Is the lateral jack-knife position responsible for cases of transient neurapraxia?
The lateral jack-knife position is often used during transpsoas surgery to improve access to the spine. Postoperative neurological signs and symptoms are very common after such procedures, and the mechanism is not adequately understood. The objective of this study is to assess if the lateral jack-kn...
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Published in | Journal of neurosurgery. Spine Vol. 24; no. 1; p. 189 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.01.2016
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Subjects | |
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Abstract | The lateral jack-knife position is often used during transpsoas surgery to improve access to the spine. Postoperative neurological signs and symptoms are very common after such procedures, and the mechanism is not adequately understood. The objective of this study is to assess if the lateral jack-knife position alone can cause neurapraxia. This study compares neurological status at baseline and after positioning in the 25° right lateral jack-knife (RLJK) and the right lateral decubitus (RLD) position.
Fifty healthy volunteers, ages 21 to 35, were randomly assigned to one of 2 groups: Group A (RLD) and Group B (RLJK). Motor and sensory testing was performed prior to positioning. Subjects were placed in the RLD or RLJK position, according to group assignment, for 60 minutes. Motor testing was performed immediately after this 60-minute period and again 60 minutes thereafter. Sensory testing was performed immediately after the 60-minute period and every 15 minutes thereafter, for a total of 5 times. Motor testing was performed by a physical therapist who was blinded to group assignment. A follow-up call was made 7 days after the positioning sessions.
Motor deficits were observed in the nondependent lower limb in 100% of the subjects in Group B, and no motor deficits were seen in Group A. Statistically significant differences (p < 0.05) were found between the 2 groups with respect to the performance on the 10-repetition maximum test immediately immediately and 60 minutes after positioning. Subjects in Group B had a 10%-70% (average 34.8%) decrease in knee extension strength and 20%-80% (average 43%) decrease in hip flexion strength in the nondependent limb. Sensory abnormalities were observed in the nondependent lower limb in 98% of the subjects in Group B. Thirty-six percent of the Group B subjects still exhibited sensory deficits after the 60-minute recovery period. No symptoms were reported by any subject during the follow-up calls 7 days after positioning.
Twenty-five degrees of right lateral jack-knife positioning for 60 minutes results in neurapraxia of the nondependent lower extremity. Our results support the hypothesis that jack-knife positioning alone can cause postoperative neurological symptoms. |
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AbstractList | The lateral jack-knife position is often used during transpsoas surgery to improve access to the spine. Postoperative neurological signs and symptoms are very common after such procedures, and the mechanism is not adequately understood. The objective of this study is to assess if the lateral jack-knife position alone can cause neurapraxia. This study compares neurological status at baseline and after positioning in the 25° right lateral jack-knife (RLJK) and the right lateral decubitus (RLD) position.
Fifty healthy volunteers, ages 21 to 35, were randomly assigned to one of 2 groups: Group A (RLD) and Group B (RLJK). Motor and sensory testing was performed prior to positioning. Subjects were placed in the RLD or RLJK position, according to group assignment, for 60 minutes. Motor testing was performed immediately after this 60-minute period and again 60 minutes thereafter. Sensory testing was performed immediately after the 60-minute period and every 15 minutes thereafter, for a total of 5 times. Motor testing was performed by a physical therapist who was blinded to group assignment. A follow-up call was made 7 days after the positioning sessions.
Motor deficits were observed in the nondependent lower limb in 100% of the subjects in Group B, and no motor deficits were seen in Group A. Statistically significant differences (p < 0.05) were found between the 2 groups with respect to the performance on the 10-repetition maximum test immediately immediately and 60 minutes after positioning. Subjects in Group B had a 10%-70% (average 34.8%) decrease in knee extension strength and 20%-80% (average 43%) decrease in hip flexion strength in the nondependent limb. Sensory abnormalities were observed in the nondependent lower limb in 98% of the subjects in Group B. Thirty-six percent of the Group B subjects still exhibited sensory deficits after the 60-minute recovery period. No symptoms were reported by any subject during the follow-up calls 7 days after positioning.
Twenty-five degrees of right lateral jack-knife positioning for 60 minutes results in neurapraxia of the nondependent lower extremity. Our results support the hypothesis that jack-knife positioning alone can cause postoperative neurological symptoms. |
Author | Molinares, Diana Margarita Davis, Timothy T Mok, James M Liu, John Chung-Liang Fung, Daniel A Daily, David Clark, Stephen |
Author_xml | – sequence: 1 givenname: Diana Margarita surname: Molinares fullname: Molinares, Diana Margarita organization: Orthopedic Pain Specialists, Santa Monica – sequence: 2 givenname: Timothy T surname: Davis fullname: Davis, Timothy T organization: Orthopedic Pain Specialists, Santa Monica – sequence: 3 givenname: Daniel A surname: Fung fullname: Fung, Daniel A organization: Orthopedic Pain Specialists, Santa Monica – sequence: 4 givenname: John Chung-Liang surname: Liu fullname: Liu, John Chung-Liang organization: Departments of Neurosurgery and Orthopedic Surgery and Spine Center, Keck Medicine of USC, Los Angeles – sequence: 5 givenname: Stephen surname: Clark fullname: Clark, Stephen organization: Athletic Physical Therapy, Westlake Village; and – sequence: 6 givenname: David surname: Daily fullname: Daily, David organization: Athletic Physical Therapy, Westlake Village; and – sequence: 7 givenname: James M surname: Mok fullname: Mok, James M organization: The Spine Institute, Santa Monica, California |
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CitedBy_id | crossref_primary_10_1016_j_wneu_2021_01_113 crossref_primary_10_1016_j_jocn_2022_02_023 crossref_primary_10_1016_j_nec_2016_08_010 crossref_primary_10_1016_j_jocn_2018_10_108 crossref_primary_10_1016_j_nec_2019_02_005 crossref_primary_10_1016_j_inat_2016_12_006 crossref_primary_10_1007_s00264_020_04508_x crossref_primary_10_1016_j_wneu_2021_01_066 crossref_primary_10_1080_02688697_2021_1995593 |
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Keywords | jack-knife neurapraxia MIS = minimally invasive surgical positioning complications RLJK = right lateral jack-knife technique tEMG = triggered electromyography 10Max test = 10-repetition maximum test RLD = right lateral decubitus |
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SubjectTerms | Adult Female Humans Lumbar Vertebrae - surgery Male Motor Activity - physiology Patient Positioning Posture - physiology Young Adult |
Title | Is the lateral jack-knife position responsible for cases of transient neurapraxia? |
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