whole cohort (hazard ratio: 2.63, 95% confidence interval: 1.43-3.36, P = 0.009). CONCLUSIONS Sarcopenia, defined as LPMA <350 as measured on preoperative computed tomography angiography, can be highly prevalent in patients undergoing elective EVAR. Although the intervention remains safe in the short term, presence of sarcopenia was significantly associated to lower long-term survival irrespective of patients' age or gender.
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12
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Yale SH, Tekiner H, Yale ES. Signs and syndromes in acute appendicitis: A pathophysiologic approach. World J Gastrointest Surg 2022; 14:727-730. [PMID: 36158282 PMCID: PMC9353750 DOI: 10.4240/wjgs.v14.i7.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/20/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Physical examination signs have not been well studied, and their accuracy and reliability in diagnosis remain unknown. The few studies available are limited in that the method of performing the sign was not stated, the technique used was not standardized, and the position of the appendix was not correlated with imaging or surgical findings. Some appendiceal signs were written in a non-English language and may not have been appropriately translated (e.g., Blumberg-Shchetkin and Rovsing). In other cases, the sign described differs from the original report (e.g., Rovsing, Blumberg-Shchetkin, and Cope sign, Murphy syndrome). Because of these studies limitations, gaps remain regarding the signs’ utility in the bedside diagnosis of acute appendicitis. Based on the few studies available with these limitations in mind, the results suggest that a positive test is more likely to be found in acute appendicitis. However, a negative test does not exclude the diagnosis. Hence, these tests increase the likelihood of ruling in acute appendicitis when positive but are less helpful in ruling out disease when negative. Knowledge about the correct method of performing the sign may be a valuable adjunct to the surgeon in further increasing their pretest probability of disease. Furthermore, it may allow surgeons to study these signs further to better understand their role in clinical practice. In the interim, these signs should continue to be used as a tool to supplement the clinical diagnosis.
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Affiliation(s)
- Steven Howard Yale
- Internal Medicine, University of Central Florida, Orlando, FL 32827, United States
| | - Halil Tekiner
- Department of the History of Medicine and Ethics, Erciyes University School of Medicine, Melikgazi 38039, Kayseri, Turkey
| | - Eileen Scott Yale
- Division of General Internal Medicine, University of Florida, Gainesville, FL 32608, United States
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13
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Dogruoz Karatekin B, Tekin ZN. Psoas muscle index is related to hip fracture in osteoporosis: a cross-sectional MRI study. Skeletal Radiol 2022; 51:1297-302. [PMID: 34859280 DOI: 10.1007/s00256-021-03967-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the properties of psoas muscle in osteoporotic patients in lumbar magnetic resonance imaging (MRI) scan and their relationship with hip fracture. MATERIALS AND METHODS One hundred seventy-seven patients with osteoporosis (63.69 ± 9.677, 105 female) who had received lumbar spine MRI and dual-energy X-ray absorptiometry (DXA) examinations were retrospectively included. Thickness (PMT), cross-sectional areas (CSA), and index (PMI) values were measured for psoas muscle at L3 level and psoas muscle characteristics were compared between hip fracture and control groups. RESULTS PMT, CSA, and PMI values were statistically significantly different between hip fracture and control groups (respectively p < .001, p < .05, p < .01). The results showed that there was a significant association between being sarcopenic and having hip fracture (χ2 (1, n = 117) = 4.57, p < .05, phi = .20). CONCLUSION PMT, CSA, and PMI might be associated with hip fracture in osteoporotic patients. However, this association is independent of bone mineral density (BMD). Psoas muscle features including PMT, CSA, and PMI should be used as significant predictors of falls and fractures in osteoporotic patients.
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14
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Engelke K, Ghasemikaram M, Chaudry O, Uder M, Nagel AM, Jakob F, Kemmler W. The effect of ageing on fat infiltration of thigh and paraspinal muscles in men. Aging Clin Exp Res 2022; 34:2089-2098. [PMID: 35633478 PMCID: PMC9464152 DOI: 10.1007/s40520-022-02149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
Background Myosteatosis, skeletal muscle fat infiltration, is associated with inflammation and fibrosis. The age-related increase of myosteatosis is an important characteristic of sarcopenia and contributes to fragility. Aims To investigate the impact of healthy aging on intermuscular adipose tissue (IMAT) and muscle fat fraction (FF) in the thigh and the paraspinal muscles in males. Methods In 54 healthy males (age 20–70), all active hobby golfers, magnetic resonance imaging was performed to determine volume of IMAT, volume of muscle tissue (MT) and of percentage of FF. Results Between ages 20–70, at the thigh, IMAT/MT volume and MT FF increased annually by 2.9% and 1.3%, respectively. At the psoas IMAT/Psoas volume did not change with age. MT FF increased by 1.5% annually. At the erector spinae IMAT/Erector volume decreased by 0.3% and MT FF increased by 2.8% annually. Discussion With increasing age, in males, thigh muscle atrophied, muscle tissue was partly replaced by adipose tissue and remaining muscle tissue also contained more fat. Similar effects were observed in the erector spinae. The psoas muscle did not atrophy, although MT FF also increased with age. Overall correlations with age were weak to moderate with higher correlations observed in the paraspinal muscles. Conclusions Age-related increases of muscle fat infiltration were observed in the thigh and in the spine. Muscle atrophy did not occur in the psoas. In cross-sectional studies, an adjustment of volumetric parameters by muscle volume is advisable when comparing age-dependent results. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02149-1.
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Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany.
| | - Mansour Ghasemikaram
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Franz Jakob
- Bernhard-Heine-Center for Locomotion Research, University of Würzburg, Brettreichstrasse 11, 97074, Würzburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
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Mohandes AF, Karam B, Alrstom A, Alasadi L, Rajab Bek MW, Daher N, Alsuliman T, Abouhareb R. Primary psoas tuberculosis abscess with an iliac bone lytic lesion: a case report. J Med Case Rep 2022; 16:209. [PMID: 35581665 PMCID: PMC9115972 DOI: 10.1186/s13256-022-03417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary psoas tuberculosis is the presence of "Koch's bacillus'' within the iliopsoas muscle caused by hematogenous or lymphatic seeding from a distant site. Muscular tuberculosis has relatively low prevalence in comparison with other cases of extrapulmonary tuberculosis, which explains the difficulties in establishing the diagnosis. CASE PRESENTATION In this report, we present a challenging diagnostic case of primary psoas tuberculosis in a 38-year-old middle eastern female from southern Syria. The diagnosis was based on the clinical orientation, the observation of pulmonary lesions on the computed tomography scan, and the necrotic signs in the vicinity of the infected area. Despite the misleading primary false-negative results, the final diagnosis was reached after sufficient repetition of tuberculosis-specific testing. The patient was treated with isoniazid-rifampin-pyrazinamide-ethambutol for 2 months, then isoniazid and rifampin for 7 months, with full recovery in follow-up. CONCLUSIONS This case highlights the importance of a clinical-based approach in the treatment of patients with psoas abscesses, especially in areas with high tuberculosis prevalence.
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Affiliation(s)
| | - Bahjat Karam
- Children’s Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Ali Alrstom
- Infectious Disease, Internal Medicine Department, Al-Mouwasat Hospital, Damascus University, Damascus, Syria
| | - Lugien Alasadi
- Gastroenterology and Hepatology, Internal Medicine Department, AL-Mouwasat Hospital, Damascus University, Damascus, Syria
| | - Mohammad wahid Rajab Bek
- Infectious Disease, Internal Medicine Department, Al-Mouwasat Hospital, Damascus University, Damascus, Syria
| | - Nizar Daher
- Infectious Disease, Internal Medicine Department, Al-Mouwasat Hospital, Damascus University, Damascus, Syria
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Tamim Alsuliman
- Service d’Hématologie, hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Raed Abouhareb
- Gastroenterology and Hepatology, Internal Medicine Department, AL-Mouwasat Hospital, Damascus University, Damascus, Syria
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Gandhi SV, Dugan R, Farber SH, Godzik J, Alhilali L, Uribe JS. Anatomical positional changes in the lateral lumbar interbody fusion. Eur Spine J 2022; 31:2220-2226. [PMID: 35428915 DOI: 10.1007/s00586-022-07195-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/13/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION ALIFs and LLIFs are now becoming more utilized for adult spinal disease. As technologies advance, so do surgical techniques, with surgeons now modifying traditional supine-ALIF and lateral-LLIF to lateral-ALIF and prone-LLIF approaches to allow for more efficient surgeries. The objective of this study is to characterize the anatomical changes in the surgical corridor that occur with changes in patient positioning. METHODS MRIs of ten healthy volunteers were evaluated in five positions: supine, prone with hips flexed, prone with hips extended, lateral with hips flexed, and lateral with hips extended. All lateral scans were in the left lateral decubitus position. The anatomical changes of the psoas muscles, inferior vena cava, aorta, iliac vessels were assessed with relation to fixed landmarks on the disc spaces from L1 to S1. RESULTS The most anteriorly elongated ipsilateral to approach psoas when compared to supine was seen in lateral-flexed position (- 5.82 mm, p < 0.001), followed by lateral-extended (- 2.23 mm, p < 0.001), then prone-flexed (- 1.40 mm, p = 0.014), and finally supine and prone-extended (- 0.21 mm, p = 0.643). The most laterally extending or "thickest" psoas was seen in prone-flexed (- 1.40 mm, p = 0.004) and prone-extended (- 1.17 mm, p = 0.002). The psoas was "thinnest" in lateral-extended (2.03 mm, p < 0.001) followed by lateral-flexed (1.11 mm, p = 0.239). The contralateral psoas did not move as anteriorly as the ipsilateral. 3D volumetric analysis showed that the greatest changes in the psoas occur at its proximal and distal poles near T12-L1 and L4-S1. In lateral-flexed compared to prone-extended, the IVC moves medially to the left (p < 0.001). The aorta moves laterally to the left (p = 0.005). The venous structures appeared more full and open in the lateral positions and flattened in the supine and prone positions. The arteries remain in full calibre. CONCLUSION The MRI anatomical evaluation shows that the psoas, and therefore lumbar plexus, and vasculature move significantly with changes in positioning. This is important for preoperative planning for proper intraoperative execution from preoperative supine MRI. Understanding that the psoas and vessels move the most anteriorly in the lateral-flexed position and to a least degree in the prone-extended is essential for safe and efficient utilization of techniques such as the traditional LLIF, traditional ALIF, prone-LLIF.
