605 - Management and Rehabilitation in Consecutive Cases with Lateral Transp...

#605 Management and Rehabilitation in Consecutive Cases with Lateral Transpsoas Access-Related Motor Deficit

Non-operative Care and Injection Therapies

Poster Presented by: R. Aquaroli

Author(s):

R. Aquaroli (1)
E. Camacho (1)
L. Marchi (2)

(1) Equilibrio Fit&Fisio, São Paulo, Brazil
(2) Instituto de Patologia da Coluna, São Paulo, Brazil

Abstract

Minimally invasive retroperitoneal transpsoas approach to lumbar spine has gained many of adepts in the last decade. The technique requires blunt dissection through the psoas muscle to reach the lumbar spine, passing by the lumbar plexus. Among the possible complications, there are two motor deficits/ partial neural injury that may occur - hip flexor weakness (psoas weakness) and quadriceps weakness. In the present work we present consecutive cases and management/rehabilitation applied.

From Mar2012 to Sep2013, 8 patients from 106 (8%) were diagnosed with motor deficit following transpsoas access (hip flexor and quadriceps incomplete deficit, but not evolving by 20 days after surgery). All subjects underwent to XLIF using EMG guidance, and L4L5 was treated in all these 8 cases. These patients were evaluated and treated with physiotherapy with spine specialized professionals. Outcomes and videos were collected. Treatment was divided in three phases: (1) analgesy - contralateral myofascial Inhibition of iliopsoas, gluteus and piriformis; passive joint mobilization of the adjacent and thoracic vertebrae; stretching of pelvic trochanteric muscles, ischium tibialis, psoas and quadriceps; passive tension and sliding neural mobilization of ipsilateral femoral and sciatic nerves. (2) functional recovery - neural automobilization; neural mobilization exercises; auto stretching; segmental and core stabilization combined with exercises that mimic daily activity activities; (3) activation phase and muscle strengthening - segmental stabilization exercises combined with load - gluteus, iliopsoas, quad, hamstrings, abdominal and paraspinal muscles.

All patients had improvement in motor strength with a range from 10 (1 months) to 50 sessions (7 months). Mean ODI scores improved from 39.5 in the 1st session to 21 in the last one. Detailed video capture shows improvement in function and muscle strength.

No case of complete nerve injury was recorded and all analyzed patients had improved function from postop motor deficit with the treatment apllied. Early detection allied with proper rehabilitation program may be very successful to treat motor deficit following transpsoas interbody fusion.