Iliopsoas Tenotomy in Patients With Neurological Diseases. A Novel Closed Technique Using an Ultrasound-Guided Minimally Invasive Approach in Neuro-Orthopaedics.

Abstract

The iliopsoas tenotomy aims at correcting the impaired hip extension that compromises patients' ability during gait, creating discomfort during postural transfers and prolonged sitting. The standard, open approach adopted for neurological disorders requires general anesthesia and sutures, with considerable odds of adverse events, such as nerve injuries, pain, and infections. To date, percutaneous release interventions have been done only on cadavers or adult patients with orthopaedic conditions. In this article, we introduce the ultrasound-guided minimally invasive approach in neuro-orthopaedics procedure for the iliopsoas tenotomy, a percutaneous release combining ultrasound-guidance and mini-invasiveness. This technique offers several advantages: reduced length of surgery, no surgical incisions, use of local anesthesia, and the possibility of visualizing the surgical target during the entire process, thus minimizing complications. It is especially useful for patients where open surgery is not recommended, such as those with extensive scarring in the abdominal region caused by previous interventions or those with a high probability of additional surgeries during their lifetime. Moreover, rehabilitation can start on day 1 after surgery and may considerably reduce recovery time.