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Affiliation(s)
- Shashank V Gandhi
- Texas Back Institute, 6020 W. Parker Road, Suite 200, Plano, TX, 75093, USA.
| | - Robert Dugan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Samuel H Farber
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Lea Alhilali
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
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Varma S, Wilson MSJ, Naik M, Sandhu A, Ota HCU, Aylwin C, Fertleman M, Peck G. The associations of psoas and masseter muscles with sarcopenia and related adverse outcomes in older trauma patients: a retrospective study. Aging Clin Exp Res 2022; 34:1901-1908. [PMID: 35357685 PMCID: PMC9283168 DOI: 10.1007/s40520-022-02119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
Background There is an emerging role for radiological evaluation of psoas muscle as a marker of sarcopenia in trauma patients. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross-sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods Patients aged 65 or above, who presented as a trauma call over a 1-year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analysed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan–Meier plots were used to determine association of sarcopenia with outcomes. Results There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Pearson’s correlation indicated a weakly positive linear relationship (r = 0.35, p < 0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47–9.73, p = 0.006) and at 2 years (adjusted HR 1.90, 95% CI 1.11–3.25, p = 0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p = 0.001). Conclusion Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2-year mortality. Our study did not support prognostic relevance of M-CSA.
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Choudhary S, Wadhawan M, Dhawan S, Ganesan PK, Mittal P, Sahney A, Kumar A. Normative values of skeletal muscle indices for nutritional assessment and implications on definition of sarcopenia in Indian adult population. Indian J Gastroenterol 2022; 41:69-76. [PMID: 35060085 DOI: 10.1007/s12664-021-01207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/02/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sarcopenia is defined as both low muscle function (performance or strength) and low muscle mass. Although aging is the main cause of sarcopenia, it can also occur due to poor nutrition and chronic diseases like liver cirrhosis, chronic kidney disease, and diabetes. OBJECTIVE To do the quantitative analysis of various normative skeletal muscle indices (to define sarcopenia) in the Indian population. METHODS Sex-specific means, standard deviations (SD), and sarcopenia cutoffs (mean-2SD) of psoas muscle thickness (PMTH), psoas muscle area (PMA), psoas muscle index (PMI), erector spinae muscle area (ESMA), skeletal muscle radiation attenuation (SMRA), total skeletal muscle area (SMA), and total skeletal muscle index (SMI) were computed. RESULTS A total of 2002 individuals (1308 males and 694 females) underwent CT evaluation. PMTH (mm/m) was observed to be 15.87±2.67 in males vs. 12.61±2.46 in females (p=0.0001); PMA (cm2) was 18.55±3.45 in males vs.13.52±2.80 in females (p=0.0001); PMI (cm2/m2) was 6.69±1.40 in males vs. 5.57±1.18 in females (p=0.0001); ESMA (cm2) was 45.74±6.01 in males vs. 35.37±5.63 in females (p=0.0001); ESMI (cm2/m2) was 16.5±2.55 in males vs. 14.62±2.6 in females (p=0.0001); SMRA was 55.80±3.91 Hounsfield unit (HU) in males vs. 52.36±3.67 HU in females (p=0.0001); SMA (cm2) was 147.73±11.77 in males vs. 106.33±12.00 in females (p=0.0001); and SMI (cm2/m2) was estimated to be 51.00±5.70 in males vs. 43.93±6.05 in females (p=0.0001). PMTH, PMI, ESMI, SMI, and SMRA cutoffs for sarcopenia at L3 were observed to be 10.53 mm/m, 3.89 cm2/m2, 11.40 cm2/m2, 39.59 cm2/m2, and 47.98 HU among males and 7.69, 3.20, 9.42, 31.83, and 45.01 among females, respectively; these values were consistent with previously reported cutoffs in Indian studies but not consistent with the cutoffs reported in other countries. CONCLUSION Normative values of skeletal muscle indices for either sex among the Indian adult population would enable future studies on sarcopenia in various medical conditions.
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Affiliation(s)
- Subham Choudhary
- Department of Radiodiagnosis, Dr. B. L. Kapur Memorial Hospital, Pusa Road, New Delhi, 110 005, India.
| | - Manav Wadhawan
- Department of Radiodiagnosis, Dr. B. L. Kapur Memorial Hospital, Pusa Road, New Delhi, 110 005, India
| | - Sugandha Dhawan
- St. Stephen's Hospital, Tis Hazari, New Delhi, 110 054, India
| | - Prem Kumar Ganesan
- Department of Radiodiagnosis, Dr. B. L. Kapur Memorial Hospital, Pusa Road, New Delhi, 110 005, India
| | - Payal Mittal
- Department of Radiodiagnosis, Dr. B. L. Kapur Memorial Hospital, Pusa Road, New Delhi, 110 005, India
| | - Amrish Sahney
- Department of Radiodiagnosis, Dr. B. L. Kapur Memorial Hospital, Pusa Road, New Delhi, 110 005, India
| | - Ajay Kumar
- Department of Radiodiagnosis, Dr. B. L. Kapur Memorial Hospital, Pusa Road, New Delhi, 110 005, India
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Ayegnon KG, Konate I, Kouadio AF, Kouassi KP, Bravo-Tsri AB, Tanoh KE, Vanga KM, Yao BL, Kouakou B, Sanogo S, N'Dri K. [Angiomyolipoma of the psoas: a case report and literature review]. Mali Med 2022; 38:51-55. [PMID: 38506201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
The psoas major muscle is one of the three muscle chiefs of the ilio-psoas muscle. The pathological processes concerning it are dominated by tumor lesions which are mostly malignant. The diagnostic approach is based on the clinic and the abdomino-pelvic scanner. If necessary, it will make it possible to direct a puncture and / or a biopsy. We report the observation of a 33-year-old patient admitted to the Bouaké University Hospital presenting with a mass in the left iliac fossa and an intermittent claudication of chronic evolution in whom the diagnosis of a psoas tumor was diagnosedthrough the abdomino-pelvic scanner and the pathology concluded to an angiomyolipoma.
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Affiliation(s)
- Kouakou Grégoire Ayegnon
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de cardiologie et chirurgie cardio-vasculaire CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Issa Konate
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Allou Florent Kouadio
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Kouamé Pb Kouassi
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Akoli B Bravo-Tsri
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Kessé Emile Tanoh
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Koffi Marius Vanga
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Brou Lamber Yao
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Bouassa Kouakou
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Sarah Sanogo
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
| | - Kouadio N'Dri
- UFR Sciences Médicales Université Alassane Ouattara (Bouaké, Côte d'Ivoire)
- Service de radiodiagnostic et imagerie médical CHU de Bouaké (Bouaké, Côte d'Ivoire)
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20
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Mejri R, Mrad Dali K, Chaker K, Mokhtar B, Ben Rhouma S, Nouira Y. Bilateral renal abscess fusing with the psoas on the right: A case report. Urol Case Rep 2021; 40:101951. [PMID: 34868881 PMCID: PMC8626646 DOI: 10.1016/j.eucr.2021.101951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Renal abscess is a medical and surgical urological emergency whose diagnosis has been improved by modern imaging. It often poses a problem of therapeutic management between antibiotic therapy or the association of a drainage. Most abscesses are unilateral, the bilateral nature of the abscessed lesions suggests a hematogenous diffusion. We report a case of a bilateral renal abscess fusing to the psoas muscle on the right that progressed well with antibiotic treatment and percutaneous drainage.
