Is the lateral jack-knife position responsible for cases of transient neurapraxia?
Diana Margarita Molinares, Timothy T. Davis, Daniel A. Fung, John Chung Liang Liu, Stephen Clark, David Daily, James M. Mok
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Journal of Neurosurgery: Spine
https://doi.org/10.3171/2015.3.SPINE14928
Jack-knife
Neurapraxia
Positioning complications
10.3171/2015.3.SPINE14928
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Lower Extremity Medicine & Life Sciences 100%
Physical Therapists Medicine & Life Sciences 45%
Signs and Symptoms Medicine & Life Sciences 35%
Knee Medicine & Life Sciences 32%
Extremities Medicine & Life Sciences 30%
Molinares, D. M., Davis, T. T., Fung, D. A., Liu, J. C. L., Clark, S., Daily, D., & Mok, J. M. (2016). Is the lateral jack-knife position responsible for cases of transient neurapraxia? Journal of Neurosurgery: Spine, 24(1), 189-196. https://doi.org/10.3171/2015.3.SPINE14928
Is the lateral jack-knife position responsible for cases of transient neurapraxia? / Molinares, Diana Margarita; Davis, Timothy T.; Fung, Daniel A.; Liu, John Chung Liang; Clark, Stephen; Daily, David; Mok, James M.
In: Journal of Neurosurgery: Spine, Vol. 24, No. 1, 01.2016, p. 189-196.
Molinares, DM, Davis, TT, Fung, DA, Liu, JCL, Clark, S, Daily, D & Mok, JM 2016, 'Is the lateral jack-knife position responsible for cases of transient neurapraxia?', Journal of Neurosurgery: Spine, vol. 24, no. 1, pp. 189-196. https://doi.org/10.3171/2015.3.SPINE14928
Molinares DM, Davis TT, Fung DA, Liu JCL, Clark S, Daily D et al. Is the lateral jack-knife position responsible for cases of transient neurapraxia? Journal of Neurosurgery: Spine. 2016 Jan;24(1):189-196. https://doi.org/10.3171/2015.3.SPINE14928
Molinares, Diana Margarita ; Davis, Timothy T. ; Fung, Daniel A. ; Liu, John Chung Liang ; Clark, Stephen ; Daily, David ; Mok, James M. / Is the lateral jack-knife position responsible for cases of transient neurapraxia?. In: Journal of Neurosurgery: Spine. 2016 ; Vol. 24, No. 1. pp. 189-196.
@article{462aae9cbc994e7e881f1b2907eecef6,
title = "Is the lateral jack-knife position responsible for cases of transient neurapraxia?",
abstract = "OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.",
keywords = "Jack-knife, Neurapraxia, Positioning complications, Technique",
author = "Molinares, {Diana Margarita} and Davis, {Timothy T.} and Fung, {Daniel A.} and Liu, {John Chung Liang} and Stephen Clark and David Daily and Mok, {James M.}",
note = "Publisher Copyright: {\textcopyright}AANS, 2016.",
doi = "10.3171/2015.3.SPINE14928",
journal = "Journal of Neurosurgery: Spine",
publisher = "American Association of Neurological Surgeons",
T1 - Is the lateral jack-knife position responsible for cases of transient neurapraxia?
AU - Molinares, Diana Margarita
AU - Davis, Timothy T.
AU - Fung, Daniel A.
AU - Liu, John Chung Liang
AU - Clark, Stephen
AU - Daily, David
AU - Mok, James M.
N1 - Publisher Copyright: ©AANS, 2016.
N2 - OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
AB - OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
KW - Jack-knife
KW - Neurapraxia
KW - Positioning complications
KW - Technique
U2 - 10.3171/2015.3.SPINE14928
DO - 10.3171/2015.3.SPINE14928
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine