Introduction: Psoas hematoma is an uncommon complication following spinal surgeries. It has been reported in both extreme lateral interbody fusion (XLIF) and posterior spinal fusion with instrumentation. Minimally invasive techniques are gaining popularity in recent years due to the appealing advantages of reduced operative time, blood loss, hospital stay, and faster recovery. Case Presentation: We are presenting a case of a 77-year-old male with chronic low back pain, diagnosed to have multilevel degenerative disc disease with central and foraminal disc protrusion at L2-L3, L3-L4, L4-L5 with secondary spinal stenosis, underwent XLIF at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws. On the fourth day post-operatively, the patient had flank pain and dropping hemoglobin with femoral nerve palsy symptoms, a CT scan revealed a large psoas hematoma. Conservative management was decided on; a follow-up CT scan and examination showed complete resolution of the hematoma and femoral nerve recovery. Discussion: The approach to iliopsoas hematoma post spinal surgeries remains controversial. Iliopsoas hematoma should be suspected in any patients post spinal surgeries even with delayed presentations. The decision to proceed with either surgical intervention or conservative management depends on multiple factors, including patient hemodynamic status, progression of collection and femoral nerve palsy. Conclusion: The exact cause of iliopsoas hematoma post different spinal surgery approaches remains vague. In our opinion, other causes including pre-and post-operative anticoagulants should be investigated. Rushing to drain iliopsoas hematomas in case of femoral nerve palsy might not be the ideal option. Instead, monitoring patient responses to resuscitation and taking a watch and wait approach for femoral nerve palsy might be the proper approach.

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The widespread of lower respiratory tract infection by the novel coronavirus (CoV) exploded in December 2019. [1] Nidovirales are enveloped, single-strand-positive RNA viruses that can infect individuals and some creatures. [2] Novel CoV (COVID19), later known as severe acute respiratory syndrome CoV 2, was recognized in December 2019 as cases of pneumonia of unknown etiology in Wuhan City (China). [3][4][5] The World Health Organization (WHO) internationalized the name of the novel CoV into COVID-19. [6] In March, the WHO reported that COVID-19 is a pandemic. [7] Physicians are among the highest risk groups for acquiring COVID-19 infection. [8] This is due to the hazardous nature of their job, which exposes them to infected patients with COVID-19, and many physicians have lost their lives getting infected in hospital settings. [9] Mortalities and morbidities among physicians due to COVID-19 endanger the systems of fighting this pandemic. Physicians can get infected from the hospital and the community, and thus unlike other population groups, they have double sources and chances of infection. In addition to the risk of infection that they are facing, physicians may act as a tool for spreading COVID-19 to patients, families, and communities. [10] The WHO recommends the prevention of COVID-19 spread by protecting physicians and other health-care workers (HCWs).

Background: Historically, talectomy has been predominantly performed to operatively treat severely rigid equinovarus feet. A limited number of investigators have studied functional outcomes in pediatric patients posttalectomy. We aimed to assess the outcomes of pediatric patients undergoing talectomy using the American Orthopaedic Foot & Ankle Society (AOFAS) score and a subjective survey of patients’ and their caregivers’ satisfaction. Methods: We performed a retrospective cohort study that included 31 patients with nonidiopathic severely rigid talipes equinovarus, in a single center, using consecutive sampling. All medical records of those patients were reviewed, and relative data were extracted. The AOFAS score was used to measure the outcomes during the last visit (April 2020). Satisfaction was evaluated in a binary manner by questioning the patients and their caregivers if they would undergo the same surgery again for the same result. Results: Thirty-one patients were included. Myelomeningocele was the primary diagnosis in 13 patients (41.9%), and arthrogryposis was diagnosed in 11 patients (35.5%). Twenty-two patients had bilateral procedures. The mean age at the time of surgery was 6.0 ± 3.0 years, and the mean follow-up was 6.0 ± 1.0 years. Plantigrade feet following the primary surgery were achieved in 88.5% of cases. Postoperatively, braces were well tolerated in 86.5% of patients. Deformity recurrence was observed in 21.2% of patients, and 17.3% of patients required subsequent surgeries. Patients with arthrogryposis had significantly higher AOFAS scores than those with myelomeningocele and other diagnoses ( P = .017). Further, patients who tolerated braces had higher AOFAS scores than those who did not tolerate braces ( P = .006). However, patients who developed hindfoot varus and dorsal bunion postoperatively had lower AOFAS scores ( P = .054 and P = .006, respectively). Patients who had recurrent deformities or required further surgeries also had lower AOFAS scores ( P = .025 and P = .015, respectively). Although 17.3% of patients were not able to comment about their satisfaction due to their general medical condition, 63.5% of patients reported that they were satisfied. Furthermore, 75.0% of caregivers were satisfied with the outcomes and their children’s functional status posttalectomy. Conclusion: The observed outcomes of primary and salvage talectomies demonstrate the general overall effectiveness of this operative intervention as an end-stage treatment for pediatric patients with severely rigid talipes equinovarus. Level of Evidence: Level III; retrospective cohort study.

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