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Affiliation(s)
- Ramzi Mejri
- Departement of Urology, Hospital Mongi Slim La Marsa, Tunisia
| | | | - Kays Chaker
- Departement of Urology, La Rabta Hospital, Tunisia
| | - Bibi Mokhtar
- Departement of Urology, La Rabta Hospital, Tunisia
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21
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Cho HJ, Hwang Y, Yang S, Kim M. A Comprehensive Analysis of the Association of Psoas and Masseter Muscles with Traumatic Brain Injury Using Computed Tomography Anthropometry. J Korean Neurosurg Soc 2021; 64:950-956. [PMID: 34689478 PMCID: PMC8590921 DOI: 10.3340/jkns.2021.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
Objective Psoas and masseter muscles are known markers of sarcopenia. However, the relative superiority of either muscle as a marker is unclear. Therefore, this study analyzed the two muscles in patients with a prognosis of traumatic brain injury (TBI).
Methods Patients with TBI visiting a regional trauma center between January 2017 and December 2018 were selected, and their medical records were reviewed. TBI patients with an abbreviated injury score (AIS) of 4 or 5 were selected. Patients with an AIS of 4 or 5 at the chest, abdomen, and extremity were excluded. Patients with a hospital stay of 1 to 2 days were excluded. Both muscle areas were measured based on the initial computed tomography. The psoas muscle index (PMI) and the masseter muscle index (MMI) were calculated by dividing both muscle areas by height in meters squared (cm2/m2). These muscle parameters along with other medical information were used to analyze mortality and the Glasgow outcome scale (GOS).
Results A total of 179 patients, including 147 males (82.1%), were analyzed statistically. The mean patient age was 58.0 years. The mortality rate was 16.8% (30 patients). The mean GOS score was 3.7. Analysis was performed to identify the parameters associated with mortality, which was a qualitative study outcome. The psoas muscle area (16.9 vs. 14.4 cm2, p=0.028) and PMI (5.9 vs. 5.1 cm2/m2, p=0.004) showed statistical differences between the groups. The PMI was also statistically significant as a risk factor for mortality in logistic regression analysis (p=0.023; odds ratio, 0.715; 95% confidence interval, 0.535–0.954). Quantitative analyses were performed with the GOS scores. Bivariate correlation analysis showed a statistically significant correlation between PMI and GOS scores (correlation coefficient, 0.168; p=0.003). PMI (p=0.004, variation inflation factor 1.001) was significant in multiple regression analysis. The masseter muscle area and MMI did not show significance in the study.
Conclusion Larger PMI was associated with statistically significant improved survival and GOS scores, indicating its performance as a superior prognostic marker. Further analyses involving a larger number of patients, additional parameters, and more precise settings would yield a better understanding of sarcopenia and TBI.
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Affiliation(s)
- Hang Joo Cho
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yunsup Hwang
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seiyun Yang
- Department of Neurourgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Maru Kim
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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22
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Parker A, Olewnik Ł, Iwanaga J, Dumont AS, Tubbs RS. Iliacus minor and psoas quartus muscles traversing the femoral nerve. Morphologie 2021:S1286-0115(21)00232-0. [PMID: 34696972 DOI: 10.1016/j.morpho.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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23
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Mejri R, Kays C, Mokhtar B, Ben Rhouma S, Nouira Y. Double retroperitoneal hydatid localization: About a case report. Urol Case Rep 2021; 39:101824. [PMID: 34504773 PMCID: PMC8417297 DOI: 10.1016/j.eucr.2021.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
The hydatid cyst is a parasitic pathology which is endemic in Tunisia and presents a public health problem.Hydatid cysts located in the retroperitoneum, especially around or in the kidney, are rare and only represent 5% of visceral locations. The kidney is the most commonly affected organ of the urinary tract.The psoas muscle is an uncommon location and not less than 70 cases have been cited. We report the Case of an unusual presentation of a right kidney hydatid cyst associated with a psoas muscle location. To our knowledge, this association of double retroperitoneal location has not been reported in the literature.
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Affiliation(s)
- Ramzi Mejri
- Departement of Urology, Hospital Mongi Slim La Marsa, Tunisia
- Corresponding author.
| | - Chaker Kays
- Departement of Urology, La Rabta Hospital, Tunisia
| | - Bibi Mokhtar
- Departement of Urology, La Rabta Hospital, Tunisia
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24
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Ezponda A, Casanova C, Cabrera C, Martin-Palmero Á, Marin-Oto M, Marín JM, Pinto-Plata V, Divo M, Celli BR, Zulueta JJ, Bastarrika G, de-Torres JP. Psoas Muscle Density Evaluated by Chest CT and Long-Term Mortality in COPD Patients. Arch Bronconeumol 2021; 57:533-539. [PMID: 35699031 DOI: 10.1016/j.arbr.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/08/2021] [Indexed: 06/15/2023]
Abstract
RATIONALE Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. METHODS At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65±8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. RESULTS PsD was lower in COPD patients than in controls (40.5 vs 42.5, p=0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p=0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p=0.023) were the variables independently associated with all-cause mortality. CONCLUSIONS In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.
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Affiliation(s)
- Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain; Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | | | - Marta Marin-Oto
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud & CIBERES, Zaragoza, Spain
| | | | - Miguel Divo
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bartolome R Celli
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier J Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P de-Torres
- Respirology and Sleep Division, Queen's University, Kingston, Canada; Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
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25
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Du X, Sun P, Yan Y, Gong X, Lian Y, Pan Z. Low CT attenuation and high fatty infiltration rate of psoas are risk factors for incisional hernias after appendicectomy: a cross-sectional single-center study from China. BMC Musculoskelet Disord 2021; 22:646. [PMID: 34330240 PMCID: PMC8325203 DOI: 10.1186/s12891-021-04333-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/23/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Decreased computed tomography (CT) attenuation of muscle is independently associated with muscle weakness. The CT attenuation of the abdominal wall muscles may correlate with that of the psoas in patients without ventral hernias. This means that the CT attenuation of the psoas may be related to the occurrence of incisional hernias (IH). CT-determined sarcopenia was deemed inefficient in predicting the development of IH, while limited attention has been paid to the association between muscle fatty infiltration and incidences of IH. In this study, we aim to investigate whether the psoas' CT measurement parameters, including the average CT attenuation, fatty infiltration rate and psoas muscle index, are associated with IH. METHODS In this study, adult patients who had undergone an appendicectomy in the past and had then, for any reason, been hospitalised in our hospital from January 2018 to December 2019 were enrolled. The patients were classified into an IH group and a non-IH group. Their psoas' CT attenuation, fatty infiltration rate (FIR) and psoas muscle index (PMI) were measured or calculated. Sarcopenia was defined according to their PMI. Differences between the two groups' indices were then compared. A logistic regression model was applied to assess the effects of psoas' CT measurement parameters on the occurrence of IH. RESULTS One hundred twenty patients were included in this study. The psoas' CT attenuation (p = 0.031) and PMI (p = 0.042) in the IH group were significantly lower than those in the non-IH group, and FIR in the IH group was significantly higher than in the non-IH group (p < 0.001). The patients' psoas' CT attenuation, FIR, PMI, age, gender and whether they had a history of smoking, were all significant factors in the univariate logistic regression analysis. After adjusting for confounding factors, a multivariate logistic regression analysis demonstrated that the psoas' CT attenuation was an independent protective factor (p = 0.042), and FIR was an independent risk factor (p = 0.018), while neither PMI (p = 0.118) nor sarcopenia (p = 0.663) showed a significant effect on the incidence of IH. CONCLUSIONS When an appendectomy has been performed, a decreased CT attenuation and increased FIR of the psoas can be considered risk factors for IH.
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Affiliation(s)
- Xuechao Du
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Pengtao Sun
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yuchang Yan
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Xiang Gong
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Yufei Lian
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Zhenyu Pan
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
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26
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Hayek J, Reddy R, Goldberg G, Alagkiozidis I. Endometrial cancer recurrence in the sacrum and the Psoas: A case report and literature review. Gynecol Oncol Rep 2021; 37:100814. [PMID: 34235242 PMCID: PMC8250163 DOI: 10.1016/j.gore.2021.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Our study describes an isolated recurrence in the sacrum and iliopsoas muscle. Chemotherapy followed by definitive radiation can be an effective treatment plan. Our case may closely resemble the Malignant Psoas Syndrome.
Musculoskeletal metastasis of endometrial carcinoma is rare. Data regarding the management of metastatic disease to these sites is limited. We report a case of a 73-year-old woman who had surgery for endometrial adenocarcinoma (FIGO stage IB, Grade II) followed by vaginal cuff brachytherapy and one year later developed an isolated recurrence in the sacrum and iliopsoas muscle. She was treated with chemotherapy followed by whole pelvis radiation and a complete clinical response was achieved. At her last follow up, 12 months after the completion of the radiation, she had no clinical or radiologic evidence of disease.
