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Hasan R. Syed, Kurt Yaeger and Faheem A. Sandhu

Several studies have described the radiographic, histological, and morphological changes to the paraspinal muscle in patients with chronic low-back pain due to degenerative diseases of the spine. Gross anatomical illustrations have shown that the psoas muscle lies lateral to the L4–5 vertebrae and subsequently thins and dissociates from the vertebral body at L5–S1 in a ventrolateral course. A “rising psoas” may influence the location of the lumbar plexus and result in transient neurological injury on lateral approach to the spine. It is postulated that axial back pain may be exacerbated by anatomical changes of paraspinal musculature as a direct result of degenerative spine conditions. To their knowledge, the authors present the first reported case of a more anteriorly positioned psoas muscle and its resolution following correction of spondylolisthesis in a 62-year-old woman. This case highlights the dynamic nature of degenerative spinal disorders and illustrates that psoas muscle position can be affected by sagittal balance. Normal anatomical positioning can be restored following correction of spinal alignment.

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Benjamin K. Hendricks, James S. Yoon, Kurt Yaeger, Christopher P. Kellner, J Mocco, Reade A. De Leacy, Andrew F. Ducruet, Michael T. Lawton and Justin R. Mascitelli

OBJECTIVE

Wide-necked aneurysms (WNAs) are a variably defined subset of cerebral aneurysms that require more advanced endovascular and microsurgical techniques than those required for narrow-necked aneurysms. The neurosurgical literature includes many definitions of WNAs, and a systematic review has not been performed to identify the most commonly used or optimal definition. The purpose of this systematic review was to highlight the most commonly used definition of WNAs.

METHODS

The authors searched PubMed for the years 1998–2017, using the terms “wide neck aneurysm” and “broad neck aneurysm” to identify relevant articles. All results were screened for having a minimum of 30 patients and for clearly stating a definition of WNA. Reference lists for all articles meeting the inclusion criteria were also screened for eligibility.

RESULTS

The search of the neurosurgical literature identified 809 records, of which 686 were excluded (626 with < 30 patients; 60 for lack of a WNA definition), leaving 123 articles for analysis. Twenty-seven unique definitions were identified and condensed into 14 definitions. The most common definition was neck size ≥ 4 mm or dome-to-neck ratio < 2, which was used in 49 articles (39.8%). The second most commonly used definition was neck size ≥ 4 mm, which was used in 26 articles (21.1%). The rest of the definitions included similar parameters with variable thresholds. There was inconsistent reporting of the precise dome measurements used to determine the dome-to-neck ratio. Digital subtraction angiography was the only imaging modality used to study the aneurysm morphology in 87 of 122 articles (71.3%).

CONCLUSIONS

The literature has great variability regarding the definition of a WNA. The most prevalent definition is a neck diameter of ≥ 4 mm or a dome-to-neck ratio of < 2. Whether this is the most appropriate and clinically useful definition is an area for future study.