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Updated: Mar 28, 2026

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
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Does it matter whether levator avulsion is diagnosed pre- or postoperatively?

S S Abdul Jalil1, R Guzman Rojas1,2,3, H P Dietz4

  • 1Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, Australia.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|December 15, 2015
PubMed
Summary
This summary is machine-generated.

Levator ani muscle avulsion diagnosis is reliable both before and after pelvic organ prolapse surgery. Postoperative diagnosis can effectively serve as a proxy for preoperative assessment in clinical studies.

Keywords:
avulsionpelvic floorprolapserecurrencetranslabial ultrasound

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Area of Science:

  • Obstetrics and Gynecology
  • Pelvic Floor Disorders
  • Medical Imaging

Background:

  • Levator ani muscle avulsion occurs in 15-30% of women after childbirth.
  • Avulsion is linked to pelvic organ prolapse (POP) recurrence after surgical repair.
  • Existing evidence on recurrence often relies on postoperative avulsion diagnoses.

Purpose of the Study:

  • To evaluate if a postoperative diagnosis of levator avulsion can be used as a proxy for a preoperative diagnosis.
  • To determine the diagnostic agreement between pre- and postoperative avulsion assessments.
  • To assess the association of avulsion diagnoses with prolapse recurrence.

Main Methods:

  • Retrospective study of 207 patients undergoing POP surgery (Feb 2007 - May 2013).
  • Three/four-dimensional transperineal tomographic ultrasound used for all assessments.
  • Cohen's kappa statistic calculated for diagnostic agreement; prolapse recurrence defined by POP-Q Stage ≥ 2.

Main Results:

  • High agreement (kappa = 0.864) between preoperative (53.6%) and postoperative (52.7%) levator avulsion diagnoses.
  • Mean follow-up of 1.3 years.
  • Both preoperative and postoperative avulsion diagnoses were significantly associated with prolapse recurrence (OR 2.5 and 2.3, respectively).

Conclusions:

  • Tomographic pelvic floor ultrasound provides equally valid levator avulsion diagnoses before and after POP surgery.
  • Postoperative avulsion diagnosis is a reliable proxy for preoperative diagnosis.
  • Postoperative avulsion identification aids in defining high-risk patients for future surgical trials.