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Affiliation(s)
- Judy Hayek
- Zucker School of Medicine at Hofstra/Northwell Health at Staten Island University Hospital, United States
| | - Rishika Reddy
- Zucker School of Medicine at Hofstra/Northwell Health at Staten Island University Hospital, United States
| | - Gary Goldberg
- Zucker School of Medicine at Hofstra/Northwell Health at Long Island Jewish, United States
| | - Ioannis Alagkiozidis
- Zucker School of Medicine at Hofstra/Northwell Health at Staten Island University Hospital, United States
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27
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Ezponda A, Casanova C, Cabrera C, Martin-Palmero Á, Marin-Oto M, Marín JM, Pinto-Plata V, Divo M, Celli BR, Zulueta JJ, Bastarrika G, de-Torres JP. Psoas Muscle Density Evaluated by Chest CT and Long-Term Mortality in COPD Patients. Arch Bronconeumol 2021; 57:S0300-2896(21)00133-2. [PMID: 33994243 DOI: 10.1016/j.arbres.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. METHODS At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65±8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. RESULTS PsD was lower in COPD patients than in controls (40.5 vs 42.5, p=0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p=0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p=0.023) were the variables independently associated with all-cause mortality. CONCLUSIONS In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.
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Affiliation(s)
- Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain; Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | | | - Marta Marin-Oto
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud & CIBERES, Zaragoza, Spain
| | | | - Miguel Divo
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bartolome R Celli
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier J Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P de-Torres
- Respirology and Sleep Division, Queen's University, Kingston, Canada; Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
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28
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Andriamanjay D, Agostini A, Bourachot M, Siles P, Pivano A. Medical management of psoas muscle deep endometriosis: A case report. J Gynecol Obstet Hum Reprod 2021; 50:102115. [PMID: 33737248 DOI: 10.1016/j.jogoh.2021.102115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/27/2022]
Abstract
Endometriosis is a common gynaecological pathology characterized by the presence of endometrial tissue outside the uterine cavity, and the most frequent locations of endometriosis are ovaries and posterior compartment of the pelvis. In this paper we report the case of a rare bilateral endometriosis location of posas muscle diagnosed and treated in a 25-year-old patient. This is the third case of psoas endometriosis location reported, but the first one successfully treated by hormone estrogen-progestogen treatment alone. Psoas endometriosis is a rare location and the medical management in first line can be an alternative to surgery and provide optimal patient relief.
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Affiliation(s)
- Dio Andriamanjay
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
| | - Marie Bourachot
- Department of Radiology, Hôpital Timone, Aix-Marseille University, Marseille, France.
| | - Pascale Siles
- Department of Radiology, Hôpital Timone, Aix-Marseille University, Marseille, France.
| | - Audrey Pivano
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
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29
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Zager Y, Khalilieh S, Ganaiem O, Gorgov E, Horesh N, Anteby R, Kopylov U, Jacoby H, Dreznik Y, Dori A, Gutman M, Nevler A. Low psoas muscle area is associated with postoperative complications in Crohn's disease. Int J Colorectal Dis 2021; 36:543-550. [PMID: 33236229 DOI: 10.1007/s00384-020-03799-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) is associated with increased postoperative morbidity. Sarcopenia correlates with increased morbidity and mortality in various medical conditions. We assessed correlations of the lean body mass marker and psoas muscle area (PMA), with postoperative outcomes in CD patients undergoing gastrointestinal surgery. METHODS We included patients with CD who underwent gastrointestinal surgery between June 2009 and October 2018 and had CT/MRI scans within 8 weeks preoperatively. PMA was measured bilaterally on perioperative imaging. RESULTS Of 121 patients, the mean age was 35.98 ± 15.07 years; 51.2% were male. The mean BMI was 21.56 ± 4 kg/m2. The mean PMA was 95.12 ± 263.2cm2. Patients with postoperative complications (N = 31, 26%) had significantly lower PMA compared with patients with a normal postoperative recovery (8.5 ± 2.26 cm2 vs. 9.85 ± 2.68 cm2, P = 0.02). A similar finding was noted comparing patients with anastomotic leaks to those without anastomotic leaks (7.48 ± 0.1 cm2 vs. 9.6 ± 2.51 cm2, P = 0.04). PMA correlated with the maximum degree of complications per patient, according to the Clavien-Dindo classification (Spearman's coefficient = -0.26, P = 0.004). Patients with major postoperative complications (Clavien-Dindo ≥ 3) had lower mean PMA (8.12 ± 2.75 cm2 vs. 9.71 ± 2.57 cm2, P = 0.03). Associations were similar when stratifying by gender and operation urgency. On multivariate analysis, PMA (HR = 0.72/cm2, P = 0.02), operation urgency (HR = 3.84, P < 0.01), and higher white blood cell count (HR = 1.14, P = 0.02) were independent predictive factors for postoperative complications. CONCLUSION PMA is an easily measured radiographic parameter associated with postoperative complications in patients with CD undergoing bowel resection.
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Affiliation(s)
- Yaniv Zager
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Saed Khalilieh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omar Ganaiem
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Gorgov
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roi Anteby
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Harel Jacoby
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Dori
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel
| | - Avinoam Nevler
- Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Vajdić ID, Štimac G, Pezelj I, Mustapić M, Grazio S. Psoas abscess during treatment with intravenous tocilizumab in a patient with rheumatoid arthritis: a case-based review. Rheumatol Int 2021; 41:819-25. [PMID: 33576887 DOI: 10.1007/s00296-021-04800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/02/2022]
Abstract
Interleukin-6 receptor antagonist tocilizumab is a biologic drug used for treating patients with active rheumatoid arthritis (RA) who failed to respond to synthetic or other biologic disease-modifying antirheumatic drugs or where they were contraindicated. Interleukin-6 receptor blockade results in a decrease of disease activity but has some potential adverse effects, the most common being infections. We present a case of a 75-year-old female patient with long-lasting RA, several comorbidities and multiple prior therapies, who developed back pain and general malaise during tocilizumab intravenous treatment. The laboratory findings were typical of toxemia, and the imaging findings revealed large psoas muscle abscess. Surgical and antibiotic treatment was performed with a good outcome. To our knowledge, this has been the first case of a psoas abscess in a patient with RA treated with tocilizumab described in the literature so far. We also present a review of the literature regarding infection, and particularly abscess formation in patients treated with biological disease-modifying antirheumatic drugs, tocilizumab included.
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Hu ZJ, Fang XQ, Zhao FD, Zhang JF, Zhao X, Fan SW. Anteroinferior Psoas Technique for Oblique Lateral Lumbar Interbody Fusion: Technical Note and Case Series. Orthop Surg 2021; 13:466-473. [PMID: 33507614 PMCID: PMC7957387 DOI: 10.1111/os.12890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/31/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of the present paper was to evaluate cases of lumbar degenerative diseases treated with oblique lateral interbody fusion (OLIF) using a modified lateral approach (i.e. anteroinferior psoas exposure under direct vision) and to analyze the effect and safety of this approach. Methods From June 2016 to April 2019, a total of 226 patients with an average age of 65.5 ± 16.2 years (98 men and 128 women) with degenerative lumbar diseases who underwent the AIP approach of OLIF were followed up and analyzed retrospectively. Data concerning operative and clinical parameters were collected, including operative time, intraoperative estimated blood loss, duration of postoperative hospital stay, and time to ambulation after surgery. For the assessment of clinical outcomes, the visual analogue scale (VAS) score (for back pain) and the Oswestry disability index (ODI) were calculated. Complications were also recorded as surgical exposure approach‐related complications. More than 6 months after surgery, 132 patients consented to having MRI examinations to evaluate the psoas muscle atrophy when they were followed up. Results The mean operative time was 82.5 ± 31.6 min. The mean operative time for each segment of OLIF was 43.3 ± 15.5 min. The mean blood loss was 48.0 ± 11.6 mL. The mean blood loss for each segment of OLIF was 25.3 ± 10.1 mL. No patients needed blood transfusion intraoperatively or postoperatively. The mean hospital stay was 4.1 ± 2.1 days. All patients were followed up for 12–31 months (mean 18.2 months). Clinical assessment showed that the VAS and ODI scores at 6 months after surgery were markedly lower than the preoperative scores (P < 0.001) but did not differ from the scores at the final follow‐up (P > 0.05). There was no significant difference in percentage changes of the cross‐sectional area of the lean psoas muscle and the T2 signal intensity ratio of gross psoas to quadratus lumborum muscles between the left side (operative side) and the right side (nonoperative side) (P > 0.05). A total of 11 surgical exposure approach‐related complications were reported, with an incidence of 4.9%: transient thigh pain/numbness, psoas weakness (2.2%), sympathetic chain injury (1.3%), cage subsidence (0.9%), and segmental artery injury (0.4%). There was no permanent motor neurological deficit, and no injury of vascular, ureter or peritoneal membranes. Conclusion The anteroinferior psoas approach for OLIF is safe and can preserve the psoas and lumbar plexus.
