Hip Flexion Weakness following Transpsoas Interbody Fusion

Abstract

Objective The present work evaluated the motor deficit resulting from the psoas muscle access through the extreme lateral interbody fusion (XLIF) approach.

Methods This was a prospective, non-randomized, controlled, single-center study with 60 patients, with a mean age of 61.8 years old. All of the subjects underwent a lateral transpsoas retroperitoneal approach for lumbar interbody fusion with electroneuromyographic guidance and accessing 1 to 3 lumbar levels (mean level, 1.4; 63% cases in only 1 level; 68% cases included L4-L5). The isometric hip flexion strength in the sitting position was determined bilaterally with a handheld dynamometer (Lafayette Instrument, Lafayette, IN, USA). The mean value of three peak force measurements (N) was calculated. Standardized isometric strength tests were performed before the procedure and at 10 days, 6 weeks, 3 months and 6 months postsurgery.

Results Ipsilateral hip flexion was diminished (p < 0.001) at the early postoperative period, but reached preoperative values at 6 weeks (p > 0.12). The mean hip flexion measures before the procedure and at 10 days, 6 weeks, 3 months and 6 months after surgery were the following, respectively: 13 N; 9.7 N; 13.7 N; 14.4 N; and 16 N (ipsilateral); 13.3 N; 13.4 N; 15.3 N; 15.9 N; and 16.1 N (contralateral). Neither the level nor the number of treated levels had a clear association with thigh symptoms, but hip flexion weakness was the most common symptom.

Conclusions Patients in the early postoperative period of transpsoas access presented hip flexion weakness. However, this weakness was transient, and electroneuromyography use is still imperative in transpsoas access. In addition, patients must be thoroughly educated about hip flexion weakness to prevent falls in the immediate postoperative period.

Resumo

Objetivo Avaliar o déficit motor decorrente do acesso através do músculo psoas na técnica de fusão intersomática por via extremo-lateral (XLIF, na sigla em inglês).

Métodos Estudo prospectivo, não randomizado, controlado, único centro. Total de 60 pacientes com média de 61,8 anos. Todos os participantes passaram por fusão intersomática lombar por acesso lateral retroperitoneal com monitoração eletroneuromiográfica. Foram operados de 1 a 3 níveis nesses casos (média de 1,4; 63% eram de apenas um nível; 68% incluíram L4-L5). A força de flexão isométrica do quadril em posição sentada foi determinada bilateralmente com um dinamômetro de mão (Lafayette Instrument, Lafayette, IN, USA). As médias das medidas de 3 picos de força (N) foram calculadas. Testes isométricos padronizados foram realizados antes e em 10 dias, 6 semanas, 3 e 6 meses após a cirurgia.

Resultados A força de flexão do quadril no lado ipsilateral diminuiu (p < 0,001) no pós-operatório imediato, mas em 6 semanas atingiu os valores pré-operatórios. As médias de pré-operatório e 10 dias, 6 semanas, 3 meses e 6 meses após a cirurgia para flexão de quadril medidas foram, respectivamente: (ipsilateral) 13 N; 9,7 N; 13,7 N; 14,4 N; 16 N; (contralateral) 13,3 N; 13,4 N; 15,3 N; 15,9 N; 16,1 N. Nem o nível nem o número de níveis tratados tiveram clara associação com sintomas na coxa, mas a fraqueza de flexão de quadril foi o sintoma mais encontrado.

Conclusões O pós-operatório imediato do acesso transpsoas apresentou fraqueza de flexão de quadril após a cirurgia. Entretanto, essa ocorrência é transiente, e o uso da eletroneuromiografia é essencial no acesso transpsoas. Somado a isso, a educação do paciente deve ser amplamente aplicada para alertar sobre a possibilidade de fraqueza de flexão de quadril com o intuito de prevenir quedas no período pós-operatório imediato.

Keywords

extreme lateral interbody fusion - hip flexion - spine - weakness - psoas

Palavras-chave

fusão intersomática por via extremo-lateral - flexão de quadril - coluna - fraqueza - psoas

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