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  • The Posterior Transthecal Approach for Repair of Cauda Equina Fibers and Ventral Dural Laceration in Lumbar Burst Fracture: A Novel Surgical Technique

    Final Number:
    1076

    Authors:
    Huan-Chih Wang, Chien-Min Chen, Lu-Ting Kuo, Jui-Chang Tsai, Abel Po-Hao Huang MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: The goals of surgery in patients with thoracolumbar fracture include neural decompression, reestablishing stability, reduction of deformity, repair of dural laceration and the damaged neural elements. The traditional posterior approach may only accomplish the former three goals. Our study has shown that by simply opening the dura during the traditional approach enables accomplishment of all the aforementioned goals, which would not be possible through an anterior or posterior approach alone.

    Methods: Simply opening the dura during the traditional posterior approach enables accomplishment of all the aforementioned goals, which would not be possible through an anterior or posterior approach alone.

    Results: We have successfully performed the transthecal approach in 5 patients with thoracolumbar burst fracture with cauda equina fiber injury. Neural decompression, reestablishing stability, reduction of deformity, and repair of dural laceration and the damaged cauda equina fiber were all achieved in these patients. No complications were noted.

    Conclusions: The transthecal approach can be applied to patients with thoracolumbar burst fracture to achieve neural decompression, reestablishing stability, reduction of deformity, and repair of dural laceration and the damaged cauda equina fiber. This approach may be an alternative to combined (circumferential) surgery.

    Patient Care: This new surgical technique will provide patients with shorter operative timing and greater potential of neurological recovery

    Learning Objectives: 1. For thoracolumbar fracture patients with cauda equina injury, neural repair with fibrin glue may be feasible. 2. Opening the dura during the traditional posterior approach, what we have termed the “transthecal” approach, facilitates direct decompression of retropulsion, dural repair, and also nerve repair. 3. The transthecal approach can achieve neural decompression, reestablishing stability, reduction of deformity, and repair of dural laceration and the damaged cauda equina fiber.

    References: 1. Boerger TO, Limb D, Dickson RA. Does 'canal clearance' affect neurological outcome after thoracolumbar burst fractures? J Bone Joint Surg Br 2000;82:629-635. 2. Sun T, Liu Z, Liu S, et al. The clinical study of repairing cauda equina fibres with fibrin glue after lumbar fracture and dislocation. Spinal Cord 2010;48:633-637. 3. Kothbauer KF, Deletis V. Intraoperative neurophysiology of the conus medullaris and cauda equina. Childs Nerv Syst 2010;26:247-253. 4. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-831. 5. McAfee PC, Yuan HA, Fredrickson BE, et al. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 1983;65:461-473. 6. Pau A, Silvestro C, Carta F. Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures? Acta Neurochir (Wien) 1994;129:186-187.

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