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Affiliation(s)
- Zhi-Jun Hu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Xiang-Qian Fang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Feng-Dong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Jian-Feng Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Xing Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
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Fukutani A, Herzog W. Differences in stretch-shortening cycle and residual force enhancement between muscles. J Biomech 2020; 112:110040. [PMID: 32980750 DOI: 10.1016/j.jbiomech.2020.110040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 01/18/2023]
Abstract
It has been suggested that cross bridge kinetics and residual force enhancement (RFE) affect force in the stretch-shortening cycle (SSC). Because cross bridge kinetics and titin isoforms, which are thought to be related to RFE, differ between muscles, the SSC effect may be also muscle-dependent. Thus, we compared the SSC effect between psoas and soleus muscles, which have a distinct fiber type distribution and different titin isoforms. Four tests (SSC, SSC control, RFE, RFE control) were conducted using isolated, skinned fibers of psoas and soleus. In the SSC tests, fibers were activated at an average sarcomere length of 2.4 μm, stretched to 3.0 μm, and shortened to 2.4 μm. In the SSC control tests, fibers were activated at an average sarcomere length of 3.0 μm and then shortened to 2.4 μm. The relative increase in mechanical work obtained during shortening between tests was defined as the SSC effect. In the RFE tests, fibers were activated at an average sarcomere length of 2.4 μm and then stretched to 3.0 μm, while the RFE control tests consisted of an isometric contraction at 3.0 μm. The difference in steady-state isometric force between tests was defined as RFE. The SSC effect was greater in soleus than in psoas, while the RFE was the same for both muscles. Since the SSC effect was greater in soleus, while the RFE was the same, the observed greater SSC effect is probably not directly caused by RFE, but may be related to differences in cross bridge kinetics.
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Affiliation(s)
- Atsuki Fukutani
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga 525-8577, Japan.
| | - Walter Herzog
- Faculty of Kinesiology, The University of Calgary, 2500 University Drive, NW, Calgary, AB T2N 1N4, Canada
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Saadi A, Mokadem S, Chakroun M, Nouioui MA, Allouche M, Bouzouita A, Derouiche A, Ben Slama MR, Hamdoun M, Ayed H, Chebil M. A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited. Morphologie 2020; 105:210-216. [PMID: 33071051 DOI: 10.1016/j.morpho.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
AIM OF THE STUDY The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle. METHODS Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall. RESULTS The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%). CONCLUSIONS Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.
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Affiliation(s)
- A Saadi
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - S Mokadem
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Chakroun
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M A Nouioui
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Allouche
- Department of legal and forensic medicine, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - A Bouzouita
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - A Derouiche
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M R Ben Slama
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Hamdoun
- Department of legal and forensic medicine, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - H Ayed
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Chebil
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
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Mak D, Chisholm C, Davies AM, Botchu R, James SL. Psoas muscle atrophy following unilateral hip arthroplasty. Skeletal Radiol 2020; 49:1539-1545. [PMID: 32361852 DOI: 10.1007/s00256-020-03447-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/28/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have demonstrated the presence of muscle atrophy around the hip in patients with hip osteoarthritis. Few studies have examined the psoas muscle or assessed it at a paraspinal level in patients post-total hip arthroplasty. The aim of this study was to determine if there is significant psoas muscle atrophy as indicated by muscle cross-sectional area and high degree of fat infiltration post-unilateral hip arthroplasty. METHODS Retrospective analysis of 341 patients with unilateral hip implant and subsequent lumbar spine MRI over a 8-year period was performed. Fat infiltration and cross-sectional area of the psoas muscle at L3/4 level were measured by two musculoskeletal fellows (1 year experience in musculoskeletal radiology), and comparison made between the implant and non-operative sides was made. Fat infiltration was measured using the modified Goutallier grading. The degree of hip osteoarthritis in the non-operative side was measured using the Kellgren-Lawrence grading. The data was analysed using paired t test, ANOVA, unpaired t test, Pearson correlation and Jonckheere-Terpstra test. RESULTS The cross-sectional area of the psoas muscle on the implant side was significantly less than the non-operative side. There was significance between the cross-sectional area difference and the fat grade of the implant side. CONCLUSION Our results demonstrate psoas atrophy on the implant side compared to the non-operative side in post-unilateral implant patients. Post-operative hip implant rehabilitation may benefit from more focused psoas strengthening exercises to improve functional outcome.
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Affiliation(s)
- D Mak
- Department of Musculoskeletal Radiology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - C Chisholm
- Department of Musculoskeletal Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK.
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
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Todd C, Karlsson J, Baranto A. Resolving anterior hip pain in a young male footballer following arthroscopic surgery for Femoroacetabular Impingement Syndrome: A case report. J Bodyw Mov Ther 2020; 24:63-68. [PMID: 31987564 DOI: 10.1016/j.jbmt.2019.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND There appear to be limited studies available regarding the conservative management of patients following hip joint arthroscopic surgery, or investigating reasons for which patients still report hip and groin pain post surgery. OBJECTIVES Treatment was applied to restore spino-pelvic mechanics and to reduce soft tissue restrictions in hip joint motion. Neuromuscular movement control and work capacity exercises were encouraged to support the integrity of the hip joint and spino-pelvic complex. CLINICAL FEATURES A 22-year-old male footballer, (height 190cm and weight 82kg) presented reporting an eighteen-month history of hip and groin pain, having previously undergone bilateral arthroscopic surgery twelve months earlier for Femoroacetabular Impingement Syndrome. Strength measurements were recorded using the MicroFET 2 Wireless Digital Handheld Dynamometer. Trunk muscular endurance was evaluated with Sorenson test. RESULTS Five treatment consultations over a five-week period resulted in pain reduction, (Visual Analogue Scale 8/10 to 0/10). Improvement in range of motion, right hip flexion (70-100°) and left (80-100°), right internal rotation (30-45°) and left (40-45°). Improvement in strength, specifically right hip flexion (0.29-0.43Nm/kg, 48%) and right hip abduction (0.35-0.46Nm/kg, 31%). Improvement in trunk muscular endurance increased 41% from 170 seconds to 240 seconds. CONCLUSION This case report supports the rationale that the post arthroscopic management of Femoroacetabular Impingement Syndrome, should include both treatment to address spino-pelvic restrictions, if appropriate, combined with exercises that specifically target hip flexor strength. However, a larger randomized study would provide a clearer understanding for the management of this particular subset of patients.
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Affiliation(s)
- Carl Todd
- The Carl Todd Clinic, 5 Pickwick Park, Park Lane, Corsham, Wiltshire, UK; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Rollins KE, Gopinath A, Awwad A, Macdonald IA, Lobo DN. Computed tomography-based psoas skeletal muscle area and radiodensity are poor sentinels for whole L3 skeletal muscle values. Clin Nutr 2020; 39:2227-32. [PMID: 31668722 DOI: 10.1016/j.clnu.2019.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
Abstract
Background and aims Computed tomography (CT)-based measurement of skeletal muscle cross-sectional area (CSA) and Hounsfield unit (HU) radiodensity are used to assess the presence of sarcopenia and myosteatosis, respectively. The validated CT-based technique involves analysis of skeletal muscle at the third lumbar vertebral (L3) level. Recently there has been increasing interest in the use of psoas muscle alone as a sentinel. However, this technique has not been extensively investigated or compared with the previous validated standard approach. Methods Portovenous phase CT images at the L3 level were identified retrospectively from a single institution in 150 patients who had non-emergency scans and were analysed by a single assessor using SliceOmatic software v5.0 (TomoVision, Canada). Manual segmentation based upon validated HU thresholds for skeletal muscle density was performed for all skeletal muscle, as well as the individual muscle groups. The muscle CSA and mean radiodensity of each group were compared against the whole L3 slice values. Results When compared with whole L3 slice CSA, anterior abdominal wall CSA had the strongest correlation (r = 0.9315, p < 0.0001) followed by paravertebral (r = 0.8948, p < 0.0001), then psoas muscle (r = 0.7041, p < 0.0001). The mean ± SD density of the psoas muscle (42 ± 8.4 HU) was significantly higher than the whole slice radiodensity (32.3 ± 9.5 HU, p < 0.0001), with paravertebral radiodensity being a more accurate estimation (34.5 ± 10.8 HU). There was a significant difference in the prevalence of myosteatosis when the density measured from the psoas was compared with that of the whole L3 skeletal muscle (27.7% vs. 66.0%, p < 0.0001). Conclusion Whole L3 slice CSA correlated positively with psoas muscle CSA but was subject to wide variability in results. Psoas muscle radiodensity was significantly greater than whole L3 slice density and resulted in underestimation of the prevalence of myosteatosis. Given the lack of equivalence from individual muscle groups, we recommend that further work be undertaken to investigate which muscle group, or indeed whether the gold standard of whole L3 skeletal muscle, provides the best correlation with clinical outcomes.
