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.

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