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1.  Conservative management of psoas haematoma following complex lumbar surgery 
Indian Journal of Orthopaedics  2014;48(1):107-110.
We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan to diagnose the cause of persistent severe radicular pain in the postoperative period.
doi:10.4103/0019-5413.125534
PMCID: PMC3931141  PMID: 24600073
Posterior lumbar interbody fusion; postoperative radicular pain; psoas hematoma
2.  Effect of Psychological Status on Outcome of Posterior Lumbar Interbody Fusion Surgery 
Asian Spine Journal  2012;6(3):178-182.
Study Design
Prospective longitudinal study.
Purpose
To determine if preoperative psychological status affects outcome in spinal surgery.
Overview of Literature
Low back pain is known to have a psychosomatic component. Increased bodily awareness (somatization) and depressive symptoms are two factors that may affect outcome. It is possible to measure these components using questionnaires.
Methods
Patients who underwent posterior interbody fusion (PLIF) surgery were assessed preoperatively and at follow-up using a self-administered questionnaire. The visual analogue scale (VAS) for back and leg pain severity and the Oswestry Disability Index (ODI) were used as outcome measures. The psychological status of patients was classified into one of four groups using the Distress and Risk Assessment Method (DRAM); normal, at-risk, depressed somatic and distressed depressive.
Results
Preoperative DRAM scores showed 14 had no psychological disturbance (normal), 39 were at-risk, 11 distressed somatic, and 10 distressed depressive. There was no significant difference between the 4 groups in the mean preoperative ODI (analysis of variance, p = 0.426). There was a statistically and clinically significant improvement in the ODI after surgery for all but distressed somatic patients (9.8; range, -5.2 to 24.8; p = 0.177). VAS scores for all groups apart from the distressed somatic showed a statistically and clinically significant improvement. Our results show that preoperative psychological state affects outcome in PLIF surgery.
Conclusions
Patients who were classified as distressed somatic preoperatively had a less favorable outcome compared to other groups. This group of patients may benefit from formal psychological assessment before undergoing PLIF surgery.
doi:10.4184/asj.2012.6.3.178
PMCID: PMC3429608  PMID: 22977697
Spine; Low back pain; Outcomes research; Spinal fusion; Psychological tests

Results 1-2 (2)