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Yuksel O, Gezer NS, Canda AE, Celik H, Topcugil B, Benli MD, Bisgin T, Alicikus ZA, Obuz F. Cross-sectional areas of rectus abdominis and psoas muscles reduces following surgery in rectal cancer patients. Support Care Cancer 2020; 28:2397-405. [PMID: 31489510 DOI: 10.1007/s00520-019-05062-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the trophic changes in rectus abdominis and psoas muscles in patients who underwent open or laparoscopic rectum resection for rectal cancer. METHODS We retrospectively analyzed preoperative staging computerized tomographies (CT) and postoperative first oncological follow-up CTs of the patients who underwent low anterior resection (LAR) for rectal cancer from 2010 through 2015. We measured cross-sectional area of left and right rectus abdominis muscles from two levels (above and below umbilicus) where they are widest and psoas muscle at mid-level of the fourth lumbar vertebral body in axial CT images and compared preoperative and postoperative measurements. We investigated the effects of age, sex, administration of preoperative chemoradiotherapy (CRT), type of surgery (open or laparoscopic), or construction of a diverting ileostomy on cross-sectional muscle area changes. RESULTS After applying inclusion and exclusion criteria 60 patients found to be eligible for the study. Muscle areas of all measurement sites were reduced postoperatively compared to paired preoperative values. There was no significant effect of age, sex, administration of preoperative CRT, type of surgery (open or laparoscopic), or construction of a diverting ileostomy to muscle cross-sectional area reductions. CONCLUSION Cross-sectional areas of the rectus abdominis and the psoas muscles of rectal cancer patients reduces following rectum resection which indicates atrophy of these muscles. Clinicians should be aware of this problem and focus on prevention of muscle atrophy during the treatment of rectal cancer patients.
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Farah K, Leroy HA, Karnoub MA, Obled L, Fuentes S, Assaker R. Does the hip positioning matter for oblique lumbar interbody fusion approach? A morphometric study. Eur Spine J 2019; 29:306-313. [PMID: 31410621 DOI: 10.1007/s00586-019-06107-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate whether left hip positioning widened the access corridor using oblique lateral interbody fusion (OLIF) approach during right lateral decubitus (RLD). METHODS Ten healthy adult volunteers underwent a T2 lumbosacral MRI (1.5 T) in the supine position, RLD position with left hip in extension and then in flexion. L2-L3 to L5-S1 disc spaces were identified. At each level, left psoas surface (in cm2), access corridor (in mm) and vessel movement were calculated in the three positions. Paired t test was used for comparison. RESULTS The mean surface of the left psoas ranged from 7.83 to 17.19 cm2 in the three positions (p > 0.05). From L2-3 to L4-5, in RLD, when the left hip shifted from extension to flexion, nor the access corridor nor vessel movements were significantly different. When the volunteers shifted from supine to RLD position with hip in extension, arteries moved 3.66-5.61 mm to the right (p < 0.05 at L2-3, L3-4 and L5-S1), while the venous structures moved 0.92-4.96 mm (p < 0.05 at L2-3) to the right. When the position shifted from supine to RLD with hip in flexion, the arterial structures moved 0.47-4.88 mm (p < 0.05 at L2-3 and L3-4) to the right, while the venous structures moved - 0.94 to 4.13 mm (p < 0.05 at L2-3 and L3-4) to the right. CONCLUSION Hip positioning was not associated with a significant widening of the surgical corridor. To perform OLIF, we advocate for RLD position with left hip in extension to move away the vascular structures and reduce the psoas volume. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kaissar Farah
- Department of Neurosurgery, Lille University Hospital, Lille, France. .,Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France.
| | | | | | - Louis Obled
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Stephane Fuentes
- Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France
| | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Michel J, Pellegrini C, Rheude T, von Scheidt M, Trenkwalder T, Elhmidi Y, Mayr NP, Brecker S, Kasel AM, Kastrati A, Schunkert H, Husser O, Bleiziffer S, Hengstenberg C. The Clinical Impact of Psoas Muscle Cross-Sectional Area on Medium-Term Mortality After Transcatheter Aortic Valve Implantation. Heart Lung Circ 2020; 29:904-13. [PMID: 31182269 DOI: 10.1016/j.hlc.2019.05.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/02/2019] [Accepted: 05/01/2019] [Indexed: 12/25/2022]
Abstract
AIM Psoas muscle cross-sectional area (CSA) is a proposed marker of frailty associated with mortality after transcatheter aortic valve implantation (TAVI). We assessed the impact of psoas CSA on medium-term mortality over 5 years in a large cohort, adjusted for pre-procedural variables. METHOD This single-centre registry-derived analysis assessed 1,731 consecutive TAVI patients between 2007 and 31 April 2015 with available abdominal computed tomography scans. Sex-stratified, height-adjusted psoas CSA was measured mid-body of the fourth lumbar vertebra. Kaplan-Meier survival distributions across psoas CSA quartiles were compared. Cox and logistic regression models were used to assess baseline variables associated with the primary outcome, which was mortality within 5 years. RESULTS Median age was 81 years (interquartile range, 77 - 85); 52.5% were women. The primary endpoint occurred in 555 patients over a mean follow-up of 775 days. Lower psoas CSA quartile patients were older, had a lower body mass index, lower creatinine clearance, and lower rates of previous cardiac surgery, with higher rates of diabetes, coronary artery disease, pacemaker, anaemia, hypoalbuminaemia, and higher European System for Cardiac Operative Risk Evaluation (EuroSCORE). Unadjusted survival by psoas CSA quartile was significantly different in men (log rank p=0.041) but not women (p=0.099). In Bonferroni-adjusted multivariate analysis, psoas CSA quartiles were not significantly associated with mortality. Hypoalbuminaemia (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.53 - 2.87 [p<0.001]) and increasing age (HR, 1.03 per year; 95% CI, 1.01 - 1.05 [p=0.002]) were associated with increased risk; female sex (HR, 0.63; 95% CI 0.51 - 0.78 [p<0.001]), and hypercholesterolaemia (HR, 0.67; 95%, CI 0.54 0.83 [p<0.001]) with reduced risk. CONCLUSIONS Psoas CSA was not significantly associated with mortality after adjusting for pre-procedural variables. Hypoalbuminaemia, sex, hypercholesterolaemia, and age were significantly associated with mortality after TAVI.
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Gültekin GD, Gülmen V, Arş E, Dilbaz S, Zileli M. Transverse Process Fractures: A Clinical Series and Coronal Injury of the Spine. World Neurosurg 2018; 124:S1878-8750(18)32706-2. [PMID: 30502476 DOI: 10.1016/j.wneu.2018.11.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Transverse process fractures in trauma patients frequently are diagnosed using computed tomography and result in severe pain and limitation of motion. However, there is no accepted standard of care. Thus, these fractures can be treated with excessive measures or inadequately treated. In this study, diagnosis and treatment of transverse process fractures are examined. METHODS The mechanisms of trauma, findings, and associated organ injuries of 50 patients with transverse process fractures and no other spinal injuries treated between 2013 and 2015 were recorded. The same treatment protocol was applied to each patient. The results of the treatments were examined retrospectively and recorded. RESULTS Deformation and edema of the fascia and muscles around the transverse process fractures were detected by computed tomography and magnetic resonance imaging. The average pain intensity of the patients before treatment was 8.8 of 10 on a visual analog scale and 5.2 of 10 after treatment with nonsteroidal anti-inflammatory drugs, muscle relaxants, flexible support corsets, and mobilization. Patients hospitalized for additional pathologies were primarily treated in thoracic surgery wards (11 of 15 patients). Transverse process fractures were caused by backward falls or blows to the back in 49 patients. CONCLUSIONS Transverse process fractures can be treated quickly and effectively with the recommended protocol after excluding any accompanying organ injuries or other spinal injuries. Transverse process fractures most often occur during backward falls or blows to the back, commonly low-energy injuries. This trauma mechanism can be described as a "coronal injury of the spine."
