Comparing Ultrasound‐Guided and Unguided Lumbar Injection of Psoas Major Muscle for Clinical Management of Hip Flexor Spasticity
Notice bibliographique
Résumé
Objective Hip flexor spasticity, resulting from brain injury or neurological disorders, can result in decreases in range of motion, leading to joint immobility. Spasticity can be managed with Botulinum Toxin A (BT‐A) injections, which decreases muscle tone, thereby increasing range of motion. Psoas major (PM) plays a significant role in hip flexor spasticity and is targeted inferior to the inguinal ligament. However, at this location, only the illiacus muscle is injected as PM is tendinous. To target the muscle belly of PM, a lumbar approach must be used. This approach has been described in the literature, yet has been rarely used for BT‐A injection due to the perceived risk to vascular structures (abdominal aorta and inferior vena cava (IVC)), lumbar plexus, and/or kidney. The lumbar approach has been performed with and without image guidance, yet potential injury to adjacent structures has not been assessed. The purpose of this cadaveric study was to compare ultrasound (US) guided and non‐guided PM lumbar injection to assess the injectate spread, location and proximity to adjacent structures. Methods 8 lightly embalmed specimens were injected bilaterally with 2ml of toluidine blue; on one side using US guidance, and on the other no guidance (unguided). The abdominal contents were removed to expose the structures of the posterior abdominal wall. Extramuscular dye spread was noted. The following were digitized (Microscribe® MLX Digitizer) and reconstructed into 3D models (Autodesk® Maya®): quadratus lumborum, iliacus, PM, great vessels, and vertebral column. The volume of PM was serially dissected at the fiber bundle level to allow digitization of the dye spread. The extent, location of dye spread was documented relative to the great vessels. Descriptive statistics were used to characterize and compare the US‐guided and unguided approaches. Results The dye was found in PM in all US‐guided specimens. No intramuscular dye spread was found in 4/8 specimens using the unguided approach. The US‐guided specimens had a mean area of dye spread of 24.4 ± 2.8 cm 2 whereas the unguided specimens had a mean area of 54.2 ± 28.0 cm 2 . The dye (guided approach) was located consistently between the superior margin of vertebral body of L3 and inferior margin of vertebral body of L4, whereas the unguided approach had its dye localized between vertebral bodies of L4 and L5. The mean distance of dye spread from: 1) the aorta was 3.19 ± 1.24cm (US‐guided approach) and 1.40 ± 0.0002cm (unguided approach), 2) the IVC was 1.81 ± 0.38cm (US‐guided approach) and 2.79 ± 0.11cm (unguided approach). There was no dye spread to the kidney using either US‐guided or unguided approaches, however the lumbar plexus was stained in 2/8 specimens using the unguided approach. Conclusions The US‐guided lumbar approach was found to target PM more consistently, with greater distance from the aorta than the unguided approach. This cadaveric study demonstrates that the US‐guided approach may have distinct advantages over the unguided approach, however this needs to be further investigated in the clinic. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».