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Affiliation(s)
- Güliz D Gültekin
- Neurosurgery Department, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey.
| | - Vehbi Gülmen
- Neurosurgery Department, Gazi Hospital, Izmir, Turkey
| | - Eda Arş
- Emergency Medicine Department, Koc University Hospital, İstanbul, Turkey
| | - Suna Dilbaz
- Neurosurgery Department, İstanbul Health Sciences University Kanuni Sultan Süleyman Educational and Research Hospital, İstanbul, Turkey
| | - Mehmet Zileli
- Neurosurgery Department, Gazi Hospital, Izmir, Turkey
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Özcan-Ekşi EE, Ekşi MŞ, Akçal MA. Severe Lumbar Intervertebral Disc Degeneration Is Associated with Modic Changes and Fatty Infiltration in the Paraspinal Muscles at all Lumbar Levels, Except for L1-L2: A Cross-Sectional Analysis of 50 Symptomatic Women and 50 Age-Matched Symptomatic Men. World Neurosurg 2019; 122:e1069-77. [PMID: 30415054 DOI: 10.1016/j.wneu.2018.10.229] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Low back pain is a common public health problem associated with lumbar intervertebral disc degeneration. It is still unclear, however, whether intervertebral disc degeneration is an isolated process or accompanied by other degenerative events. We analyzed whether disc degeneration was associated with vertebral end-plate changes and fatty infiltration in the paraspinal muscles. We also aimed to identify whether the severity of disc degeneration influenced this association. METHODS Intervertebral disc degeneration, vertebral end-plate changes, and fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar intervertebral disc levels were evaluated on lumbar spine magnetic resonance images of 50 symptomatic women and 50 age-matched symptomatic men. RESULTS The women had greater lumbar intervertebral disc degeneration scores at L4-L5 and L5-S1 and in total. The women had more fatty infiltration in the multifidus and erector spinae muscles at L4-L5 and L5-S1. The men had more fatty infiltration in the psoas muscle at L5-S1. Patients with severe intervertebral disc degeneration were more likely to have increased fatty infiltration in the multifidus and erector spinae muscles. The rate of vertebral end-plate changes was also greater in the patients with severe intervertebral disc degeneration. CONCLUSIONS Severe disc degeneration in the lumbar spine is closely associated with Modic changes and fatty infiltration in the multifidus and erector spinae muscles. We suggest that disc degeneration is not an isolated event but, rather, a continuum of events that could more clearly be shown in future prospective, large sample-size studies.
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Hanımoğlu H, Çevik S, Yılmaz H, Kaplan A, Çalış F, Katar S, Evran Ş, Akkaya E, Karaca O. Effects of Modic Type 1 Changes in the Vertebrae on Low Back Pain. World Neurosurg 2018; 121:e426-e432. [PMID: 30267950 DOI: 10.1016/j.wneu.2018.09.132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The present study examined the physical extent of Modic type 1 (MT1) changes and other phenotypic magnetic resonance imaging (MRI) findings in the vertebrae of patients with low back pain (LBP) and MT1 changes. We also identified any correlations of these findings with the severity of pain and the Oswestry Disability Index (ODI). The relationship between the presence of pain and MT1 changes has been examined in several studies. However, to the best of our knowledge, no study has assessed the relationships between pain severity and ODI and the total vertebral area of MT1 involvement. METHODS After excluding any patient with MT2 or MT3 changes, 49 patients with a diagnosis of LBP and MT1 changes demonstrated on MRI were included. MT1 involvement area, disc height, number of Schmorl's nodes, disc degeneration (Pfirrmann grade), and cross-sectional area of the lumbar muscles were obtained via MRI. Additionally, patient demographic data, body mass index, physical activity level, and disability (ODI) scores were assessed. RESULTS The total vertebral area of MT1 involvement correlated significantly and positively with the ODI (P = 0.001). In the multivariate linear regression model, with ODI as the dependent variable and age, mean Pfirrmann grade, total vertebral area of MT1 involvement, and sex as independent variables, only the total vertebral area of MT1 involvement was significantly associated with the ODI. CONCLUSIONS A significant positive correlation was noted between the vertebral MT1 involvement extent and changes in the ODI. Other MRI features of patients with LBP were not related to pain severity or ODI.
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Affiliation(s)
- Hakan Hanımoğlu
- Department of Neurosurgery, School of Medicine, Koç University, İstanbul, Turkey
| | - Serdar Çevik
- Department of Neurosurgery, İstininye University Liv Hospital, İstanbul, Turkey.
| | - Hakan Yılmaz
- Department of Radiology, Ağrı State Hospital, Ağrı, Turkey
| | - Atilla Kaplan
- Department of Radiology, Ağrı State Hospital, Ağrı, Turkey
| | - Fatih Çalış
- Department of Neurosurgery, Doç. Dr. Yaşar Eryılmaz State Hospital, Ağrı, Turkey
| | - Salim Katar
- Department of Neurosurgery, Selahaddin Eyyübi State Hospital, Diyarbakır, Turkey
| | - Şevket Evran
- Department of Neurosurgery, Bahçelievler State Hospital, İstanbul, Turkey
| | - Enes Akkaya
- Department of Neurosurgery, Arnavutköy State Hospital, İstanbul, Turkey
| | - Onur Karaca
- Department of Department of Anesthesiology and Intensive Care, Aksaray Education and Research Hospital, Aksaray University, Aksaray, Turkey
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Lambrechts MJ, Wiegers NW, Ituarte F, Shen FH, Nourbakhsh A. Safe zone for irrigation and debridement of psoas abscess through a dorsal spinal approach. Surg Radiol Anat 2018; 40:1217-1221. [PMID: 29978329 DOI: 10.1007/s00276-018-2063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE This cadaver study was initiated to identify safe zones for psoas abscess debridement using a dorsal spinal approach. METHODS Twenty total specimens were dissected and lumbar transverse process (TP) and psoas muscles were identified. The distance from the lateral psoas muscle to the transverse process tip was measured. The lumbar plexus was dissected from the psoas and the distance from the TP to the lateral border of the lumbar plexus was measured. The area between the lateral edge of the psoas and lumbar plexus at each lumbar level was considered a safe zone of approach for entry into the psoas muscle for abscess debridement. RESULTS The most lateral portion of the lumbar plexus was 9.3 mm medial to the superior tip of the L1 TP and 9.2 mm medial to the inferior tip at L1, it was 11.8 and 11.7 mm medial at L2, 10.5 and 9.8 mm medial at L3, 6.6 and 6.2 mm medial at L4, and 1.0 and 0.9 mm medial at L5. The distances from the TP tip to the lateral edge of the psoas muscle were 5.7 and 5.5 mm medial to the superior and inferior tip of the TP at L1, 5.1 and 4.7 mm medial at L2, 2.5 and 1.8 mm medial at L3, 0.4 and 0 mm medial at L4 and 3.7 and 3.8 mm lateral at L5. CONCLUSIONS This study provides landmarks to avoid the critical structures in the lumbar spine.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Nicholas W Wiegers
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Felipe Ituarte
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Francis H Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Ali Nourbakhsh
- Spine Surgery Division, Well Star Atlanta Medical Center, 303 Parkway Dr. NE, Atlanta, GA, 30312, USA.
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Ouellette L, Hamati M, Flannigan M, Singh M, Bush C, Jones J. Epidemiology of and risk factors for ilio psoas abscess in a large community-based study. Am J Emerg Med 2018; 37:158-159. [PMID: 29784279 DOI: 10.1016/j.ajem.2018.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/13/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Lindsey Ouellette
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States
| | - Mary Hamati
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Matt Flannigan
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Matt Singh
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Colleen Bush
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States
| | - Jeffrey Jones
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan St NE 736, Grand Rapids, MI 49503, United States; Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States.
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Buckland AJ, Beaubrun BM, Isaacs E, Moon J, Zhou P, Horn S, Poorman G, Tishelman JC, Day LM, Errico TJ, Passias PG, Protopsaltis T. Psoas Morphology Differs between Supine and Sitting Magnetic Resonance Imaging Lumbar Spine: Implications for Lateral Lumbar Interbody Fusion. Asian Spine J 2018; 12:29-36. [PMID: 29503679 DOI: 10.4184/asj.2018.12.1.29] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/18/2017] [Accepted: 05/29/2017] [Indexed: 11/18/2022] Open
Abstract
Study Design Retrospective radiological review. Purpose To quantify the effect of sitting vs supine lumbar spine magnetic resonance imaging (MRI) and change in anterior displacement of the psoas muscle from L1–L2 to L4–L5 discs. Overview of Literature Controversy exists in determining patient suitability for lateral lumbar interbody fusion (LLIF) based on psoas morphology. The effect of posture on psoas morphology has not previously been studied; however, lumbar MRI may be performed in sitting or supine positions. Methods A retrospective review of a single-spine practice over 6 months was performed, identifying patients aged between 18–90 years with degenerative spinal pathologies and lumbar MRIs were evaluated. Previous lumbar fusion, scoliosis, neuromuscular disease, skeletal immaturity, or intrinsic abnormalities of the psoas muscle were excluded. The anteroposterior (AP) dimension of the psoas muscle and intervertebral disc were measured at each intervertebral disc from L1–L2 to L4–L5, and the AP psoas:disc ratio calculated. The morphology was compared between patients undergoing sitting and/or supine MRI. Results Two hundred and nine patients were identified with supine-, and 60 patients with sitting-MRIs, of which 13 patients had undergone both sitting and supine MRIs (BOTH group). A propensity score match (PSM) was performed for patients undergoing either supine or sitting MRI to match for age, BMI, and gender to produce two groups of 43 patients. In the BOTH and PSM group, sitting MRI displayed significantly higher AP psoas:disc ratio compared with supine MRI at all intervertebral levels except L1–L2. The largest difference observed was a mean 32%–37% increase in sitting AP psoas:disc ratio at the L4–L5 disc in sitting compared to supine in the BOTH group (range, 0%–137%). Conclusions The psoas muscle and the lumbar plexus become anteriorly displaced in sitting MRIs, with a greater effect noted at caudal intervertebral discs. This may have implications in selecting suitability for LLIF, and intra-operative patient positioning.
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Yeh DD, Ortiz-Reyes LA, Quraishi SA, Chokengarmwong N, Avery L, Kaafarani HMA, Lee J, Fagenholz P, Chang Y, DeMoya M, Velmahos G. Early nutritional inadequacy is associated with psoas muscle deterioration and worse clinical outcomes in critically ill surgical patients. J Crit Care 2018; 45:7-13. [PMID: 29360610 DOI: 10.1016/j.jcrc.2017.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 12/11/2017] [Accepted: 12/30/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To explore whether psoas cross sectional area (CSA) and density (Hounsfield Units, HU) are associated with nutritional adequacy and clinical outcomes in surgical intensive care unit patients. MATERIALS AND METHODS Subjects with at least one CT scan within 72h of ICU admission were included. Demographic, nutritional, radiographic, and outcomes data were collected. Psoas muscle CSA and HU were assessed at the L4-L5 intervertebral disk level. Change (Δ) in CSA and HU overall and per day were calculated. RESULTS 140 patients were included. There was no significant correlation between baseline CSA and HU and clinical outcomes. Patients with at least two CT scans (n=65), had a median decrease in CSA of -15% [IQR: -20%, -8%] and decrease in HU of -2% [IQR: -30%, +24%]. Patients with the greatest daily %HU decline received significantly fewer calories/kg and proteins/kg and accumulated greater protein deficits at day 7 and overall. Patients with daily %HU increase had the shortest ICU and hospital LOS and more ventilator-free days in univariate and multivariable analyses. CONCLUSIONS In this exploratory study, early nutritional deficits were correlated with muscle quality deterioration. Inpatient gain in psoas density, compared to maintenance or loss, is associated with shorter hospital stay.
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Fortin M, Lazáry À, Varga PP, Battié MC. Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis. Eur Spine J 2017; 26:2543-51. [PMID: 28748488 DOI: 10.1007/s00586-017-5228-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is a disabling condition associated with narrowing of the spinal canal or vertebral foramina. Paraspinal muscle atrophy and fatty infiltration have been reported in patients with chronic LBP and disc herniation. However, very few imaging studies have examined paraspinal muscle morphology and composition in patients with LSS. The purpose of this study was to investigate the association of paraspinal muscle size, composition and asymmetry with functional status in patients with LSS. METHODS Thirty-six patients diagnosed with LSS at L4-L5 with neurogenic claudication were included. Paraspinal muscle measurements were obtained from axial T2-weighted MR images, bilaterally, at the level of the superior and inferior vertebral endplates of L5. Muscle measurements of interest included: total cross-sectional area (CSA), functional CSA (FCSA), the ratio of FCSA to CSA (FCSA/CSA) as an indicator of muscle composition, and relative % asymmetry in muscle CSA. The association between muscle parameters and other patient characteristics with function as indicated from Oswestry Disability Index (ODI) scores and pain interference status was investigated. RESULTS Greater multifidus muscle fatty infiltration (e.g., lower FCSA/CSA) and lower psoas relative CSA were associated with lower function (higher ODI and pain interference scores) in univariable and multivariable analyses. There was no association between the different muscle parameters and stenosis severity or back or leg pain duration or severity. CONCLUSIONS Our findings suggest an association of multifidus muscle fatty infiltration and psoas muscle size with functional status in patients diagnosed with LSS. Future prospective studies are needed to evaluate whether such muscle parameters are associated with prognosis and functional recovery following surgical treatment.
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Crawford RJ, Elliott JM, Volken T. Change in fatty infiltration of lumbar multifidus, erector spinae, and psoas muscles in asymptomatic adults of Asian or Caucasian ethnicities. Eur Spine J 2017; 26:3059-3067. [PMID: 28698963 DOI: 10.1007/s00586-017-5212-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Fatty infiltration (FI) is a feature of degenerating muscle that predominates in the low lumbar spine, associates with pain, and is confounded by age, spinal degeneration, and curvature. We determined rates for decline of lumbar muscle quality according to ethnicity, muscle, and spinal level in asymptomatic subjects. METHODS Cross-sectional simulation study assessing aggregated data; 650 Asians aged 20-89 years versus 80 Caucasians aged 20-62 years. Change in lumbar multifidus, erector spinae (ES), and psoas fat content were computed using synthetic data and Monte Carlo simulations. General linear regression models and multivariate adaptive regression splines enabled estimation of yearly decline rates [with 95% confidence intervals (CI)]. RESULTS ES at L1-5 (total) shows steeply reduced density (rate; CI) for Asians in older (>53.3 years) adulthood (-0.32; -0.27 to -0.36/year). For Asians, multifidus (-0.18; -0.15 to -0.20/year) and psoas (-0.04; -0.03 to -0.06/year) also decline, while ES in younger ≤53.3 years) adults does not (0.06; 0.01-0.12/year). Caucasian multifidus declines (increasing FI % rate; CI) insignificantly faster (L1-5; 0.23; 0.10-0.36%/year) than ES (0.13; 0.04-0.22%/year). Multifidus decline does not differ between ethnicities. ES in older Asians generally declines fastest across ethnicities and muscles, and particularly in the low lumbar levels. Low lumbar levels show higher rates of decline in Asians, with mixed level-dependencies apparent in Caucasians. CONCLUSIONS Decline in lumbar muscle composition may differ between ethnicities and muscles. ES and low lumbar levels appear increasingly susceptible in Asians. Longitudinal studies examining rate of change to muscle composition may provide distinction between spinal conditions.
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Affiliation(s)
- Rebecca J Crawford
- Institute for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, 8401, Winterthur, Switzerland. .,Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - James M Elliott
- Institute for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, 8401, Winterthur, Switzerland.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Thomas Volken
- Institute for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, 8401, Winterthur, Switzerland
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Abstract
Schwannomas are usually benign tumours arising from Schwann cells of peripheral nerve sheath. Retroperitoneal location is extremely rare compromising 0.5-5% of all schwannomas, except in patients having von Recklinghausen's disease, in whom retroperitoneal location is more frequent and malignant cases are known to occur. Complete surgical excision with negative margins is the definitive treatment on which the diagnosis is usually made due to nonspecific radiologic appearance. In this article we would like to present an unusual cause of recurrent, abdominal pain in an eighty-six-year-old male.
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Affiliation(s)
- Elias Makhoul
- Department of Gastroenterology and Hepatology, University Hospital Notre Dame de Secours, Byblos, Lebanon.
| | - Ralph Kamel
- Department of Gastroenterology and Hepatology, University Hospital Notre Dame de Secours, Byblos, Lebanon
| | - Naim Hanna
- Department of Gastroenterology and Hepatology, University Hospital Notre Dame de Secours, Byblos, Lebanon
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Kim SY, Kim DG, Park YM, Jeon YH. Psoas compartment block for treatment of motor weakness and pain following herpes zoster. Korean J Pain 2017; 30:62-65. [PMID: 28119773 PMCID: PMC5256265 DOI: 10.3344/kjp.2017.30.1.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022] Open
Abstract
Reactivation of the latent varicella zoster virus in the sensory ganglion causes herpes zoster (HZ). Its characteristic symptom is a painful rash in the involved dermatome. HZ-induced motor weakness is rare and is usually resolved within one year of the onset, but some patients permanently experience motor dysfunction. Epidural steroid administration, with antiviral therapy, can be effective in treating pain from HZ and preventing postherpetic neuralgia. But an epidural block is contraindicated in patients receiving thromboprophylaxis. A psoas compartment block (PCB) provides equivalent analgesic efficacy with significantly low incidence of complication, compared to an epidural block. A 68 year old male patient recieving thromboprophylaxis presented with motor weakness following painful rash in his left L4 dermatome. Ten days before presentation, herpetic rash occurred on his left leg. We performed PCB with a steroid and local anesthetic, which successfully and safely alleviated the pain and motor weakness from HZ.
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Affiliation(s)
- Sae Young Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Gyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yong Min Park
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Hoon Jeon
- School of Dentistry, Kyungpook National University, Daegu, Korea
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